Some Recent Success Stories

This week’s success story concerns a patient who did not trigger for full assessment on the Checklist, but was subsequently found ELIGIBLE for full NHS Continuing Healthcare Funding (CHC) six months prior to that date!

The patient was considered for CHC Funding by her local NHS Clinical Commissioning Group (CCG) by means of a screening Checklist – which did not indicate the need for full assessment. The patient died shortly thereafter. Her family complained to the CCG about the inaccuracy of the Checklist; the CCG agreed to conduct a retrospective review for the last twelve months of life.

Farley Dwek Solicitors were instructed to assist the family with the retrospective review.  We obtained copy of the patient’s care and medical records, and prepared a Written Submission in support of the case. Following an initial assessment, the CCG awarded CHC funding but only for the two months prior to the patient’s death.

Farley Dwek appealed the decision of ineligibility for the remaining period and attended a Local Review Panel arranged by the CCG. The Panel upheld the CCG’s decision of ineligibility.

We requested Independent Review of the decision by appeal to NHS England, which set a date for the Panel hearing. One week prior to the hearing, the CCG contacted us to advise it had reconsidered its decision and agreed with us the patient met the criteria for full CHC Funding throughout the period of appeal.

This is a wonderful result for the family and quite a turnaround in the case of someone who supposedly did not even meet the criteria for full assessment!

Stuart (not his real name) took advantage of our Clinical Review Service and instructed us to review his father’s potential eligibility for NHS Continuing Healthcare Funding (CHC).

The matter was allocated to one of our specialist nurse assessors who then promptly met with the patient and his family at the care home. Having reviewed his care home records and medical records, our specialist nurse considered that there were good prospects of successfully claiming CHC funding to cover the cost of his ongoing care fees and accommodation.

For continuity, the same nurse subsequently attended the NHS’s Multi-Disciplinary Team meeting as the family’s appointed advocate. The MDT agreed to recommend CHC funding to pay for all future care fees.

Based on our review of the available evidence, we felt that Stuart’s father should also have been assessed and awarded CHC funding much earlier. Farley Dwek were then instructed by Stuart to pursue a retrospective claim against the CCG and seek reimbursement of past care home fees paid for the time when his father should have been found eligible for CHC funding.

After submitting our application form, the CCG gave careful consideration to the matter and upheld our claim. As a result of our intervention, the family are now expected to receive over £28,000 reimbursement of back-dated care fees.

Many families without legal representation only tend to look forward to see how they can save huge monthly care fees for their spouse, parent or relative. Sadly, many are totally unaware that in certain circumstances they can also make a retrospective claim for CHC funding as well!

If you want help assessing your relative’s potential current or past eligibility for CHC funding, or else need professional expert advocacy support at an MDT or appeal, get in touch with us directly on 0800 011 4136 or via our website to find out how we can help you.

Farley Dwek were instructed in 2015 by ‘Mrs X’ (to protect her identity) on behalf of her mother to undertake our Records Review Service.

Our Nurse Specialist reviewed the available medical evidence and care home records and concluded that Mrs X’s mother was eligible for a previously unassessed period of care spanning some 15 months prior to her death.

As a result of our Records Review, we accepted instructions from Mrs X to register a Retrospective claim with the NHS Clinical Commissioning Group (CCG).

After years and months of endless chasing for updates, the CCG outsourced their review to an external company in September 2018 in order to expedite their case load.

We eventually received the CCG’s draft Needs Portrayal Document in December 2019, and in return promptly provided them with our detailed Written Submissions in response a few weeks later, in early 2020. Due to Covid delays, it took some time before the matter could be reviewed by the CCG’s Multi-Disciplinary Team (MDT), who subsequently confirmed that the patient was indeed eligible for CHC funded care for the full 15-month period under consideration.

Although this CHC process may have taken just short of 6 years to complete, it goes to show that perseverance can pay off! The family are expected to receive reimbursement in excess of £55,000 for their mother’s wrongly paid care fees.

Get in touch if you would like us to carry out a review of your relative’s records to assess whether they may be eligible for CHC funded care or if you need professional advocacy support to help fight your corner at an MDT or appeal.

We were approached by Mr. X for assistance, after his relative was found not to meet the criteria for CHC funding by the CCG.

We conducted a thorough review of the care and medical records, and prepared a detailed report.  We found the CCG’s decision to be patently incorrect and immediately lodged appeal on our client’s behalf.  We also submitted a request for retrospective review from date of admission, two years earlier, as the patient had never been considered for CHC funding.

The CCG provided its appeal and retrospective review forms, which we duly submitted alongside a detailed Written Submission.  Copy of the records we had obtained was sent to the CCG for consideration.

