Case Studies

Farley Dwek Solicitors were instructed by Ronald’s family after his death, to seek a refund of care home fees that were improperly charged.

His niece, recalls her uncle Ronald “as a very active, independent gentleman who enjoyed socialising with friends and keeping birds in his aviary at home. He trained as a chef and went to work in the navy with this skill, before becoming Head Chef at the Liverpool Teaching Hospital. He retired at age 52, and enjoyed travelling, and always having a nice car to take care of”.

It was unfortunate that this came to a sudden end in January 2014, when he fell down the stairs at his home and was rendered unconscious.

He had been lying there for seven days before the Police were alerted and forced their way into his home. Ronald was admitted to hospital. He suffered a bleed on the brain, dehydration, malnutrition, open sores to his back and left foot, together with general bruising to his body.

After being stabilised, he was discharged from hospital to Park House Nursing Home to recuperate. But, within a matter of days, he had a fall from his bed (unwitnessed) in the EMI (elderly mentally infirm) unit and also from the toilet, requiring readmission to hospital for a head injury, with the onset of left sided weakness. Upon discharge he was then transferred to Prospect House Nursing Home, to best cater for all his healthcare needs in a 24 hour care setting. Care Home fees were £693 per week.

Ronald exhibited challenging behaviour, was resistive to intervention, with episodes of physical and verbal aggression – occasionally hitting out at carers when assisting with his personal care; became agitated at times, confused and disorientated as to time, place and his surroundings and needed lots of reassurance; was non-compliant and would become aggressive when receiving care; was not able to verbalise his needs and wishes consistently or alert staff to his level of pain; had left sided weakness as a result of significant head injury following his fall; was unable to weight bear independently, needed hoisting and required full assistance from 2 staff members with mobilisation to prevent falls; had to be nursed in bed due to his high risk of falls, increased vulnerability and pressure sores (sacral spine wound grade 4, and heel wound grade 3); the pressure sores were compounded by his lack of mobility, poor dietary intake, weight loss and incontinence –  requiring input from a Tissue Viability Nurse/District Nurse; needed a special pressure relieving mattress and repositioning every 2 hours, with his dressings changed daily; often refused personal care, food and medication; following SALT assessment needed encouragement, close monitoring and assistance with eating and drinking; due to difficulty swallowing, needed to be fed with soft or pureed foods and thickened fluids to prevent aspiration and (recurrent) choking episodes; was at risk of weight loss; and required staff to assist and intervene with all aspects of his personal care and hygiene.

His niece contacted Farley Dwek Solicitors for help in recovering Ronald’s care home fees retrospectively, that should not have been paid, had he been correctly assessed and found eligible for NHS Continuing Healthcare Funding –   a FREE package of care provided by the NHS that covers all health needs and accommodation charges.

Having obtained and collated various care home and medical records, Farley Dwek set about reviewing and considering whether there are any prospects of maintaining a claim against West Cheshire Clinical Commissioning Group.

Following our assessment, we considered that there were sufficient merits to proceed.

On 27^th November 2015 Farley Dwek wrote a letter before action to West Cheshire CCG, setting out the backgrounds to the claim.

The CCG referred the matter to the NHS Wirral Clinical Commissioning Group for review as to Ronald’s eligibility for NHS Continuing Healthcare. Due to a lack of resources leading to delays in the CCG obtaining their owns set of records, reviewing and preparing their Needs Portrayal Document (NPD), the matter eventually went before the Local Resolution Panel on 20^th October 2017. The Panel’s recommendation concluded that Ronald was not eligible for fully funded NHS Continuing Healthcare for the period claimed. 

Farley Dwek felt very strongly that Ronald’s healthcare needs had been underscored by the Local Resolution Panel, particularly in relation to the four of the key Care Domains, and so an appeal was lodged.

The appeal was first dealt with at a preliminary Local Resolution Teleconference.  Our team argued the various deficiencies in the CCG’s NPD, their low scoring in certain Care Domains, and the fact that we did not feel they had paid sufficient attention to detail in assessing of the totality of Ronald’s needs, when applying the four key indicators.

The outcome of that meeting was that the CCG’s assessor agreed that Ronald was eligible for funding for the full period claimed, and resulted in a repayment to Ronald’s Estate in excess of £22,500. 

Our comment: thorough preparation, knowing the client’s case inside out, and persuasive advocacy are the keys to success.

Ronald’s niece and Executor of his Estate said, “Although this case took a long time to reach a satisfactory conclusion, largely because of the CCG’s delays, and then in an inadequate Needs Portrayal Document of my late Uncle’s needs, I am most grateful to Farley Dwek Solicitors for their help, support and advice over four years.  Without their encouragement and perseverance, I don’t think that I would have proceeded with the claim, nor would it have resulted in such a successful outcome without their professional input at every stage. Their attention to detail, care and support throughout this process has been exemplary. If you need a Solicitor who specialises in recovering care costs, then I would highly recommend Farley Dwek. I cannot think that their service could have been bettered in any way.”

Key points:

Barry Pritchard is an ex-police officer from Salisbury. Without getting lawyers involved he says his father probably wouldn’t have received the NHS Continuing Healthcare Funding he was entitled to all along…

My father became ill with dementia and was gradually getting worse. At first, we arranged for some help from social services in his own home but it soon became clear that his needs were greater than the daily 15 minute visits allocated to him. One day my sister went round to his house only to find him injured on the floor. He had slipped and hurt himself quite badly.

Edward Battersby’s 93-year old mother, Marion Wilson, was already receiving NHS Continuing Healthcare Funding but the family was called to a re-assessment of her situation and they wanted to make sure funding wasn’t removed so they contacted Farley Dwek.

Mr Battersby, a retired businessman, explains:

“My mother who has dementia has been in a nursing home setting for the past seven years and has received NHS Continuing Healthcare Funding for the past three. This funding is invaluable and it is an enormous financial support for our entire family.

When we were asked to attend an assessment to see if my mother was still eligible we were worried that a mistake might be made and that funding might be pulled. We’d read horror stories about families having to sell their homes and make massive financial sacrifices and wanted to avoid that happening to us.

The assessment process for NHS Continuing Healthcare funding is complicated and we were told that the NHS didn’t always get it right. We felt more confident going into the review process with Farley Dwek on our side. After they attended the assessment meeting with us we secured the funding and we continue to save on the astronomical care home fees that we might otherwise have had to pay.

I firmly believe there are many families out there who don’t know about this NHS Continuing Healthcare Funding and that they should see if their loved one or loved ones are eligible. We didn’t realise we could get it ourselves until we’d spent £42,000 on care home fees. It has saved us a fortune and it is comforting knowing that my mother is getting all the assistance she requires from the NHS after a lifetime of paying into the system.”

Andrew Farley of Farley Dwek said:

“It is true that the process for applying for NHS Continuing Healthcare Funding is too complex for most families to get right. The NHS will always be looking to save money and all too often it is families who are entitled to funding who pay the price. If you’ve got an assessment coming up or you know someone who has it’s sensible to get legal advice from an experienced solicitor.”

When Alice Newton (88) entered a care home five years ago she was told that she would not be eligible for any kind of funding. Five years and £158,000 in care home fees later, her family have finally secured NHS Continuing Healthcare Funding after getting Farley Dwek involved.

