John’s Story

Farley Dwek Solicitors were approached by John’s* family for assistance with a retrospective claim for NHS Continuing Care Funding – seeking reimbursement of care fees paid wrongly paid by John for a short period at the end of his life. Two Fast Track referrals had been submitted in the months preceding his death, but both had been rejected out of hand by the NHS Integrated Care Board (ICB).

Following John’s death, the ICB agreed its process had been flawed and offered to conduct a retrospective review from the date of the first Fast Track referral to end of the John’s life. The initial outcome of this review was that John did NOT meet the eligibility criteria for NHS CHC Funding at any time. The family asked us for advice.

After a discussion with the family, it became apparent that John had never been assessed for CHC Funding prior to this short end-of-life period, despite living in a care home for over four years!

Farley Dwek conducted a review of John’s records, from the date of his admission to care to the date of his death, and recommended he met the criteria for full NHS Funding for at least some of this period.

Our CHC specialist team appealed the ICB’s decision of ineligibility for the end-of-life period and also requested retrospective review of the unassessed period of care. We drafted detailed Written Submissions in support of both claims.

At the Local Resolution Meeting for the latter period, the ICB overturned its decision for the last week of the John’s life, but nothing more. The appeal was placed on hold pending the retrospective outcome, which was eventually confirmed to be negative. We appealed this decision and attended another Local Resolution Meeting, but the outcome remained unchanged.

A request for Independent Review for both periods (end-of-life and the unassessed period of care) was subsequently lodged with NHS England and a date for the Independent Review Panel (IRP) was set.

Some weeks prior to the IRP, the ICB wrote to us to confirm that John DID meet the criteria for the last two years of his life. Quite the turnaround!

The anticipated restitution is expected to be a six-figure refund for John’s family.