Such were the clinical facts of this case, the CCG immediately overturned its decision of ineligibility without putting the family through Local Resolution.  The CCG also immediately confirmed, without even completing a DST,  that the patient had, in fact, been eligible for CHC funding from the date of his admission to the nursing home, some two years earlier!

This case goes to show how wrong CHC assessors can get it, and how often people are not referred for CHC consideration by nursing homes despite being clearly eligible for funding.

‘Mrs X’ (for anonymity) was discharged from hospital into a nursing home. However, about a month prior to discharge, she underwent a Checklist assessment for NHS Continuing Healthcare Funding (CHC) but received a negative outcome – indicating she was not eligible for CHC and that she should not be referred for a full assessment. This was despite her doctors advising she had only weeks to live! 

Her family disputed the veracity of the Checklist, stating that it was done prematurely and should be ignored. Ideally, in order to get a better picture of her long-term healthcare needs, the Checklist should have been completed once Mrs X was out of the acute hospital setting and had settled into the nursing home.

Following a complaint, the CCG subsequently agreed to undertake a full assessment of Mrs X’s needs. A Multi-Disciplinary Team meeting (MDT) was convened and, following completion of their Decision Support Tool, again found that Mrs X was ineligible for CHC. Her family were aggrieved by this flawed decision, but in the meantime, until an appeal could be launched, were still obliged to continue paying for her ongoing significant care fees out of private means.

Although Mrs X was eventually awarded Fast Track funding some months later to cover the last few weeks of her life, sadly she died shortly afterwards.

Farley Dwek Solicitors were then instructed by the family to appeal the CCG’s decision to refuse CHC Funding and to seek reimbursement of wrongly paid care fees.

After a review of the papers, our specialist Team concluded that Mrs X’s health was unstable and rapidly deteriorating, and that upon discharge from hospital she should have been Fast Tracked for CHC funding in compliance with the National Framework, instead of undergoing a Checklist assessment. We argued that it was apparent to the hospital clinicians that Mrs X had a rapidly deteriorating condition and was nearing the end of her life; the same facts ought to have been apparent to the CCG which should have Fast-Tracked Mrs X for CHC Funding!

Farley Dwek lodged detailed Written Submissions in support of an appeal to the CCG’s Local Resolution Panel (LRM) who agreed that Mrs X did meet the eligibility criteria for CHC, backdated to the date of her admission to the nursing home until she was Fast Tracked a few weeks just before she passed away.

Her family are expected to receive in excess of £20,000 reimbursement for wrongly paid care fees.

Farley Dwek represented a young, international footballer who sustained significant leg injuries as a result of a serious road traffic accident. They were a passenger in an off-road vehicle when the driver lost control, causing it to flip over, and in doing so, ejected our client, before the vehicle landed on their leg.

Our client sustained a comminuted (i.e. multi-fragment) fracture of the left femur, a rupture of the posterior cruciate ligament and a significant puncture wound and muscle damage to the left thigh. They have been left with permanent, extensive, unsightly scarring and an obvious deformity and unevenness in the contours of the injured leg.

Emergency surgery (with the insertion of metal work) was needed to unite the leg fracture. However, initial surgery proved unsuccessful. This resulted in three more invasive surgical procedures under general anaesthetic (including complete revision surgery to remove all the metal work and replace it) and extensive hospital stays on each occasion whilst recuperating. When discharged home after each surgery to convalesce, our client needed help and support with all aspects of their daily care, hygiene and mobility, which was provided by family and friends.

Despite their resilient character, our client inevitably suffered with Post Traumatic Stress Disorder (including frequent nightmares, a fear of travel and specific phobia of travelling as a passenger) and symptoms of depression, frustration, anxiety, upset and fear, insomnia, mood swings, often weepy and tearful, and they became reclusive and introverted. There was a long road ahead in terms of convalescence and rehabilitation, and each surgery was a major setback.

Our client was told by their medical consultant that they would struggle to walk again, let alone be able to kick a football and should forget any thoughts of playing competitively at any level. It seemed, just as their career was starting to take off, their dreams of continuing to play at even higher standards had come to an abrupt end. The numerous surgeries and time spent in-between recuperating, all took their toll physically, psychologically and emotionally  – both on our client and their family – and also put our client at risk of failing their University degree, too.

However, through sheer perseverance, gutsy determination and willpower, our client pushed themselves to heroic levels and refused to give in. After sourcing specialist football-related rehabilitation, they rigorously followed an extensive programme of therapy and were gradually able to take small progressive steps to recovery. From wheelchair bound to mobilising with crutches; to walking with a stick and gradually building up strength to be able to jog slowly; to kicking a football casually; to having a kick around with friends socially; to joining a 7-a-side team in a local league (but engaging in only light tackling); to eventually building up sufficient strength and confidence to return to their former standards as a reputed ferocious tackler and aspiring to join a top club.

This is an amazing story of remarkable human courage, bravery, stoicism and determination, defying all the odds and their medical consultants!