The family will now save around £2,700 per month in nursing home fees.

David Newton, 65, is a site supervisor at a local school and lives in Bamber Bridge in Lancashire – less than two miles from where his mother now resides in a nursing home. He takes up the story:

“After my father died my mother’s health slowly began to decline until she was diagnosed with dementia and over time developed various other conditions including incontinence and mobility issues.

As a family we decided that the best thing to do would be to bring her to live near me and my wife in Lancashire so we could support her better. After a period in a rest home she then entered a nursing home.

We noticed that other people in the home were getting financial support but they appeared to be in much better state of health than my mother. We were told that they may have different circumstances and we shouldn’t get concerned about that.

It seemed a little unfair to us at the time but because we were in a position to pay the fees after we sold my mother’s home in Hertfordshire we felt we had to do so.

Whenever we approached the subject of NHS Continuing Healthcare Funding we felt like we were getting fobbed off by system. We kept being told that because my mother didn’t fall into a certain category of health requirements and had assets in the form of the funding from the house sale we would have to pay. We were simply told ‘that’s the law’.

We now know that this is not the case and that NHS Continuing Healthcare Funding is based on health needs and not how much money you’ve got in the bank.

After reading an article in the Daily Mirror we got in touch with Farley Dwek and they agreed to look at our case. After they reviewed our position they said we have a strong case for NHS Continuing Healthcare Funding. Then they supported us in the crucial assessment meeting with the NHS by sending one of their experienced nurses who was able to make sure the assessment criteria was applied fairly and properly. Without Farley Dwek’s support we wouldn’t have secured the funding.

Soon after we presented our case with Farley Dwek we were informed by the NHS that my mother was entitled to the funding after all. It was a huge relief because the size of the care home fees can be a huge worry.

There must be many other families out there in the same position as us. I’d urge people to seek legal advice from a specialist law firm to see if they too can secure the funding they are entitled to. We’re happy with the outcome knowing that the right decision was made but we’re unhappy about the long drawn out process to get proper information on how and when we would be entitled to it.”

Andrew Farley, of Farley Dwek, who acted for the Newton family, said:

“We’re pleased that we made sure the NHS came to right decision to grant Mrs Newton the funding she is fully entitled to. The fact that she was rejected so many times is a worrying indictment of the current system and we will be looking into this aspect a little further.

In this particular case a very hard-working family that has paid taxes all their lives in Britain has had to sell of an inheritance asset in the form of a family home and pay more than £158,000 for care home fees. People should not feel coy about challenging the NHS over fees they have already paid or fees they are already paying.

This isn’t money being claimed from the NHS – this is money that has already been mistakenly paid over by families and ending up in the hands of private care operators. It is essential that families are assertive in claiming and reclaiming what is rightfully theirs in the first place.”

Mrs. P contacted us for help with her mothers NHS Continuing Healthcare Funding Assessment. She felt that her mother should receive funding and had organized a Checklist Assessment date with her mothers CCG, but having read our Free Guides and considered the process, she felt that she needed support. We assessed her mother’s condition and agreed that we felt she would qualify for funding. One of our senior nurses arranged to attend the Assessment as her advocate.The NHS Assessor started the meeting by saying that on her initial assessment, she felt that Mrs. P’s mother didn’t score highly in any of the care domains and appeared to have a stable condition requiring routine care.After a 3 hour clinical discussion with our nurse, the NHS Assessor agreed that Mrs. P’s mother did indeed have complex care needs and scored her as having 1 severe, 4 high, 3 moderate and 3 low needs. Two days later Mrs. P received confirmation from her CCG that her mother was eligible for funding and her care costs would be met in full.

Needless to say, Mrs. P was delighted with the service and the way in which our nurse challenged the NHS Assessor on clinical grounds about her mother’s condition. She remarked on the adversarial nature of the assessment and the way in which the NHS Assessor had come prepared to decline her mothers funding from the outset.

Mrs P said, “The service I have received from Andrew Farley for a Continuing Healthcare Funding claim for my mother has been excellent. The initial contact with Andrew gave me a clear picture of the process, outlining timescales and explaining the stages that I would have to go through to achieve a successful outcome.

“After completing the questionnaire and sending all relevant paperwork a very competent nurse was sent to support me at the assessment meeting where a decision was taken as to whether Continuous Healthcare Funding would be awarded. The presence of the nurse was crucial to the outcome of this case. Her medical knowledge and awareness of assessment criteria resulted in my mother being awarded full funding.

“Involving Farley Dwek in this process was one of the best decisions the family has made. My mother has complex medical needs and it is something the NHS should automatically fund, but lack of information from the NHS means that many families who are entitled to claim are denied the funding because they are unaware of the Continuous Healthcare Provision. Involving Farley Dwek has gone some way to redress that balance and I would recommend any family in the same circumstances to consider using the services of this company.”

Andrew Farley who dealt with Mrs.P’s case said:

“It’s not unusual for our clients to have already arranged Assessments, but it’s important that they are represented. This was a classic example of the way the NHS approaches many Assessment with a view to decline funding from the outset. Mrs. P was in no doubt that if we hadn’t been on hand to argue her case from a clinical and legal perspective, that her mother would not have qualified for full funding”

‘I got cash back after flawed tests’ Brian Marshall is waiting for a cheque for more than £40,000 after his father was wrongly charged for care home fees.Brian, 62, from Surrey, says: “I don’t like to take money out of the health service but I feel strongly that my dad, who has now passed away, was hard done by and didn’t get his entitlement.“My dad left school at 15, joined the Army at 16 and worked hard, paying his taxes, all his life. Then he got dementia.

“We tried to care for him as a family but he was just too ill and we had to put him into a home. He had done the right thing and saved and bought his own home, so we had to pay for it – £700 a week. He was initially assessed in hospital when he wasn’t so ill but he never got re-assessed, despite the fact he quickly deteriorated.

“For the first two weeks in the home, he could get out of bed and eat but after that he never got out of bed again.

It has taken us a couple of years to sort this out but it has now been agreed he should have been reassessed.

What worries me, looking away from Dad, is that other people going forward could be struggling to find the money needed to pay their way when they are entitled to help. We really need a fairer, more transparent system that doesn’t penalise the mass of hard workers who have always paid their way and saved up.

The costs for care are so high and that needs to be looked at. You don’t need any more worry about how to come up with the money at a time when you are trying to cope with the emotion and distress of trying to get the best care possible for loved ones. This needs sorting out and I’m glad Farley Dwek is on my side and helping through the process.”

Jonathan Dwek of Farley Dwek who is representing Mr Marshall, said:

“This is a national disgrace and if the Government is to avoid being accused of a cover up, it has to give the NHS the resources it needs to communicate this policy effectively.

We estimate there are millions of pounds on standby for the relatives of victims but we believe local CCG’s are quietly satisfied at the relatively slow take-up, thanks to a strategy of trying to keep the issue low profile.

Families with a relative who was rejected for funding on financial eligibility alone should definitely challenge the decision immediately and seek advice from Farley Dwek.”

