Retrospective Funding Success Story

Farley Dwek Solicitors acted on behalf of the late ’Mrs X’ and were instructed to request that her Clinical Commissioning Group (CCG) undertake a retrospective review of her healthcare needs. We were concerned that either no assessments had been undertaken, or that any assessments that were carried out failed to fully address Mrs X’s health and nursing needs. Mrs X’s needs were a combination of complex mental and physical health, which could only be managed effectively by skilled intervention over a sustained 24 hour period. She needed nurses to assess, plan, implement and monitor a package of sustained care to meet her needs and to review her care as her mental and physical health deteriorated. Based on the evidence collated, we believed that Mrs X met the criteria for NHS Continuing Healthcare funding and should have been assessed for, and awarded, NHS Continuing Healthcare funding when she first went into care.

We presented the claim to the CCG in September 2015. The CCG carried out enquiries and completed their Decision Support Tool which did not recommend that Mrs X was eligible for NHS Continuing Healthcare funding.

An appeal was lodged to a Local Resolution Panel (conducted by the same CCG) which again found that Mrs X was not eligible for NHS Continuing Healthcare funding.

A final appeal was then lodged with NHS England. In late 2020, an Independent Review Panel determined that the CCG’s decision to refuse retrospective funding was ‘unsound’ on numerous counts and it had acted in contravention of the established principles set out in the National Framework for NHS Continuing Healthcare. The IRP recommended that Mrs X be awarded reimbursement of more than 2 years’ care home fees.

Mrs X’s family are expected to recover over £25,000.