Farley Dwek Solicitors were happy to provide legal expertise to support our client throughout their claim and help them achieve significant compensation for their injuries.

This week’s success story concerns a family who had been wrongly charged for their mother’s care home fees.

Farley Dwek Solicitors were instructed to pursue a retrospective claim for NHS Continuing Healthcare Funding on behalf of the late ‘Mrs X’ (for anonymity) after her application for NHS-funded care was rejected by her local NHS Clinical Commissioning Group (CCG). Her family were dissatisfied with the CCG’s decision and so approached us for assistance. Farley Dwek obtained copy of the patient’s care home and medical records and carried out our Records Review. We found that the CCG’s assessors had failed to consider all the relevant evidence and had manifestly underscored Mrs X’s needs in some of the care domains. We appealed the CCG’s decision to refuse CHC funding to her Local Resolution Panel. However, at appeal, the CCG again held that Mrs X did not meet the eligibility criteria and so refused to award her CHC funding. 

Our Team at Farley Dwek maintained that the CCG’s previous decisions were patently inaccurate and clinically unsound and that the Mrs X was eligible for full CHC funding during the period in question. Firm in our belief, we then appealed the matter to an Independent Review Panel (IRP) conducted by NHS England. Having lodged our detailed written Appeal Submissions in advance, we argued our case in front of the IRP.

The Panel agreed with us and found that the CCG’s decision to refuse CHC funding was ‘unsound’ and that Mrs X should have received CHC funding had she been correctly and robustly assessed at the outset by the CCG. In their outcome decision, the IRP recommended that Mrs X was entitled to retrospective reimbursement for wrongly charged care fees for the whole period under consideration. Mrs X’s family are expected to recover care fees in excess of £30,000.

We were so pleased to help this family achieve justice for their relative and secure CHC funding to which she was legally entitled.

Farley Dwek Solicitors represented two separate families both seeking retrospective reimbursement for wrongly paid care home fees for their respective relatives.

Both cases went to appeal at NHS England, who found that each of the NHS Clinical Commissioning Groups’ decision to refuse NHS Continuing Healthcare Funding was fundamentally wrong and unsound.

The outcome decisions meant that both claimants should be reimbursed their care home fees, in fulll, for the approved period of eligibility.

The CCGs asked both families for proof of payment to substantiate the care fees paid, so that they could make proper restitution repayment (plus added interest). However, as both cases had taken so many years passing through the NHS assessment and appeal’s process to come to a final decision, the claimants had died in the meantime. In an effort to clear out waste, the families had thrown away the necessary key evidence to prove what care fees had been paid (ie care home invoices, statements of account and bank statements), not realising their value further down the line now that their relatives’ claim were successful. Worse still, one care homes had closed and the other’s records couldn’t be located due to a take-over. The trail of proof had gone cold with no way of retrieving the evidence, so many years later.

The CCGs were understandably reluctant to make any payment without the necessary evidential proof of the care fees paid, and so further delays ensued whilst the CCGs considered their positions.

Both cases were looking like ‘pyrrhic’ victories – ie a win on eligibility, but no payment! However, we presented the CCGs with supporting case studies from the little known Parliamentary and Health Service Ombudsman’s Guidance – which states that reimbursement should still be made even where evidence is no longer available – both CCGs agreed to make restitution. Both client families will now receive reimbursement after many years battling with the CCGs for justice.

This week our Farley Dwek team saw another excellent result in the case of a retrospective claim for CHC funding, which took almost 6 years to resolve.

Having reviewed the patient’s care and medical records, we advised our client that her mother should not have been charged for care.  We lodged a request for retrospective review with the responsible CCG all the way back in 2015.

Despite frustrating delays and prevarication throughout, the CCG finally considered our client’s case in early-2020.  Faced with overwhelming evidence, the CCG agreed eligibility for CHC funding for the full period at the first stage of the assessment process.

A fantastic outcome for our client, which underlines the importance of perseverance, particularly where retrospective claims are concerned.

This week we saw another positive result for a family who had been wrongly charged for care.  Despite their relative presenting with extremely challenging behaviour, such that her safety and that of those around her was placed at serious risk, the CCG assessed her as having only a “HIGH” level of need in the Behaviour domain.

The family appealed the outcome of the assessment, before coming to Farley Dwek Solicitors for expert support with the Local Resolution process.

Farley Dwek Solicitors obtained copy of the patient’s care records and drafted a Written Submission, detailing every instance of challenging behaviour in the three months leading up to the CCG’s assessment.  At the LRM, we presented our evidence to the CCG and argued that its assessment of the Behaviour domain was patently inaccurate and clinically unsound.

