Another success for our continuing healthcare team in recovering care home fees, this time obtaining a rebate of £170,000
Sophie Styles, a member of our continuing healthcare team, was approached by a client who wished to secure NHS Continuing Healthcare Funding for his father. Luckily, our client had been appointed as his father’s Attorney, so she was able to pursue the claim by way of his Health and Welfare Lasting Power of Attorney. Our client’s father had recently been diagnosed with Addison’s Disease, and he had suffered a fall while being diagnosed causing him to suffer a brain injury.
Our client’s father was admitted to a North Devon Nursing Home and required a strict medication regime to control his Addison’s disease to ensure that he did not suffer an adrenal crisis, as if this was left untreated, it could be fatal.
We attended the initial NHS Continuing Healthcare Funding meeting for her client’s father in order that a Decision Support Tool (“DST”) could be undertaken by the Devon Clinical Commissioning Group (“CCG”). The CCG concluded that whilst he was eligible for NHS Nursing Funding Contribution from the date of his admission, he was not eligible for full NHS Continuing Healthcare Funding on the basis that his care needs could be managed in the current nursing home setting.
We appealed the DST on the grounds that our client’s father presented with a primary health need, as he required 24 hour care to ensure that his Addison’s Disease was managed to prevent a deterioration of this health. Unfortunately, the CCG again concluded that her client’s father did not present with a primary health need.
We requested an independent panel review with NHS England to appeal the Decision of the CCG, on the grounds that her client’s father’s care needs flowed from his Addison’s Disease diagnosis and his brain injury – needs primarily of health.
The NHS Independent Review Panel concluded that her client’s father was eligible for full NHS Continuing Funding from the time of the DST. This decision was reached on the grounds that the nursing and health services which were required were beyond the scope of what could be provided by the local authority social services.
Sophie then pursued a retrospective NHS Continuing Healthcare Claim for the period that her client’s father was admitted to the nursing home until the time of the DST. The Devon Integrated Care Board (“ICB”) (formerly the Devon CCG) concluded that our client’s father was not eligible for full NHS Continuing Healthcare Funding throughout the retrospective period. The decision was made on the grounds that he did not present with a primary health need, as his health needs could be met through daily routine care with intermittent support from outside professionals.
Sophie appealed the DST on the basis that her client’s father required 24-hour care for the control and management of his Addison’s Disease, and without such an intensive level of care, he was at risk of physical and mental health deterioration. Following the appeal, the Devon ICB concluded that Sophie’s client’s father did present with a primary health need and was provided with a rebate of his care home fees from his admission in November 2018 until July 2020.
In total, Sophie recovered in excess of £170,000 for her client in respect of wrongly paid care him fees, and secured NHS Continuing Healthcare Funding for her client’s father. This claim was pursued under our popular no win, no fee agreement.
With the increasing costs of living, care home fees are rising and if your loved one is paying for the entirety of care home fees, when perhaps they shouldn’t be, then please do not hesitate to contact us for a free case review.
If you have recently lost a loved one with health needs which require daily management, we may be able to pursue a retrospective claim on their behalf if they did not receive any help with their fees.
