Retrospective CHC Claim Story

A case of maladministration, botched assessments and shocking behaviour by the CCG, which left our client at her wits’ end when she approached us for assistance.

This patient had very complex physical and psychological needs and had already been awarded CHC funding for a two-year retrospective period. Unbelievably, the CCG had then completed a Checklist for the subsequent two years she was in nursing care, with the outcome that she did not qualify for full assessment!

We reviewed the care and medical records for the period and found there to be NO discernible difference in the patient’s presentation; in fact, her needs had actually increased during the time the CCG claimed she did not qualify for full assessment!

We drafted a detailed complaint to the CCG, setting out the inadequacies of the Checklist, supported by extensive clinical evidence.  The CCG’s Complaints Team ultimately agreed with our submission and instructed the CHC Team to undertake a full retrospective review of the outstanding period.

The CHC Team went on to complete a Needs Portrayal Document, using the records we provided to them, and a full Decision Support Tool. Our client was delighted when funding was finally awarded, some six years after her mother’s death. Even more satisfying than the reimbursement of wrongly paid fees to her mother’s Estate was to be vindicated after all those years of being treated like a nuisance who did not understand the criteria for CHC.

We could not be happier for our client and encourage anyone who encounters such abusive tactics from their CCG to contact us for our professional advice.  As this case shows, getting expert help really can make all the difference.