Faced with the evidence we had collated, the CCG was forced to agree to increase the level of need in Behaviour to “SEVERE”.  Along with an agreed “SEVERE” level of need in Cognition, the patient was automatically found eligible for CHC and reimbursed almost £40,000 in wrongly paid care fees and interest.  This was for a three-month period, so we can only imagine the ongoing costs to the patient had her family not sought our expert assistance.

We were so pleased to help this family achieve justice for their relative and secure the funding to which she was legally entitled.

Farley Dwek Solicitors acted for the family of the late Mr ‘A’ (to protect his identity) in a retrospective claim for wrongly charged care fees. After early appeals to the local Clinical Commissioning Group were rejected, Farley Dwek then appealed the matter to an Independent Review Panel (IRP) at NHS England. The outcome was successful and IRP found that the CCG’s decision to reject Mr A’s claim for NHS Continuing Healthcare funding was “unsound” (ie fundamentally wrong!). The CCG have since agreed the IRP’s outcome decision to award Mr A. reimbursement for some 4.5 months of care fees worth around £15,000.

Farley Dwek represented the late Mr ‘P’,  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 P 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. The wrist splint gave him some degree of stability (but not to the same extent as before his fall) but without it, his dominant hand was virtually useless.

The accident affected Mr P. in all aspects of his daily activities and he became heavily reliant on care and assistance from his devoted son and two professional carers for even simple daily routine tasks such as getting out of bed, dressing/undressing, washing, hygiene and showering, toileting and getting up and around. He lost his independence and his confidence.

A claim was presented to the hospital who admitted liability. After negotiations, Mr P was awarded £40,000 compensation for this life-changing event.

Sadly, Mr P passed away recently, aged 95, and didn’t know his claim for negligence had been successful.

In February 2018, a Fast Track Tool was completed by a CHC Nurse Coordinator, which found Mrs X (to protect her identity) was eligible for Fast Track funding. This decision was reached following discussion with the GP and staff at the Nursing Home. The Nursing Home records indicated a rapid decline in her condition and identified ‘end of life’. The GP’s prognosis was less than 6 weeks, as Mrs X was suffering advanced dementia and was not taking diet and fluids.

For reasons which are unclear, rather than reviewing Mrs X after 3 months – which is usual following an award of Fast Track Funding – the CCG reviewed her healthcare needs within a shorter period of only 6 weeks (in March 2018), without involving the family in the review. A clear abuse of process. Mrs X’s niece received a telephone call from the CCG’s Assessor to advise that she was at the nursing home, had reviewed Mrs X and had assessed her aunt as no longer qualifying for CHC funding – despite poor prognostic indicators, no significant change in Mrs X’s condition or life expectancy, or indeed any justification for this further assessment!

After raising concern about the assessment, the Assessor subsequently confirmed that CHC funding would be reinstated and a further assessment would take place in two weeks’ time (still within the usual 3 month period under the National Framework).

In April 2018, Mrs X was formally assessed at a Multi-Disciplinary Team Meeting (MDT) and following consideration of the evidence, the CCG’s representative and the Local Authority representative disagreed on the appropriate level of need in the ’Behaviour’ domain of the Decision Support Tool, and moreover, her overall eligibility for CHC funding . The CCG’s representative concluded that Mrs X was no longer eligible for funding, but the Local Authority Social Worker disagreed, and felt that she was eligible and said so, both at the MDT and when the matter then came back before the CCG’s Panel for ratification of the MDT’s recommendation for funding.

However, CCG ultimately unilaterally decided that Mrs X was not eligible for CHC funding. When Farley Dwek called upon the CCG to provide frank disclosure, the documents gave insufficient reasoning why, or how, the ratification Panel had reached this outcome. There was a complete lack of transparency as to what was evidence had been considered, what the arguments were between the CCG’s two appointed representatives attending both the MDT and CCG’s ratification Panel, and what was the rationale for refusing Mrs X’s CHC funding.

Farley Dwek Solicitors were instructed to lodge to an appeal to the CCG’s Local Resolution Panel and were successful in recovering nearly £60,000 for Mrs X in wrongly paid care fees during the period her CHC funding was incorrectly withdrawn by the CCG.

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 thecriteria 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.

Our CHC Team had a tremendous success this week, in the case of a young man whose CHC funding had been unfairly withdrawn.

Not only had the CCG failed to identify any reduction in the level of his needs since the most recent DST, their documentation was littered with gross clinical inaccuracies which, we argued, rendered their review and reassessment invalid.

A further assessment was undertaken but, unbelievably, the errors and inaccuracies from the original review, which our client had taken great pains to draw to the CCG’s attention, were simply repeated verbatim!

Almost two years after the decision was made, the CCG finally agreed to organise a Local Review Panel to discuss the case and we provided a robust Written Submission for its consideration.  This evidence therein was, apparently, too great for even this CCG to dismiss.