Peter Shaw is a retired teacher from Pickering in North Yorkshire. He had to sell his mother’s home in order to pay for her care home fees. Then, not long after her funeral he discovered that she should have received free funding from the NHS and was entitled to NHS Continuing Healthcare Funding all along.

Farley Dwek was able to recover around £44,000 of fees from Powys Local Health Board which were wrongly paid when his mother, Edna, lived in her local nursing home.

Mr Shaw explains:

“In 2006 my mother fell off a stool which resulted in her breaking her hip. At the time she was nearly 87 years old and she stayed in hospital for about two and a half months before we took the decision to transfer her to a nursing home where she lived until she passed away at the age of 88.

When you’re researching nursing homes for your mother there isn’t enough time to consider whether she may be eligible for funding. You simply want the best care and focus on making sure she’ll be happy and comfortable.

From day one we were asked to pay the fees and we paid each bill for the 18 months that she stayed in the home. It was a huge amount of money and obviously we were forced to sell her home in order to fund the costs of her care.

After my mother’s funeral, I read something about NHS Continuing Healthcare Funding and felt I should investigate further. After doing my own research, gathering medical records and looking at my mother’s care plan I appointed Farley Dwek to handle my case.

Farley Dwek were exceptional and explained the process of recovering these care home fees every step of the way. Farley Dwek were able to reassure me that I had a strong case and always kept me in the picture with progress. It was a stress-free experience and the fact the service was provided on a no-win-no-fee basis meant I could proceed with peace of mind and avoid running up expensive legal bills.

Farley Dwek are doing something unique and have been reassuring and informative throughout the process to gain a result. They are recovering what is rightfully yours in a clear, concise and professional way. It is as far removed from other ‘no win- no fee’ legal services as you can get. It’s a specialist area of law and they know their stuff inside out.

More people should claim NHS Continuing Healthcare Funding. Getting it right in the first place will save other families the heartache of having to sell property to pay for care home fees. The system is wrong and needs looking at. It relies on naivety and ignorance from families at a time when they are vulnerable and simply want to focus on the best nursing home for their mother or father.

Too many people also want to close the book on a traumatic experience and don’t want to see if they are eligible for reclaiming care home fees. I would urge families who feel they have a case to take legal advice to see how they can recover these fees. My mother died when she was 88 and I’m sure that she’d be pleased to know that her family was eventually able to reclaim what was rightfully theirs in the first place.

If a relative of yours is going into a care home or nursing home, I’d 100% recommend you to call Farley Dwek to see if you are eligible for NHS Continuing Healthcare Funding.”

Andrew Farley of Farley Dwek, said:

“We’re pleased we got a good result for Mr Shaw and his family and recovered the fees that were wrongly paid all those years ago. It is important that families who currently have relatives in care take action if they feel they too may be entitled to NHS Continuing Healthcare funding. We’re proud that we are able to help families like Mr Shaw’s to recover this money which is rightfully theirs. We know that there are thousands of other families out there who are unaware that their mother, father or elderly relative should be receiving this funding. Hopefully, we are doing our bit to shine a light on this little-known area of NHS funding.

Mr Shaw is quite correct, the system is wrong and relies on ignorance and an unwillingness from families to look more closely into the detail of their relative’s care plan and medical history.

Applying for NHS Continuing Healthcare Funding is no walk in the park. It’s confusing, emotional and complex. We’re happy that we’re providing a much-needed service for families all over the UK.”

Mr Leslie and Mrs Jean Needham from Rotherham, South Yorkshire, were both admitted to different care homes by Rotherham PCT and then Barnsley PCT. Their daughter Mrs Jacqueline Atkin approached law firm Farley Dwek who are now seeking a refund for the £66,000 care home fees which were wrongly paid from 2008 – 2011.Their cases are now both being handled by the West and South Yorkshire and Bassetlaw CSU retrospective Close Down Project.Mr Leslie Needham, 81, suffered with a history of dementia, Alzheimer’s, depression and memory loss. He was admitted to two care homes owned by Rotherham PCT from April 2008 – July 2009. The family estimate they paid £30,000 in care fees for his time in care.His case was registered with Rotherham PCT on 4 January 2012. An assessment was completed by Rotherham PCT on 14 March 2012 which confirmed the ‘checklist’ had been completed and indicated a full Continuing Healthcare Funding review was necessary.

The family was advised in May 2012 the retrospective Close Down Project was being set up to manage their claims. They weren’t updated about their claim by the Close Down Project until a letter arrived on 23 July 2013 confirming a ‘Checklist’ has been completed and indicating a full review was necessary to access their claim. This was 16 months after Rotherham had previously confirmed the same action, who evidently had done little or nothing to progress the matter in the meantime. There was no timeframe provided for the completion of the full review and the family felt their case was being stalled by the Rotherham PCT.

Mrs Jean Needham, 78, suffered from dementia, Alzheimer’s and chronic kidney failure. She was in care from 30 April 2008 – 04 October 2011 in two different care homes covered by first Rotherham PCT and then Barnsley PCT. Her family paid £36,000.00 paid in care fees.

Her case was registered with Barnsley PCT on 11 October 2011. Her family were advised in May 2012 the Retrospective Close Down Project was being set up by to manage the claims. A letter was sent on 27 February 2013 confirming a ‘Checklist’ had been completed and it indicating a full review was necessary. Mrs Atkin is still waiting for an update from them regarding the completion of a full review.

Mrs Jacqueline Atkin said:

“My parents were in care for about one and a half years as their needs were so demanding. They needed intensive nursing care. They were told as they had savings and a house, they would have to pay for their own nursing home fees. They were forced to sell our family home, which they’d originally wanted to bequeath to us, to cover the costs. To add insult to injury, my father, who received a substantial company pension, had to use that as payment. He was effectively penalised for working hard. All their savings were eaten by care home costs.

No other option was given. If we hadn’t seen an article about a person who managed to claim back her mother’s care fees we wouldn’t have known about the refunds they were entitled to.

Our case has been delayed by the retrospective Close Down Project, set up by Rotherham PCT. I’m frustrated that everything seems to take so long, establishing the ‘Close Down Project’ has just made it all ten times worse. The process is now so long and complex it’s like it’s been designed to deter people from trying to secure refunds.

Other families must come forward if they feel they have been unfairly charged and take legal action. The NHS will try and put you off and it can be a bureaucratic process but you must remember you are entitled to this refund because mistakes were made.”

Hannah McLuckie, solicitor at Farley Dwek Solicitors, said:

“I’ve got no doubt that Mrs Atkin’s case is the tip of the iceberg. The Close Down project is a bureaucratic nightmare. It’s unfair that hard-working families should have to pay for the mistakes made by the NHS and the Primary Care Trusts. The sad thing is there are hundreds of other families out there who are unaware that they should have received funding too. With average claims totalling £45,000 that can date back to April 2012, it’s well worth hundreds of families pursing a refund case.”

Mr Barrow, 78, of Ashford in Kent applied for NHS Continuing Healthcare Funding for his mother in law, aged 89 and says Farley Dwek helped to successfully secure funding which saves his family £1,400 per week in BUPA care home fees…

“Twelve years ago my mother in law was diagnosed with Altzheimer’s Vascular Dementia and stayed in her own home all that time with support from the family and other local health professionals. She was adamant she didn’t want to go in to a care home and we supported her with this choice for many years.

