Alex’s Story

‘Alex’ was severely unwell with multiple conditions including end-stage Parkinson’s and related dementia, breast cancer and severe arthritis.  She became dependent on round the clock care which was provided largely by her niece, Caroline, working with a team of domiciliary carers funded by the local County Council.

Caroline was in full-time employment and a part time lecturer but had plans to begin her own consultancy business which she hoped would give her the flexibility to continue working whilst also caring for her aunt.

An assessment for NHS Continuing Healthcare Funding (“CHC”) was made in 2015.

July 2016: a Decision Support Tool identified that Alex’s needs were primarily for healthcare, by which time, Caroline had now effectively given up all work in order to provide full time care for her aunt

Around this time Caroline began staying over with her aunt regularly in order to provide overnight care. She only managed to go back home about once a month. This impacted on her social life and also significantly reduced her ability to work.

September 2016: the CCG accepted Alex qualified for CHC – a fully funded package of care provided for all her healthcare needs by the NHS (via the CCG) – FREE of charge.

January 2017: the CCG commissioned a package of care from a local care provider, but in respect of daytime care only and with substantially fewer hours than the CCG’s assessment had identified. This left Caroline to provide cover for her aunt’s entire night-time needs and much of her daycare as well, which she did with help from a family friend and very occasional help from Marie Curie.

Throughout the period September 2016 to November 2017, Caroline frequently tried to get in touch with the CCG to query the lack of care, but was consistently rebuffed or simply ignored. Eventually, in desperation, Caroline submitted a safeguarding alert which triggered the attention of the local district nurse manager who immediately arranged a review of Alex’s care needs.

November 2017: a review of Alex’s needs was carried out and the CCG’s panel confirmed the need for overnight care.

January 2018: the full care package was commissioned – some 16 months later! However, this was not implemented for some two weeks – leaving Caroline to continue providing all of Alex’s care.

January 2018: Caroline submitted another complaint, but again, this was refused.

However, in late 2018, the CCG carried out a full case review and confirmed that there had been no material change in Alex’s healthcare needs during the review period. The outcome remained that she did have a requirement for a commissioned care package for the entire review period, commencing in September 2016.

Sadly, the CHC care package was still not fully implemented when Alex died on 5 March 2018.

Compensation (Redress)

January 2019: the CCG wrote to Caroline, assuring her that she would be reimbursed for all her care costs in line with the NHS Continuing Healthcare Refreshed Redress Guidance, 2015, including any claim for loss of earnings as a result of giving up work to look after her aunt.

Caroline had suffered financial loss of income from her various employments and work opportunities, plus a loss of consultancy work as a direct result of the shortfall in CHC Funding.

She was drained and exhausted from looking after her frail aunt. She suffered distress caused by seeing her aunt denied the proper nursing care with which she should have been provided by the CCG since September 2016. In addition, she suffered additional distress from seeing her own plans for developing her consultancy business frustrated; and the loss of time and the frustration caused by having to battle against the CCG’s repeated refusal to accept its responsibilities.

The CCG invited Caroline to submit documentary evidence in support of her financial losses – which she duly did.

Despite full and frank disclosure, the CCG rejected her claim, saying that all the information provided was insufficient to substantiate the losses claimed. Her evidence raised numerous concerns and in response they accused her, amongst other things, of benefit fraud and concluded with a threat to report her to the NHS Counter Fraud Authority for further investigation!

Caroline was understandably distraught by the CCG’s personal attack. She had put her life on hold for some 2.5 years whilst looking after her elderly, sick aunt – all because the CCG had failed to provide timely care – and to add insult to injury, was now being taken to task by the same CCG who openly invited her to submit details of her losses for reimbursement.

As renown experts in the field of CHC Funding, Caroline came to Farley Dwek Solicitors for legal help. Her reputation and good character was on the line.

It was clear to us at Farley Dwek that the CCG’s Panel had fundamentally misinterpreted the evidence as to her claim for loss of income and their hints at serious allegation (not to mention their improper suggestion that Alex should use her paltry winter fuel allowance to pay for her own care!) were wholly without basis and grossly inappropriate in the light of their admitted maladministration.

With Specialist Counsel’s input, a comprehensive Letter of Claim was sent to the CCG setting out Caroline’s claim for redress on account of the CCG’s inherent failings.

Outcome

The matter settled after negotiation for a very substantial sum including Caroline’s loss of income, interest accrued, compensation for distress and a contribution to her legal fees.

Jonathan Dwek, Solicitor, said, “This was a highly complex case. When CHC Funding is awarded, a package of care is usually implemented swiftly by the CCG to meet the individual’s assessed healthcare needs. Somehow, Alex had fallen through the net, which put enormous strain on Caroline, her sole surviving relative, to look after her aunt and step in to provide the 24-hour care needed – care which the CCG should have been providing. This is an unusual scenario, compounded by the CCG’s dismissive attitude and misinformed stance on her losses, caused solely by their abject failure to provide the care they’d approved and agreed to fund!

Jonathan adds, “We are delighted with the outcome and redress awarded. Caroline has been fully vindicated in her claim, following years of selfless care which left her physically and emotionally exhausted. We are pleased that her reputation has been fully restored.”