Following a lengthy and often mind bogglingly frustrating battle, during which the CCG breached just about every provision of the National Framework, and the laws by which it is underpinned, the CCG finally saw sense and agreed the decision should be overturned, without putting the family through the stress of Local Resolution.

A fantastic result for our client, who can now look forward to his future rather than worrying about funding, and a fantastic result for our expert team.

Farley Dwek Solicitors acted on behalf the late Mr X in pursuing his retrospective claim for NHS Continuing Healthcare Funding against his local Clinical Commmissioning Group (CCG). We successfully argued that he was eligible for CHC Funding for a short period of care leading up to his death. Mr X recovered reimbursement of care home fees that were wrongly paid to the care home during this period.

However, that isn’t the end of the matter. The case raised an interesting point of principle…

Under the terms of the contract with the care home, Mr X’s family were charged ongoing fees for an extended period of care fees beyond his passing. Mr X’s family argued that this was unreasonable, but the care home stuck to their contractual rights and insisted on payment for the full extra period.

We turned to the CCG and sought reimbursement for this additional period from them instead, but they, too, refused to repay Mr X’s family. The CCG argued that they were only liable to reimburse actual care fees paid for the support provided up to the date of death, not beyond.

We disagreed and contended, that if the CCG had carried out a robust assessment of Mr X’s eligibility in the first place, they would have found that he was indeed eligible for CHC Funding at the outset. In that eventuality, the CCG would have entered into a standard contract with the care home and taken over responsibility for direct payment of Mr X’s fees. Upon death, all future payments for care fees would inevitably have come to an immediate end pursuant to that contractual arrangement (CCGs understandably don’t pay a day longer than necessary), and there would be no further liability to the care home for fees beyond the date of his passing.

However, the CCG refused to consider reimbursement of any additional fees beyond the date of death.

Farley Dwek lodged a complaint with the Parliamentary and Health Service Ombudsman (PHSO) who investigated the matter. They agreed with our position and found that had the CCG awarded CHC at the appropriate time, Mr X would not have needed to take out a private contract with the care home and therefore would not have been liable for these extra fees post-death.

The PHSO referred to the NHS Redress Guidance, whose core essence is to put the complainant back to the position they would have been in, but for the CCG’s maladministration. The CCG had failed in their duty to make proper restitution, and accordingly, have now agreed to reimburse this additional period following the PHSO’s intervention.

Mr X was admitted to hospital in December 2017 after suffering a stroke. He was transferred to a step-down facility in early February 2018, where he was then assessed by his Clinical Commissioning Group (CCG) within a matter of days afterwards, and found not eligible for NHS Continuing Healthcare funding.

Mr X’s daughter appealed the CCG decision and attended the Local Resolution Meeting, but the CCG still concluded that Mr X was noteligible.

Mr X’s daughter subsequently contacted Farley Dwek Solicitors to represent her in the appeal to NHS England (Independent Review Panel).

Farley Dwek prepared a comprehensive Written Submissions Document on behalf of our client to support the request for IRP, arguing amongst other things, that Mr X had been assessed too early in February 2018. The IRP accepted that Mr X had suffered a dramatic change to his life and circumstances, and it could be expected that he was still adjusting at the time of his assessment.

The IRP upheld the appeal and accepted that the CHC assessment may well have been undertaken too early in February 2018, and that at the time, Mr X was eligible for CHC funding.

The CCG subsequently accepted the IRP’s recommendation and agreed to reimburse care fees paid in excess of £25,000.

Our CHC team won a challenging battle after many years, successfully securing retrospective NHS Continuing Healthcare Funding (CHC) for the late Mrs X.

We argued that her local Clinical Commissioning Group had wrongly denied Mrs X CHC funding and forced her family to undertake a retrospective appeal to an Independent Review Panel (IRP) convened by NHS England.

Our request for an appeal to IRP was lodged at the end of June 2017.

However, because NHS England had found a number of issues with the way the CCG’s outsourced agents had completed their reviews, the CCGs were instructed to review their cases again before NHS England would arrange the IRP meeting.

Despite much chasing and delays by the CCG reviewing matters, an appeal date was eventually provided for October 2020. Our team filed detailed written submissions in support of the appeal.

However, just days prior to IRP taking place, the CCG conceded partial eligibility, accepting that Mrs X would have been eligible for NHS Continuing Healthcare funding for the initial 10 months period of care.

We remained dissatisfied with the CCG’s position, contending that Mrs X was eligible for the full retrospective period of care claimed ie another year’s worth of wrongly paid care fees beyond this initial period. Despite our invitation to save NHS England time and expense, the CCG refused to extend the eligibility period, and so the matter proceeded to the full IRP (which took place remotely due to COVID restrictions). Farley Dwek Solicitors represented Mrs X and were wholly successful in persuading the CCG to grant retrospective funding for this extended period as well.