At the end of 2014 we went away to Wales for the weekend leaving her with care support. She called an ambulance, which she was prone to doing from time to time when she was upset and disorientated, and she was taken to hospital. We received a call from the hospital and dashed back to be with her. It was clear at that stage that she needed more intensive support in a care home setting.

During her six week stay in hospital she was assessed three times for NHS Continuing Healthcare Funding. The first time the assessment was done without our knowledge and we were rejected for funding and told to pay our own care home fees. We pushed for another assessment which was done – and then amended without our knowledge and we were rejected again. Again, we pushed for another assessment but this time we had done our research online and read about Farley Dwek helping families to get NHS Continuing Healthcare Funding.

We instructed Farley Dwek on a fixed-fee basis to represent us during the assessment. Farley Dwek guided us through the process and arranged for one of their experienced nurses to attend the assessment meeting with the local NHS assessment panel. There was a marked change in attitude from the assessment panel when they realised we had someone on our side who was experienced at assessing NHS Continuing Healthcare criteria.

When the meeting was over we were ushered out of the room and then called back in 5 minutes later to say we had been awarded NHS Continuing Healthcare Funding.

I feel like the presence of Farley Dwek in the process was the key factor in our family securing the funding and saving £1,400 per week in care home fees for the BUPA hospital that we had chosen. To say we are pleased with Farley Dwek is an understatement. We’ve been absolutely delighted with everything the team has done and would recommend any family in the same circumstances speak directly to them to give them the best chance of getting the funding.”

Andrew Farley of Farley Dwek, said:

“We see too many cases of elderly relatives diagnosed with dementia being rejected for NHS Continuing Care Funding. Although dementia alone is not the only factor in securing the funding there are other criteria which need to be applied. It is all too common for families who are rightfully entitled to NHS Continuing Healthcare Funding to be unfairly rejected multiple times. We’re acting for hundreds of families who are going through the assessment process and saving them thousands of pounds a year on care home fees.”

Christopher Andrews was wrongly told there was no other choice than to self-fund when he was forced to place his parents in a care home:

“My parents have been in and out of care homes for the past four years. They both suffered from dementia and when they could no longer manage living on their own, a care home was the only option. When dad died last year, we had paid out more than £150,000 in fees to various care homes.

We had to sell my parents’ house to pay the fees. It didn’t seem right that they had to fund everything themselves after working hard and paying taxes all their lives. After digging around online, I came across something called NHS Continuing Healthcare Funding and thought we might be entitled to it.

In order to have our case reviewed and see if we can claim money back, we have to have a review by Medway CCG (Previously West Kent PCT). Farley Dwek, our solicitors actually registered our claim back on 20th August 2012 but we’ve had no timescales as to when this review may take place. The CCG is not obliged to work to any deadline which means we have no idea how long we could be waiting.

It’s hard to believe that people are being punished for working hard all their lives, paying taxes and buying their own homes. Mum was a policewoman and dad was a docker. It’s shocking that we were never told about the funding available to people in their situation.”

Andrew Farley of specialist care funding solicitors Farley Dwek, which helps families secure NHS Continuing Healthcare Funding for relatives, said it’s unacceptable that families should have to wait years to get their money back:

“The problem is that the current funding system is unfair and very slow to repay the money to families who are entitled to it. Mr Andrews’ case is unfortunately the tip of the iceberg and we’re acting for hundreds of families who are awaiting decisions or money from the NHS.

“It hits those who have worked their whole lives, spent their money wisely and put a bit aside for a rainy day. Families are often given short notice by their local NHS to attend a complex funding assessment meeting and in many cases I see they are improperly assessed or even worse not even made aware that funding is available at all.

“Crucial decisions are made that could spell the difference between paying nothing and paying £700 a week. If a family member has an NHS Continuing Healthcare Funding assessment looming I’d strongly suggest getting legal advice to make sure the process is carried through properly.

“Local NHS Trusts have made too many mistakes regarding funding and it is important you get the funding you are entitled to and ensure that your relative is assessed on a regular basis.

“This funding is also available for people receiving care at home and not just those in a care home. It isn’t applicable to everyone but should be considered by those whose needs are greatest.

“The system needs simplifying so that decisions within the NHS can be made more quickly and more correctly and hard working families like the Andrews family can get closure on the issue and move on with their lives.”

When Geoffrey Matthews’ 94-year-old mother from Flixton went into a care home, he didn’t think twice about whether he had to pay the fees, but as he explains, his mother’s deteriorating health meant she qualified for the little known NHS Continuing Healthcare Funding.

This funding would have paid the full cost of the care home fees, but his NHS Trust, local authority and the care home didn’t mention this option to him and his brother and sister.

Instead they were forced to use his mother’s savings and enter into an agreement with their local authority that meant when his mother passed away, it would claim some of the money from her house sale to pay for care home fees that were accrued during her stay. In all, the money owed would total more than £31,000.

Now, five years after his mother died, this money has been repaid. Mr Matthews takes us through the experience.

He said: Mum was a sprightly and independent lady and was able to stay at home until she was 94-years-old, with a mixture of support from my brother, me and regular visits from care workers.

“Unfortunately she was suffering from dementia and it reached a point when mum was assessed by our local authority to see if she could still live at home on her own with daily support.

The assessment ruled that mum’s dementia was too severe for her to be left at home and she needed the full time care only a care home could provide.

We were told she would have to pay the care home fees as she had more than £23,250 in assets, including her home.

We looked at her savings and our ability to help pay the fees herself, but this wouldn’t have covered the weekly cost of about £530.

Our local authority then informed us that the best option was to enter an agreement with them to hand over the deeds to her house. When she passed away the house would be sold.

The accrued care home fees would then be deducted and kept by the local authority and we would receive the rest of the money.

It was a real kick in the teeth for me, my brother and sister as my mum had wanted to leave the house to us as an inheritance. She worked hard all of her life to eventually own the house and suddenly it was being taken away from her, through no fault of her own.

In 2009, after 18 months in the care home, mum sadly passed away. Her home was then sold and we received the money, minus the care home fees.

“We had effectively paid more than £31,000 in total, but we didn’t think about this as we had just lost mum.

“About two and a half years later we were put in touch with specialist care funding solicitors, Farley Dwek. From that moment on we actually felt someone was looking out for our interests – Farley Dwek opened our eyes to the NHS Continuing Healthcare funding.

Luckily we had kept most of mum’s records and, after reviewing the paperwork, Andrew Farley agreed to take up our case and would only be paid if we won.

“Three years later and the NHS agreed that mum should have received financial support through its Continuing Healthcare Funding and all the money that was paid for mum’s care has now been paid back, plus interest.

It’s a massive relief for us as a family to know that mum’s lifetime of working to buy her house has been recognised and the nest egg she wanted to leave her children is still intact.

If it wasn’t for Farley Dwek we would not have had the money paid back and as a family we’ll be eternally grateful for their knowledge, experience and professionalism in guiding us through the extremely complex world of care home fees and the NHS Continuing Healthcare Funding.

I would urge people to check whether their relatives are eligible for financial support for care home fees through the NHS Continuing Healthcare Funding system and contact Farley Dwek. They will be able to offer advice on who is eligible and be with you throughout the process, making sure you keep what is rightfully yours and your family’s.

