By Rosalind Hughes, founder of Just Caring Legal
This month has seen six-figure sums in recovered care fees for clients who were wrongly denied NHS Continuing Healthcare funding.
Both cases dated back to 2018. Both went as far as an NHS England Independent Review Panel stage of the appeals process. And in both cases, involving two different CCGs, we were able to highlight a catalogue of flaws in their decision-making processes. These led to both clients paying out for more than three years’ worth of care fees when they should not have paid a penny.
Both CCGs consistently failed to provide clear rationales for their decisions. Both failed to carry out a full and accurate assessment of care needs in line with the National Framework for NHS Continuing Healthcare. And both gave the clear impression that their processes were designed with financial gatekeeping, rather than fairness, in mind.
Lessons to take away
This is not the first time we have won six-figure sums in recovered care fees for our clients. It might seem incomprehensible that NHS CHC disputes can run on for more than three years. But both of these cases did. Unfortunately, this is far from unusual. The key is not to give up – staying power is essential. In one of these cases, the dispute outlived the vulnerable person who was wrongly paying care fees for the duration of the dispute. Her estate will now get that money back.
Another lesson: in your local dispute with the CCG, ensure you dot all the i’s and cross the t’s. Reply to letters, meet deadlines, check timeframes. NHS England has been known to refuse cases for independent review on the flimsiest of grounds. For example, one refused to grant a review because the family had failed to reply to one of the CCG’s letters, even though it had been superseded by a whole slew of more recent correspondence.
Time for a reality check?
But possibly the most important takeaway is this: do not think you are going mad. So many of our clients tell us that this is how they feel when trying to get a straight answer from their CCG. Believe me, you are not going mad. But the NHS Continuing Healthcare process can often make you feel that way.
This is where Just Caring Legal can help. As a niche business specialising in NHS Continuing Healthcare, we can provide a much needed reality check. We deal with these cases all day, every day. And we think we have probably heard it all.
But these recent big wins show that there is still some fairness in the system – even if it takes a while to get there. It is worth fighting. So if you think you have been wrongly denied NHS Continuing Healthcare, why not give us a call? Because while we never start the fight here at Just Caring Legal, we certainly make sure you can finish it.