Total restitution recovered for Mrs X’s family in excess of £60,000.

We were contacted by a family in turmoil after their relative’s CHC funding – which had been in place for almost fifteen years – was withdrawn. Their difficulties were compounded by the fact the nursing home was failing to keep a proper record of care, making it difficult to evidence the complexity and intensity of the needs. The patient’s needs had not changed in any substantial way, but improper record keeping by the nursing home had provided the CCG with a loophole, which they were fully prepared to exploit. Despite the CCG’s own Assessors having confirmed the inadequacy of the nursing home’s records, particularly in respect of significant challenging behaviours, on no less than THREE occasions, it refused to overturn the decision.

To add insult to injury, the CCG failed to inform the family of the withdrawal of funding, and failed to notify the Local Authority of the change in funding status, resulting in a substantial bill being accrued to the nursing home, without the family’s knowledge! That the CCG took almost two years to arrange a Local Resolution Panel appeal was the bitter cherry on the cake.

The family instructed Farley Dwek Solicitors to act on their behalf and we conducted our own independent assessment of the patient’s needs. Our Nurse Assessor was able to confirm, through discussion with the nursing home staff, that Care Plans were inaccurate and did not reflect the care interventions required. We obtained Mental Health and GP records, which confirmed the behaviours were long-standing and unchanged. A robust Written Submission was prepared for consideration by the CCG.

At the Local Review Panel appeal, the CCG accepted the inadequacy of its process and the inaccuracy of its assessment. The decision to withdraw funding was overturned and unreserved apologies were made to the family for the worry and hardship the CCG’s actions had caused.

Remember – CHC funding can ONLY be withdrawn if the 3-month or annual review identifies that the needs amounting to eligibility have been PERMANENTLY REDUCED OR ELIMINATED.

Our CHC team won a 5 year battle to secure Mrs X’s eligibility for NHS Continuing Healthcare Funding. The CCG denied funding and forced our client to appeal to NHS England, where she was successful and granted retrospective funding for 3 year period estimated to be worth around £220k redress for the claimant’s family.

Our litigation team successfully reclaimed losses for client who had given up work to look after her sick aunt as a result of the CCG failing to deliver her awarded NHS Continuing Healthcare funded care package for well over a year. Without providing such intense personal care for her aunt’s complex healthcare needs, she wouldn’t have been able to survive alone at home. Compensation for lost income, distress, interest and a contribution to legal costs were also recovered as part of the settlement sum.

Farley Dwek Solicitors were instructed on behalf of the late Mrs X to pursue a retrospective claim for NHS Continuing Healthcare Funding (CHC) against her local Clinical Commissioning Group for wrongly paid care home fees.

Initially, upon retrospective assessment, the CCG concluded that Mrs X was eligible for CHC Funding for the last 5 months in care before she passed away. However, the CCG rejected the claim for CHC for any prior period of care. Farley Dwek remained dissatisfied with this outcome arguing that the CCG’s decision was flawed.

Farley Dwek then pursued an appeal to an Independent Review Panel held by NHS England.

The IRP found that the CCG’s decision was unsound and Mrs X was eligible for CHC for the full prior period of care under appeal.

In total, the team at Farley Dwek Solicitors have helped Mrs X’s family recover over £45,000 in care fees.

A case of maladministration, botched assessments and shocking behaviour by the CCG, which left our client at her wits’ end when she approached us for assistance.

This patient had very complex physical and psychological needs and had already been awarded CHC funding for a two-year retrospective period. Unbelievably, the CCG had then completed a Checklist for the subsequent two years she was in nursing care, with the outcome that she did not qualify for full assessment!

We reviewed the care and medical records for the period and found there to be NO discernible difference in the patient’s presentation; in fact, her needs had actually increased during the time the CCG claimed she did not qualify for full assessment!

We drafted a detailed complaint to the CCG, setting out the inadequacies of the Checklist, supported by extensive clinical evidence.  The CCG’s Complaints Team ultimately agreed with our submission and instructed the CHC Team to undertake a full retrospective review of the outstanding period.

The CHC Team went on to complete a Needs Portrayal Document, using the records we provided to them, and a full Decision Support Tool. Our client was delighted when funding was finally awarded, some six years after her mother’s death. Even more satisfying than the reimbursement of wrongly paid fees to her mother’s Estate was to be vindicated after all those years of being treated like a nuisance who did not understand the criteria for CHC.

We could not be happier for our client and encourage anyone who encounters such abusive tactics from their CCG to contact us for our professional advice.  As this case shows, getting expert help really can make all the difference.

Farley Dwek Solicitors were instructed by ‘Jill’ (not her real name) in July 2018. Her Mother, Mrs X (for anonymity) had been assessed in October 2017 and found not eligible for CHC funding despite having multiple complex and challenging healthcare needs. The negative outcome had been appealed by Jill prior to her Mother’s death in April 2018, and she subsequently sought our support and advocacy representation in connection with the appeal.