There should be much more publicity about NHS Continuing Healthcare Funding, so families don’t have to go through the extremely stressful process of finding the right care home and the money to pay the fees.

Currently the system doesn’t work for people and the emotions of putting a family member in a care home can often lead to people forgetting about whether they are eligible for financial support.

The family have never had a problem or criticism of mum’s standard of care while in the care home, just the process of being made aware of NHS Continuing Healthcare Funding.”

Andrew Farley, of Farley Dwek, said: “Mr Matthews and his family have now been rightly compensated for being forced to pay for care home fees when they shouldn’t have done so. Theirs is just one case of the NHS Continuing Healthcare Funding not being made available; we think there are potentially tens of thousands of families who are either going through this complex system or have been through it and wrongly paid money for care.

“It is very unfair as it hits those who have worked their whole lives, spent their money wisely and put a bit aside for a rainy day or a nest egg for their children. Families are spending millions of pounds on care home fees unnecessarily. They often struggle to secure the funding because they are given short notice by their local NHS Trust (now CCG) to attend a complex funding ­assessment meeting. In many cases they are improperly assessed or even worse, not advised that funding is available at all.

“Crucial ­decisions are made that could spell the difference between paying nothing and paying £700 a week.

“Applying for NHS Continuing Healthcare Funding is confusing, emotional and complex, when it should be openly available, easily explained and quickly processed.”

Retired legal professional Gilmour Shelley was forced to learn quickly the complex rules around the NHS Continuing Healthcare Funding after his 82-year-old father-in-law was rushed into hospital just after Christmas in 2013.

During his stay in hospital, Mr Shelley’s father-in-law’s condition deteriorated to such an extent that he was told he wouldn’t be able to go back home to live on his own and would have to be looked after in a care home. He had previously been supported by regular social care visits for which he had paid.

Through support from specialist care funding solicitors Farley Dwek, Mr Shelley was able to secure temporary funding through the NHS Continuing Healthcare policy, and is awaiting a final decision on full financial support. But as he explains, the process was not straightforward.

He said: “My father-in-law became ill on New Year’s Eve 2013 and after being rushed into hospital it became quite apparent he had dementia that was rapidly deteriorating. He had previously been an independent person, living at home alone with support twice a day from social care workers to help him with meals and getting dressed.

He was in hospital for about six weeks, during which time he contracted pneumonia. We were told he would have to go in to a care home as his worsening dementia meant he could no longer live at home alone. This was such a shock as we had never contemplated this scenario or even carried out research into it.

My wife and her brothers started looking into suitable care homes, as they had been told by a social worker that as the fees were means tested, the fact my father-in-law owned his property and had savings meant he would have to pay the care home charges. There was no mention of an assessment for the NHS Continuing Healthcare Funding.

Fortunately I had heard about this funding so after some quick research on the internet, asked for an assessment to be carried out. In mid-February this year the family was shocked as this was carried out while he was still in his hospital bed and with no members of the family present.

I then found the results on his bedside table and upon reading the report was appalled as it didn’t seem to match the condition we knew my father-in-law was in.

I immediately wrote a nine page document on why the family believed the assessment to be wrong and handed it to the hospital. Within 48 hours I received a telephone call from the hospital ward manager, who apologised for the way the assessment was carried out and promised a new one within a few days.

The first assessment resulted in ten C and one B grades, which meant my father-in-law wasn’t eligible for care home funding under the NHS Continuing Healthcare Funding, but the second assessment results produced three A, three B and five C grades, which meant he moved to the next level and a Decision Support Tool meeting. This eventually decides if full financial support for care home fees is provided.

After further reading into the subject I was struggling to understand the medical terminology and criteria required for the funding. I then searched for suitable support, was impressed with Farley Dwek and contacted Andrew Farley.

Within 48 hours we had a meeting with the specialist nurse appointed by Farley Dwekand she explained the process that would be undertaken, the terminology that would be used at the Decision Support Tool meeting and attended it with us to ensure the correct procedure was followed.

Our family felt such relief when we realised the professional support we were receiving from Farley Dwek would remove a huge amount of stress. The outcome of the meeting in mid-March resulted in my father-in-law receiving an interim six week funding for his care home fees.

He entered the nursing home, which is almost next door to his home, in early April and unfortunately his condition has deteriorated further.

At the end of May there will be a final assessment of my father-in-law, at which Farley Dwek will continue to provide professional support and advice. He is now bed-bound and can’t stand so we’re confident the care home fees will be met through the NHS Continuing Healthcare Funding.

The complexity of the process we’ve had to undertake has been horrendous for the family, in particular my wife, but the support we received from Farley Dwek has been exceptional.

From the moment I picked up the phone to Farley Dwek the stress levels we suffered dropped significantly as we had everything explained to us. As it was no-win-no-fee, we had nothing to lose.

I would urge people to check whether their relatives are eligible for financial support for care home fees through the NHS Continuing Healthcare Funding and contact Farley Dwek. They will be able to advise on who is applicable and be with you throughout the process, making sure you keep what is rightfully yours and your family’s.

There should be much more publicity about NHS Continuing Healthcare Funding, so families don’t have to go through the extremely stressful process of finding the right care home and the money to pay the fees.

Currently the system doesn’t work for people and the emotions of putting a family member in a care home can often lead to people forgetting about whether they are applicable for financial support.

Paying for care home fees is so complex, your only hope is professional help. If a relative of yours is going into a care home or nursing home, I’d fully recommend calling Farley Dwek to see if you are eligible for NHS Continuing Healthcare Funding.

The family have never had a problem or criticism of his standard of care while in hospital, just the process of being assessed for continuing health care.”

Andrew Farley of Farley Dwek, said:

“The current funding system is unfair as it hits those who have worked their whole lives, spent their money wisely and put a bit aside for a rainy day. Families are spending millions of pounds on care home fees unnecessarily. They often struggle to secure the funding because they are given short notice by their local NHS to attend a complex funding ­assessment meeting. In many cases they are improperly assessed or even worse, not advised that funding is available at all.

“Crucial ­decisions are made that could spell the difference between paying nothing and paying £700 a week.

“We’re pleased to be supporting Mr Shelley and hope his case is resolved successfully very soon to ensure his family don’t have to sell a property that holds many years of happy memories spent with his father-in-law. You can’t put a price on keeping memories and we hope we’ve helped preserve many happy memories for the family.

“Applying for NHS Continuing Healthcare Funding is confusing, emotional and complex. We’re happy that we’re providing a much-needed service for families all over the UK.”

Mrs Barbara Brogden was admitted to a nursing home in Leeds 2004 and due to her capital and income the family were told she had to pay for her own nursing care.Despite changes to her health, which meant that the decision not to fund care should have been re-assessed, she continued to pay for her own care until she sadly died aged 79 in February 2009.After reading about families who had successfully recovered care home fees, Mrs Brogden’s son Paul instructed Farley Dwek Solicitors to review the case. He was shocked to discover she should have received funding for her care. This was because her care needs had changed but this fact wasn’t reflected in the funding decision by the local Primary Care Trust (PCT).

