Reclaiming £200k in Care Fees

This week’s success story concerns a patient who was being charged an extortionate amount of money, to fund his own healthcare!

The family initially came to us for representation at a Multi-Disciplinary Team Meeting which was the first time the patient had been considered for CHC funding by the NHS. (See our Supported Assessment Service).

Despite having our Nurse Assessor in attendance, and despite the patient’s primary need clearly being for healthcare, the ICB still decided he did not meet the criteria for CHC funding.

We appealed the negative decision and obtained a full set of records from the nursing home. Upon review, it quickly became apparent that much of the information provided verbally to the MDT by the nursing home staff was patently incorrect. In fact, the patient’s needs were even greater than we – and the NHS – had been led to understand.

We drafted full Written Submissions in support of the appeal, and attended a Local Resolution Meeting with the family. Following this meeting, the NHS agreed the patient met the criteria for CHC funding at the point of DST completion.

Another fight then ensued when the NHS tried to avoid funding the patient’s 1:1 care cost – i.e., over 50% of the care package! A formal complaint was submitted and finally upheld, with the ICB agreeing to reimburse the full cost to the patient.

If your relative is receiving 1:1 care, this exceeds the lawful remit of the Local Authority (nature, intensity) and, in all but the most exceptional cases, means they are entitled to receive CHC funding. The patient is expecting to recover over £200,000 by way of reimbursement of wrongly charged care fees.

If your relative is in receipt of CHC funding and the NHS is refusing to fund the full cost of the care package, it is likely acting illegally.

As times get ever tougher, the NHS appear to be taking more drastic steps to avoid funding costly care packages. Don’t be fobbed off and always seek professional advice to maximise your chances of success.