We reviewed evidence and prepared a full Appeal Submission in readiness for the NHS Local Resolution appeal meeting. The CCG upheld the appeal and agreed that Mrs X was eligible for full CHC funding from October 2017 to the date of death in April 2018.

We had also noted that Mrs X had not previously been assessed for CHC funding from admission into the Care Home in February 2016 until October 2017. Following the successful appeal, we requested that the CCG now undertake a retrospective review of this unassessed period as well. The CCG’s review concluded that Mrs X was eligible for CHC funding for part of this period, too.

In total, Farley Dwek have successfully helped Jill recover 14 months of CHC funding for her late mother’s care.

This week’s success story concerns a patient who had been in receipt of CHC funding for some years, before this was unjustifiably withdrawn by the CCG.

We were contacted by the family after their local appeal to the CCG was unsuccessful.  We conducted our own Clinical Review Assessment  of the patient’s needs, and recommended immediate reassessment by the CCG, which was duly arranged.  The CCG found the patient not eligible for CHC funding, despite its own Nurse Assessor having assessed one ‘severe’ and five’ high’ levels of need!!  We appealed the CCG’s decision, making a robust written submission.  The appeal was upheld on the basis of our submissions, with the CCG finally accepting the patient’s current eligibility for CHC funding.

In addition, as a separate matter, the CCG’s initial decision to withdraw CHC was appealed to NHS England.  Upon receipt of the appeal, NHS England advised it could not consider the case, because the CCG had taken far too long to implement its decision to withdraw funding.  The CCG was instructed to undertake a retrospective review from the date funding actually ceased until the date of the next current assessment.

We await the outcome of the retrospective review but having conducted our own Records Review  of the evidence for this separate period, and given the recent confirmation of funding from the date of the current assessment, we feel confident this will be successful with a little more determination.

‘Joan’ (not her real name) was living in a care home and privately paying substantial monthly fees for her care.

Her family made an application NHS Continuing Healthcare funding (CHC) but it failed, and Joan was found ineligible for free funded care.  She was therefore forced to use up her savings to pay for her own ongoing care at the care home.

Her family approached Farley Dwek Solicitors to see if we could assist with Joan’s appeal to get NHS CHC funding for her care home fees.

After collating and analysing copious care home and medical records, we lodged Joan’s appeal with her local Clinical Commissioning Group (CCG).

Some months later the matter was dealt with on appeal by the CCG’s Local Resolution Meeting (LRM). Our nurse advocate in attendance found “many irregularities where due process and the NHS National Framework were not followed robustly.” 

The LRM then took an inordinate time to consider eligibility, and despite much frequent chasing, no outcome decision was in sight. Our nurse advocate reported, “I am concerned the family are still awaiting an outcome of the LRM as this is usually completed on the day not 6 weeks later and still waiting….This has been extremely distressing for the family and unacceptable to not have an outcome and I believe NHSE would agree there have been major breaks within the CHC, LRM process.”

Given the delays in finalising the LRM appeal process and notifying the family of the outcome decision on eligibility, Farley Dwek lodged a formal complaint with the CCG.

In the meantime, whilst waiting for the outcome of the appeal, Joan was running out of funds and her family contacted us to say they were now having to consider selling her house in order to pay for her ongoing care. The matter was becoming even more urgent!

The LRM’s draft Decision Support Tool was eventually received some months later and it recommended Joan was indeed eligible for CHC funding. However, the LRM’s recommendation still had to be approved by the CCG, who had the final decision as to funding. Once accepted, it would result in the CCG taking over payment of Joan’s ongoing care home fees and relieve her of this huge financial burden.

Another two months on, and there was still no confirmation that the CCG had approved the LRM’s recommendations for CHC funding – despite more chasing, much frustration and anxiety, and Joan still paying care expensive daily care fees!

This triggered yet another formal complaint which eventually prompted the CCG’s agreement to CHC funding and accepting responsibility to take over funding Joan’s care home fees. Joan’s family calculate that this successful outcome has saved her over £231,000 future care during her placement in the care home. In addition, the CCG also made a backdated, retrospective payment of almost £120,000 – reimbursing Joan’s care fees wrongly paid during assessed period of eligibility for CHC funding.

The CCG’s conduct and significant delays in processing this appeal for a living patient who was running out of hard-earned funds, was simply shocking – even though the CCG were repeatedly made aware of the urgency of the situation.

The family recognise that without Farley Dwek’s intervention and perseverance to bring this matter to a successful conclusion, Joan may have continued paying for her care quite needlessly, and probably would have ended up selling her home.