Leeds Primary Care Trust has now agreed that Mrs Brogdon’s care needs should have been funded after all. Farley Dwek is now seeking to recover around £45,000 in fees.

Mr Brogdon said:

“My mother was in a nursing home because she was very ill and required intensive nursing care. I was simply told that as she had savings and a house, she had to pay for her own nursing home fees. No other option was given. If we hadn’t seen an article about a person who managed to claim back her mother’s care fees we wouldn’t have known about NHS continuing care.

“Other families must come forward if they feel they have been unfairly charged and take legal action. The NHS will try and put you off and it can be a bureaucratic process but you must remember you are entitled to this refund because mistakes were made.”

Andrew Farley, director at Farley Dwek Solicitors, said:

“Like hundreds of other sons and daughters who have seen their parents struggle to meet the costs of care home fees in the latter stages of life, Mr Brogdon has had to battle hard for something to which his family is – and always have – been fully entitled too. It is unfair that hard-working families should have to pay for the mistakes made by the NHS and the Primary Care Trusts. The sad thing is there are hundreds of other families out there who are unaware that they should have received funding too.”

Mr Wright, 46, of Norwich was shocked to discover that his late parents Jack and Jean may have paid for care fees unnecessarily and is now taking legal action to try and recover fees of around £70,000 plus interest from Norfolk PCT and Hampshire PCT. Jack was initially reluctant to leave home and enter a care home, and therefore relied on home help on a daily basis. Once this was no longer sufficient to meet his needs he stayed in Baytree House, Norwich, for twelve months until he passed away aged 85. The nursing home fees were approximately £560 per week. Jean stayed in Bedhampton Nursing Home, Hants for fourteen months until she passed away aged 76. The nursing home fees were approximately £700 per week.

Both parents never had their care needs assessed during their time in the care homes, a process which informs key funding criteria and can alter decisions made by PCT’s. The cost of the care home fees for the pair was more than £70,000 and legal experts say both parents may have been eligible for funding despite being told otherwise.

“I’m upset and angry that my parents were unfairly rejected for funding by the local primary care trusts. I strongly believe other people have probably found themselves in the same position.

We were told that due to my parent’s capital and income they would both have to pay for their own nursing care costs. When the rejection letter came through my parents both accepted it. They would have never questioned the integrity of the NHS but since reading about mistakes being made I believe they shouldn’t have paid.

The fact that my parents and the rest of the family had to suffer needlessly is very upsetting. The NHS and the Government should have done more to let families know that mistakes were made so they could be rectified.”

Andrew Farley, director at law firm Farley Dwek Solicitors, which is handling the case, said:

“If your parents were told that they could only have been assessed on ‘financially eligibility’ then you should challenge the decision immediately. We’re representing hundreds of families who were initially rejected for families and we suspect there are thousands of other families who can successfully claim back care home fees. We estimate there is hundreds of millions of pounds available for families to recover from PCT’s who made mistakes.”

Mr X (to protect his anonymity) was admitted to hospital in December 2017 after suffering a stroke. He was transferred to a step-down facility on 4^th February 2018, where he was then assessed by the CCG on 13^th February 2018 and found not eligible for CHC funding.

Mr X’s daughter appealed the CCG decision and attended the Local Resolution Meeting in December 2018. The CCG then held a follow up meeting in February 2019 but still concluded that Mr X was not eligible. Mr X’s daughter subsequently contacted Farley Dwek Solicitors to represent her in the appeal to NHS England (Independent Review Panel).

A comprehensive Written Submissions Document was prepared on behalf of our client to support the request for IRP, including evidence for the period right up to the date of death. We argued that Mr X had been assessed too early, at a time when he had spent 6 weeks in hospital, followed by only a matter of days in the step-down facility. The IRP accepted that he had suffered a dramatic change to his life and circumstances, and it could be expected that he was still adjusting. The IRP accepted that the CHC assessment may well have been undertaken too early and ongoing assessment was required to identify those needs and means to address them effectively.

The IRP concluded that Mr X had experienced a rapid change in his life as a result of a medical, life-threatening emergency to a man requiring round-the-clock care in an environment where professionally trained staff were at hand at all times. He had a wide range of needs across many domains of care which were health in nature, and outside the powers of a Local Authority to meet. The IRP recognised that pain medication had been reduced on his arrival at the step-down facility, but shortly after the DST it was increased to a slow-release opioid – which suggested that at the time of the DST, active judgment and monitoring was having to be made very frequently about the level of pain.

Our advocate argued that:-

• The CCG’s DST was very brief in some parts
• Mr X had only been in the step-down facility for 9 days, and in these circumstances, there were very few records available to the MDT
• The MDT had access to the hospital discharge report but no other hospital records
• The MDT had no access to a GP report or records
• Significant weight had been attached by the MDT to one report only, namely the “health needs assessment” produced ready for discharge and which contained very little information.
• That, in all of the above circumstances, there was insufficient evidence available to the MDT to complete an accurate assessment of Mr X’s ongoing needs.

The IRP upheld the appeal and concluded that at the time of the DST, Mr X was eligible for CHC funding.

The CCG subsequently accepted the IRP’s recommendation relating to the February 2018 DST and agreed to reimburse fees up to the date of Mr X’s death in May 2019.

Linda Gregg was born in 1942 and married her beloved Roy in 1964. They moved to Kent where they had a happy and busy family life raising their daughter and son. Linda loved the outdoors, walking the family’s Afghan hounds, led an active life, had a large circle of friends and enjoyed many social events and travelling abroad.

Linda remained a devoted wife for 51 years, caring for Roy as he struggled with dementia, even though her own health was failing. She was a truly wonderful mother and fantastic grandmother, always full of fun and with a zest for life and remained positive throughout her very difficult final years.

In late 2014, at a time when she was caring for her husband, Roy, who was suffering with dementia, Linda started having problems with her balance, suffered constant dizziness and had some falls. As her condition continued to deteriorate, she was referred to various hospital departments including the falls clinic and numerous tests were carried out.

In August 2015, following a full body scan, Linda was diagnosed with ovarian cancer and surgery was successfully carried out. Sadly, Roy passed away suddenly a couple of months later.

In December of that year, Linda fell and broke her hip and following a period of respite care in a care home, Linda moved to full time residential care in March 2016. There were numerous falls and a general decline in Linda’s health at this time.

Tests continued, and finally in May 2016, Linda was diagnosed with Progressive Supra-Nuclear Palsy, a rare degenerative neurological condition affecting vision, balance, movement, speech, swallow, mood and behaviour. It is a progressive, incurable condition that results in gradual physical deterioration caused by the damage to nerve cells in the brain. There were also episodes of dehydration, delirium, and numerous UTIs resulting in hospital visits and admissions.

To aid nutrition and medication a PEG (percutaneous endoscopic gastrostomy) feeding tube was fitted which required a nurse to oversee five times daily. There were many healthcare departments involved in Linda’s care including speech and language, physiotherapy, occupational health and hospice care. In the last year of her life, she was fully dependent on nursing and care staff for all her daily living activities due to her complex needs.

Sadly, in November 2019, Linda suffered a stroke and passed away peacefully in her sleep.

