Reclaiming £30k in Care Fees

This week’s success story concerns a family who had been wrongly charged for their mother’s care home fees.

Farley Dwek Solicitors were instructed to pursue a retrospective claim for NHS Continuing Healthcare Funding on behalf of the late ‘Mrs X’ (for anonymity) after her application for NHS-funded care was rejected by her local NHS Clinical Commissioning Group (CCG). Her family were dissatisfied with the CCG’s decision and so approached us for assistance. Farley Dwek obtained copy of the patient’s care home and medical records and carried out our Records Review. We found that the CCG’s assessors had failed to consider all the relevant evidence and had manifestly underscored Mrs X’s needs in some of the care domains. We appealed the CCG’s decision to refuse CHC funding to her Local Resolution Panel. However, at appeal, the CCG again held that Mrs X did not meet the eligibility criteria and so refused to award her CHC funding. 

Our Team at Farley Dwek maintained that the CCG’s previous decisions were patently inaccurate and clinically unsound and that the Mrs X was eligible for full CHC funding during the period in question. Firm in our belief, we then appealed the matter to an Independent Review Panel (IRP) conducted by NHS England. Having lodged our detailed written Appeal Submissions in advance, we argued our case in front of the IRP.

The Panel agreed with us and found that the CCG’s decision to refuse CHC funding was ‘unsound’ and that Mrs X should have received CHC funding had she been correctly and robustly assessed at the outset by the CCG. In their outcome decision, the IRP recommended that Mrs X was entitled to retrospective reimbursement for wrongly charged care fees for the whole period under consideration. Mrs X’s family are expected to recover care fees in excess of £30,000.

We were so pleased to help this family achieve justice for their relative and secure CHC funding to which she was legally entitled.