Slee Blackwell win NHS Continuing Healthcare Funding appeal against the Midlands and Lancashire Commissioning Support Unit.
Mr R was diagnosed with Motor Neurone Disease and frontal lobe dementia in mid 2019, though his wife had noticed changes in his behaviour during the latter part of 2018. He was admitted to a care home on 8 August 2019 following discharge from hospital due to a deterioration of his condition resulting in varying levels of aggression and unpredictability of his behaviour. His wife asked for a ‘Decision Support Tool’ assessment to be undertaken to determine whether he was eligible for NHS Continuing Healthcare Funding. This was completed two days after his death. However, it concluded that he was not eligible for retrospective free funding of his care home costs for the period 9 October 2018 to 14 December 2019.
Our team, which specialises in care home funding claims, was asked by Mrs R whether the decision of Midlands and Lancashire Commissioning Support Unit could be challenged. After reviewing the case we said that it could and agreed to make an NHS continuing healthcare funding appeal, working on a No Win, No Fee basis.
We undertook a comprehensive assessment of Mr R’s records to evidence incidents that had taken place which the retrospective team had not taken into account. We established how Mr R’s motor neurone disease affected him both physically and mentally, causing reduction of his movements, and how his unpredictable behaviour had led to verbal and physical aggression and attempts to abscond from the care home
While the National Framework for NHS continuing healthcare funding stipulates that a patient is not necessarily eligible because they are diagnosed with a medical condition, we submitted a comprehensive, detailed and persuasive appeal case to the Midlands and Lancashire Commissioning Support Unit. We demonstrated that they had failed to consider how the totality of Mr R’s care needs interacted and were of sufficient intensity, complexity and unpredictability to amount to a primary health need.
As a result of our submissions Mrs R won the continuing healthcare funding appeal, recovering a significant refund.