‘Fiona’ (not her real name) instructed us to undertake a review of her late mother’s case for NHS Continuing Healthcare Funding (CHC) and to see if she was eligible for a refund of care home fees that were wrongly paid whilst a resident in a care home. The period in question spanned several years before Fiona’s mother was awarded fast-track funding for end of life care in the weeks immediately prior to her passing.

Farley Dwek obtained and reviewed the care home and GP records. Our CHC team concluded that due to an increase in her mother’s health needs and challenging behaviours, there were good grounds for reclaiming backdated care home fees during this lengthy period when her mother should have been assessed as eligible for CHC funding.

A letter of claim was sent to the NHS Clinical Commissioning Group (CCG) requesting a retrospective review.

The CCG’s appointed nurse assessor eventually provided several draft, separate Decision Support Tools (DSTs) for each year in question under review, and invited our comments prior to the matter proceeding to an assessment by an NHS Multi-Disciplinary Team (MDT).

Having reviewed the CCG’s DSTs, and with Fiona’s input, Farley Dwek then provided our own detailed robust Written Submissions in response for consideration by the MDT.

The MDT panel outcome found that Fiona’s mother was indeed eligible for CHC funding for part of the period under review and her representatives are expected to receive a refund in expected to be in excess of £40,000.

This week’s success story is one of perseverance and, ultimately, negligence by a very well-known provider.

The family came to us after an application for CHC funding had been rejected by the Integrated Care Board ICB). The patient was in receipt of 24-hour 1:1 care, which the home had insisted was required due to the risks posed by his challenging behaviours. When the patient was found not eligible for CHC funding, the family was faced with a monthly bill of over £10,000. When they refused to pay, the home tried to evict the patient, but no alternative placement could be found, even with the assistance of a specialist agency. The family was stuck between a rock and a hard place.

We conducted an independent assessment for CHC funding and recommended the decision be appealed. Our review of the care home’s records revealed shocking omissions and a clear failing to evidence the need for 1:1 care, which is why the application for CHC funding had been turned down. Whenever this highly restrictive level of care is required, the care provider must demonstrate why it is needed – through 10-minute observation charts – and must demonstrate its attempts to find an alternative solution – through detailed behaviour monitoring charts or “ABCs” (Antecedent, Behaviour, Consequence). In this case, the home had not even bothered to document incidents of assault so serious the police had been called.

Despite these failings on the part of the care provider, we were able to pull together sufficient evidence from its inadequate records, the Mental Health Team and the family to demonstrate clearly the severity of the risks posed by the behaviour, and the need for 24-hour 1:1 care.  At Local Resolution appeal, the ICB overturned the decision of ineligibility and agreed to reimburse almost two years’ care fees, and to fund the placement going forward.

A genuine need for 24-hour 1:1 care should ALWAYS lead to a finding of eligibility for CHC funding on the grounds of nature and intensity, as it far exceeds the lawful remit of the Local Authority. However, in our experience, many families find themselves being asked to foot the extortionate bill for these fees, usually because the care provider has failed to demonstrate why this level of care is needed.

Is your relative being charged for 1:1 care unnecessarily? Contact us today for advice on 0161 272 5222 or 0800 011 4136 or get in touch via at farleydwek.com if you need help with your CHC case.

We were instructed by ‘Clare’ in relation to her father, ‘Geoff’s’ claim for NHS Continuing Healthcare Funding (CHC).

Geoff was assessed at a Multi-Disciplinary Team Meeting (using the standard DST) in April 2019 and found NOT eligible for CHC Funding.

The decision was appealed by Clare. She had also requested the NHS Clinical Commissioning Group (CCG) review earlier and later periods of care, including the period up to her Father’s death in August 2019. However, these requests were declined by the CCG on the basis that Geoff’s needs were the same as those identified in April 2019, for which the patient had already been found not eligible.

Clare bravely dealt with the appeal at Local Resolution stage herself, but the CCG upheld their original recommendation and found that her Father was not eligible for CHC Funding.

Clare subsequently lodged a request for review with NHS England. She instructed Farley Dwek at that stage to represent her at the Independent Review Panel (IRP) and to consider further periods of care which the CCG (now renamed ICB) had refused to review.

Our expert team reviewed the full case file and prepared a detailed Appeal Submission for presentation to the IRP. We also corresponded with the ICB to reach agreement as to review of additional periods of care.

We represented Clare at the IRP meeting in November 2022 and funding was awarded, backdated to January 2019 up to the date of Geoff’s death in August 2019, which is expected to result in restitution for wrongly paid care fees in the region of over £40,000 plus interest.

In addition, the ICB are now dealing with the retrospective review of the earlier period of care.

If you need help with your relative’s CHC MDT assessment, appeal or retrospective claim, contact our specialist team on 0161 272 5222 or email us at enquiries@farleydwek.com.

*The names have been altered for anonymity.