After Linda moved from her home into her first dedicated care home suite, the staff made the family aware of the Funded Nursing care and NHS Continuing Healthcare. The family had no real involvement at this stage as the care home staff dealt with the application for Funded Nursing Care – a small weekly fixed contribution awarded to offset the cost of nursing care fees.

At the end of January 2017 Linda had to move care homes and her new care home fell under the auspices of a different NHS Clinical Commissioning Group (CCG).

On 27^th April 2017, Linda was assessed by the new CCG as to her eligibility for Funded Nursing Care (FNC) and NHS Continuing Healthcare (CHC). Having experienced a very streamlined and effortless assessment with the previous CCG, nothing really prepared the family for the inept, unprofessional attitude of the new CCG.

DST 1:

Linda was assessed for CHC funding by the CCG on 1st June 2017. Although the Multi-Disciplinary Assessment Team (MDT) had made a clear and unequivocal recommendation for fully-funded CHC, the CCG disregarded it and only awarded Linda the lesser FNC.

An appeal was immediately launched as the National Framework guidelines state that the MDT’s recommendation should be followed (unless there are exceptional circumstances).

DST 2:

Following the family’s intention to appeal the June 2017 decision, for reasons unknown, the CCG decided to complete another Decision Support Tool on 9^th January 2018 – some 6 months after the decision to appeal was made, putting the family through the strain of another assessment. The MDT’s findings again made a clear and unequivocal recommendation for CHC funding. But again, the CCG refused to accept the MDT’s decision and awarded only weekly FNC payments.

On 26^th July 2018, the family attended an appeal at a Local Resolution Meeting (LRM) – almost 12 months after the initial assessment (1^st June 2017) – to discuss the rationale on the previous Decision Support Tool (DST). It was revealed at the meeting that the case had been reviewed, but neither Linda nor her family were told about it. Breaches of the National Framework and errors within the DST were pointed out and acknowledged by the CCG – including getting Linda`s name wrong!

The family requested Independent Review of the decision by NHS England and engaged their local MP who asked to be kept informed. Another year passed by with Linda steadily declining.

DST 3:

On 7^th August 2018, the CCG carried out a further DST of Linda’s eligibility for CHC, to run concurrently with the appeal to review the CCG’s previous decisions to refuse CHC funding. The outcome of discussions with the healthcare professionals at the MDT again clearly and unequivocally recommended that Linda was well over the criteria threshold for CHC funding.

Nevertheless, by letter dated 27^th September 2018, the CCG advised that its decision remained unchanged and again refused to uphold the MDT’s recommendation in contravention of the National Framework. Of far greater concern was the fact that the Key Indicators of the 9^th January 2018 DST had been entirely rewritten by a sole Nurse Assessor, disregarding the MDT’s professional opinion and raising concerns of potentially serious malpractice!

Chris Gregg, her son, explains:

“Due to the complexity of mum’s increasing needs and the fact that the CCG were not adhering to the National Framework, the family decided that a formal appeal would have to lodged with the CCG in order to get an Independent Review carried out. Research was done and Farley Dwek Solicitors were contacted as having a specialist knowledge in this arena.

In February 2019, the family spoke to Andrew Farley and explained the difficulties encountered dealing with the CCG and the general situation surrounding mum`s health. Farley Dwek were instructed to investigate whether the case was worth pursuing, and also to provide the independent evidence should it merit an appeal. Once this was preliminary exercise was done, it was quite clear that the CCG had displayed complete disregard for National Framework, made grave procedural breaches, made errors of fact, and shown general incompetence (including several missed deadlines imposed by the National Framework which were subject to separate complaints en-route!).”

The reins were handed over to Farley Dwek by the family who felt like they had done as much as they could have done as “lay” people in this complicated process. Farley Dwek agreed to act on as a no win, no fee basis.

Chris continues: “Ruth Pople was the case manager at Farley Dwek and she immediately got to work amalgamating all the necessary paperwork and report compiling. As well as acting for the family in relation to the Independent Review Panel with NHS England, Farley Dwek also took a keen interest in the local appeal process and were present at the 2^nd Local Resolution Meeting with the CCG. Yet again, the CCG demonstrated their incompetence by not preparing for the meeting; managerial staff that had promised to be at the meeting failed to attend; and no explanation was given as to why the CCG had completely ignored the recommendations of all the MDT healthcare professionals employed to assess mum’s eligibility for CHC. It was decided that the LRM will have 28 days to reconsider the decision, and if it is not overturned, and mum awarded CHC, then NHS England will be involved for all 3 DSTs.”

The CCG responded and asked for the matter to be referred to NHS England (which was already happening).

“Sadly, mum passed away of her illness in November 2019 never got to learn how her case ended.”

In February 2020, Farley Dwek Solicitors represented the family at the NHS England Independent Review Panel (IRP).

Chris continues: “Ruth Pople from Farley Dwek was well prepared, professional and verbalised the families concerns at the CCG`s handling of the case – pointing out their multiple failures.”

Finally, in April 2020, the NHS England’s IRP upheld the appeal and confirmed that Linda was eligible for CHC contrary to the CCG`s previous decisions.

Chris: “Farley Dwek again took over and entered negotiations with the CCG, eventually coming to a substantial settlement which included backdated interest under the NHS Redress Guidance (2015).

Summing up the process as the member of family who dealt with the majority of the paperwork and the correspondence with the CCG, I can say that it is not an easy process to understand. Not only is it emotional, reliving all the heartache and having your loved-one discussed as case or a number, but the CCG will look to extend all the time limits put in place siting any number of excuses at their disposal. There appears to be no punishment in place for deviating from the National Framework.”

Chris says: “This process took three and a half years in total, and at all stages, I got the impression that the CCG just wanted me to go away and stop bothering them. Employing the specialist solicitors allows the family time to breathe and takes away the stress of the process. They are able to cut through all the red tape that the CCG try to tie you up with and have the backup of their legal status. Had I not engaged with Farley Dwek Solicitors, I very much doubt that the case would have gone in Linda`s favour.

I cannot recommend FARLEY DWEK enough should you find yourself in this unfortunate situation. They ring you when they say they will, they write to you with updates and keep you informed all the way.

I`d like to especially thank Ruth Pople and Jonathan Dwek who I regularly spoke to during the process.”

‘Alex’ was severely unwell with multiple conditions including end-stage Parkinson’s and related dementia, breast cancer and severe arthritis.  She became dependent on round the clock care which was provided largely by her niece, Caroline, working with a team of domiciliary carers funded by the local County Council.

Caroline was in full-time employment and a part time lecturer but had plans to begin her own consultancy business which she hoped would give her the flexibility to continue working whilst also caring for her aunt.

An assessment for NHS Continuing Healthcare Funding (“CHC”) was made in 2015.

July 2016: a Decision Support Tool identified that Alex’s needs were primarily for healthcare, by which time, Caroline had now effectively given up all work in order to provide full time care for her aunt

Around this time Caroline began staying over with her aunt regularly in order to provide overnight care. She only managed to go back home about once a month. This impacted on her social life and also significantly reduced her ability to work.

September 2016: the CCG accepted Alex qualified for CHC – a fully funded package of care provided for all her healthcare needs by the NHS (via the CCG) – FREE of charge.

