January Newsletter - Farley Dwek Solicitors

January Newsletter

Welcome to our first newsletter!

Our news

We are the first law firm in the country to deliver a free guide explaining Continuing Healthcare Funding (CHCF) – as endorsed by Gloria Hunniford.

You have requested our Free Guide which has been widely downloaded by thousands of people. It is an authoritative free guide as to the complex nature of Continuing Healthcare Funding (CHC), and contains an explanation of the NHS processes and hurdles to overcome to seek eligibility for this free funding for a loved one’s care fees.

We have had some great feedback and our customers have told us that they found the detailed information very helpful in getting to grips with understanding the complicated NHS processes for claiming CHC Funding – which are slanted toward the NHS and not the ‘man in the street’.  We are proud to say, that some customers have told us how grateful they are to have received our Free Guide, as it was an invaluable tool and so informative, that they did not need to engage our services and managed to fight the NHS to obtain funding themselves. See our new Guide on line.

You can now follow us on facebook and see what we have to say about CHC Funding.

We also offer 4 free services:

  • Free initial advice
  • Our Free Guide
  • Free financial advice for care home fees
  • Free review of your asset protection and inheritance tax advice – provided by Farley Dwek Financial Planning.

Recent success stories

We acted for Mrs X on behalf of her late mother, Mrs H, and successfully recovered care home fees wrongly paid over a 6 year period, in excess of £172,000 including interest.  Having saved all her life and paid taxes, when at the point Mrs H. needed NHS funded care she had to pay for it out of private funds. If Mrs H. had been properly assessed at the outset, her care home fees should have been funded at the point of need by the NHS – ie free of charge.

Read on to hear the scandalous story of NHS delays and incompetence, and how Farley Dwek helped Mrs H. and her family to recover care home fees.

The story starts when Farley Dwek were instructed in September 2012 and presented a letter of claim to the NHS on 25th September 2012.

Following the CCG’s acknowledgement and our completion of their Questionnaire, we obtained all relevant medical and care home records from various sources to investigate the matter. One of our specialist Nurse Assessors was then instructed to prepare our own comprehensive Needs Portrayal Document (some 49 pages long) in conjunction with all the copious records received. Our Nurse’s conclusion was that she believed that Mrs H was eligible for NHS Continuing Healthcare Funding (CHCF) dating back to April 2006 until she sadly passed away on 3rd January 2012.

We presented our papers to the CCG on 5th July 2013 and pressed for an assessment of Mrs H’s health needs to ascertain whether she met the criteria for CHCF.  The CCG initially rejected the claim by letter dated 26th September 2013. The premise for rejection was that Mrs H had been assessed regularly from 2009 onwards until her death in 2012, in relation to her care needs and was found ineligible – end of the matter! The CCG’s contended, quite adamantly, that robust procedures had been followed and that they were not prepared to reconsider their assessments again, nor undertake a further retrospective review of this period. – this is despite Mrs H actually being found eligible by the Multi-Disciplinary Panel for funding in November 2010, but most unusually, their recommendation for CHCF was not followed at the subsequent eligibility panel held on 6th January 2011!).

However, as a concession, the CCG did agree that to consider a review of an earlier previously unassessed period (April 2006 to January 2009).  We argued that only reviewing this short period was inadequate, and the whole period from 2006 to 2012 should be properly assessed. In support, we pointed out that the Health Service Ombudsman had made findings that many patients had in the past been wrongly refused CHC funding due to inadequate guidance, flawed or non-existent assessments, or due to the NHS’s failure to understand the guidance and correctly apply the criteria to determine eligibility.

By letter dated 14th April 2014, the CCG eventually agreed to undertake a retrospective review for the whole claim period April 2006 to January 2012, in order to ensure that their processes were seen to be fair and robust, despite still maintaining that there was evidence of previous assessments in 2009. Result!

The CCG then set about collating Mrs H’s medical and care home records for themselves in order to be able review matters afresh. Due to inherent further delays in this collation process, we also sent the CCG copies of all records we held on file to assist them expedite matters.

By letter dated 24th May 2016, some 2 years after agreeing to undertake the review, the CCG finally disclosed their detailed Needs Portrayal Document (NPD) containing their formal assessment of Mrs H’s health needs and eligibility (some 97 pages). In essence, it took the CCG over 3 years from July 2013 to review this matter, but they only gave us one week – until the 31st May 2016 –  to respond to their NPD and serve our considered Submissions in reply. Grossly unfair! Despite the plethora of documents to consider, but buoyed by our convictions, our Submissions in response were completed quickly by our expert Nurse Assessor and promptly submitted to the CCG on 7th June 2016.

The matter went before the CCG’s Multi-Disciplinary Panel for review on 15th June 2016, and it was reported to us on 23rd August 2016 that Mrs H. met the criteria for CHCF for the whole claim period April 2006 to January 2012. Result!

After protracted investigations and further information gathering by the CCG, interest calculations and negotiations, the CCG calculated Mrs H’s losses in excess of £172,000 including interest of over £28,000 using applicable RPI rates. However, we remain critical of and entirely dissatisfied with their approach.  Mrs H was not assessed adequately during her 6 years in care, and then it took the CCG another 4 years since starting the claim in September 2012 to confirm that she was indeed eligible for CHCF, dating back to 2006.  Due to the CCG’s failings and inordinate delays in processing this claim, we contend that a higher rate of interest should be applied to rebalance the injustice done to Mrs H. The matter remains in dispute and is currently with the Parliamentary and Health Ombudsman for determination.

Did you know?

  1. That when a patient is discharged from hospital and needs to go into care, the NHS will decide whether a patient’s ongoing long-term care is a matter for Social Services (provided by the Local Authority) or whether it is a matter for the NHS. As NHS budgets are constrained, the NHS will invariably try and manoeuvre patients out of their remit and either down the route of Social Services or towards paying for their own care privately – it doesn’t matter, just so long as funding the patient’s care doesn’t come out of their NHS budget.
  2. The NHS will ask if private funding is available or if the patient has any assets (such as a house to sell) to release funds to pay fund care fees. That is the wrong question! The first and only question is whether the patient has a health need. If so, then regardless of wealth (billionaires included), if the patient has a health need then they should be considered for CHC Funding.Remember our motto: “health not wealth”.
  3. The NHS won’t necessarily volunteer an assessment for CHC Funding as it is generally not in their interests to do so – you have to know about it! Make sure you request an assessment if you think your family member may be eligible for free funded care.
  4. Believe it or not, the NHS may not even see the patient when carrying out an initial assessment for CHC Funding. Make sure they do their job properly, and insist that you are notified about the assessment in advance and given an opportunity to attend.

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