January 2017: the CCG commissioned a package of care from a local care provider, but in respect of daytime care only and with substantially fewer hours than the CCG’s assessment had identified. This left Caroline to provide cover for her aunt’s entire night-time needs and much of her daycare as well, which she did with help from a family friend and very occasional help from Marie Curie.

Throughout the period September 2016 to November 2017, Caroline frequently tried to get in touch with the CCG to query the lack of care, but was consistently rebuffed or simply ignored. Eventually, in desperation, Caroline submitted a safeguarding alert which triggered the attention of the local district nurse manager who immediately arranged a review of Alex’s care needs.

November 2017: a review of Alex’s needs was carried out and the CCG’s panel confirmed the need for overnight care.

January 2018: the full care package was commissioned – some 16 months later! However, this was not implemented for some two weeks – leaving Caroline to continue providing all of Alex’s care.

January 2018: Caroline submitted another complaint, but again, this was refused.

However, in late 2018, the CCG carried out a full case review and confirmed that there had been no material change in Alex’s healthcare needs during the review period. The outcome remained that she did have a requirement for a commissioned care package for the entire review period, commencing in September 2016.

Sadly, the CHC care package was still not fully implemented when Alex died on 5 March 2018.

Compensation (Redress)

January 2019: the CCG wrote to Caroline, assuring her that she would be reimbursed for all her care costs in line with the NHS Continuing Healthcare Refreshed Redress Guidance, 2015, including any claim for loss of earnings as a result of giving up work to look after her aunt.

Caroline had suffered financial loss of income from her various employments and work opportunities, plus a loss of consultancy work as a direct result of the shortfall in CHC Funding.

She was drained and exhausted from looking after her frail aunt. She suffered distress caused by seeing her aunt denied the proper nursing care with which she should have been provided by the CCG since September 2016. In addition, she suffered additional distress from seeing her own plans for developing her consultancy business frustrated; and the loss of time and the frustration caused by having to battle against the CCG’s repeated refusal to accept its responsibilities.

The CCG invited Caroline to submit documentary evidence in support of her financial losses – which she duly did.

Despite full and frank disclosure, the CCG rejected her claim, saying that all the information provided was insufficient to substantiate the losses claimed. Her evidence raised numerous concerns and in response they accused her, amongst other things, of benefit fraud and concluded with a threat to report her to the NHS Counter Fraud Authority for further investigation!

Caroline was understandably distraught by the CCG’s personal attack. She had put her life on hold for some 2.5 years whilst looking after her elderly, sick aunt – all because the CCG had failed to provide timely care – and to add insult to injury, was now being taken to task by the same CCG who openly invited her to submit details of her losses for reimbursement.

As renown experts in the field of CHC Funding, Caroline came to Farley Dwek Solicitors for legal help. Her reputation and good character was on the line.

It was clear to us at Farley Dwek that the CCG’s Panel had fundamentally misinterpreted the evidence as to her claim for loss of income and their hints at serious allegation (not to mention their improper suggestion that Alex should use her paltry winter fuel allowance to pay for her own care!) were wholly without basis and grossly inappropriate in the light of their admitted maladministration.

With Specialist Counsel’s input, a comprehensive Letter of Claim was sent to the CCG setting out Caroline’s claim for redress on account of the CCG’s inherent failings.

Outcome

The matter settled after negotiation for a very substantial sum including Caroline’s loss of income, interest accrued, compensation for distress and a contribution to her legal fees.

Jonathan Dwek, Solicitor, said, “This was a highly complex case. When CHC Funding is awarded, a package of care is usually implemented swiftly by the CCG to meet the individual’s assessed healthcare needs. Somehow, Alex had fallen through the net, which put enormous strain on Caroline, her sole surviving relative, to look after her aunt and step in to provide the 24-hour care needed – care which the CCG should have been providing. This is an unusual scenario, compounded by the CCG’s dismissive attitude and misinformed stance on her losses, caused solely by their abject failure to provide the care they’d approved and agreed to fund!

Jonathan adds, “We are delighted with the outcome and redress awarded. Caroline has been fully vindicated in her claim, following years of selfless care which left her physically and emotionally exhausted. We are pleased that her reputation has been fully restored.”

Farley Dwek represented the late Mr Kenneth Phillips, an elderly gentleman, who was admitted to Hospital by ambulance, then aged 94, with shortness of breath, reduced mobility in his left leg and cellulitis Whilst admitted, he had an unwitnessed fall; it is thought that he fell out of bed due to lack of bedrails (a ‘never event’). He was known to be at high risk of falling.

Mr Phillips sustained a significant unsightly fracture to his dominant right wrist, a suspected hip injury, significant bruising all down his left side, tenderness to his cervical and thoracic spine and a potential head injury. Mr Phillips was immobilised and his neck put in a brace (quite frightening for an elderly patient). His wrist was placed in a plaster cast and was treated conservatively due to his age and other medical conditions.

Mr Phillips was left with a physically and visibly deformed shortened angulated (‘spoon’) wrist, which was very painful and stiff, with significantly impaired grip strength, residual weakness, instability, and muscle spasms. He needed to wear a splint most of the time for support and to counter instability in his wrist. His independence was gone, and with it, a total loss of confidence. The accident affected him in all aspects of his daily activities, such as:

• His mobility and independence was adversely affected. He could no longer use his walking stick and needed a Zimmer frame and someone to accompany him when mobilising at all times due to his reduced grip.
• He could no longer rely on his injured wrist for support or grip to steady himself when walking indoors, if he lost balance or if he needed to push himself up from a seated position.
• When walking, he shifted his body to compensate, putting excess strain on his left side – knee hip and back – aggravating any existing degeneration and previous knee replacement surgery.
• He needed someone to push him in his wheelchair as he couldn’t rotate the wheel rims with his damaged hand.
• He now needed daily assistance from his son and 2 professional carers who were employed to help with basic tasks that he could do now longer do for himself since his accident eg help getting out of bed, cooking, cutting up food and eating, hygiene (eg washing and showering and other aspects of personal hygiene), toileting, dressing (eg help with shoes even though they have Velcro), buttons, zips and clothes that go over his head are a particular problem.

Farley Dwek presented a claim for negligence against the NHS who apologised and admitted liability.

Medical evidence was sought from a Consultant Hand Specialist who confirmed that the wrist symptoms and deformity would be permanent and “with the splint off, there is virtually no use in Mr Phillips’ right hand. With the splint on there is a degree of stability, but not enough to manage to the same degree of mobility and independence that he enjoyed before the accident in question.”

Mr Phillips’ case was settled for £40,000.

Sadly, Mr Phillips passed away recently, aged 95, and didn’t see the end of his case.

His son, Craig, said: “My father was mobile and independent before his fall, and sadly, this accident literally knocked the wind out of his sails and robbed him of his dignity and quality of life; from being a strong independent gentleman to requiring round-the-clock full time care. I am over the moon with the way in which Farley Dwek Solicitors have handled my late father’s claim. The matter was dealt with in an extremely efficient and robust manner. My father and I were kept informed throughout the whole process and we had frequent contact with our solicitor, Jonathan Dwek. His experience and empathy instilled great confidence and I am delighted with the outcome. Whilst my father never lived to see this brilliant result, I will be giving some of the money to local causes in memory of both my late parents.