We have recently reported on the issue of whether the withdrawal of the fully funded NHS care package (formally known as NHS Continuing Healthcare) by a Clinical Commissioning Group (CCG) can be challenged. The answer is yes. More information on the process for appealing a decision to remove eligibility can be found by clicking here.
Whilst the statistics, reported by NHS England, demonstrate the real difficulties in succeeding when it comes to challenging the withdrawal of NHS Continuing Healthcare funding; approaching the appeals process in a planned, forensic and structured way makes a big difference to the likely outcome of your challenge.
Withdrawal of NHS continuing healthcare case study
Recently, we assisted an Attorney to challenge the CCG’s decision to withdraw his mother’s NHS Continuing Healthcare funding.
The Attorney’s mother has an acquired brain injury following an aneurysm suffered in January 2011. CT scans completed at the time of the aneurysm demonstrated severe damage to her frontal lobe. An assessment by a Consultant Psychiatrist identified that, as a result of the lady’s progressive medical condition, it was highly unlikely that she would ever recover from the significant damage to her cognitive faculties, and as a consequence, it was unlikely her condition would ever improve.
After multiple eligibility assessments post injury and an appeal to NHS England, an Independent Review Panel (IRP) concluded in September 2013 that the multiple eligibility assessments completed by the CCG were flawed and agreed that the patient ought to have been found eligible for fully funded NHS care.
As a result of the IRP’s decision, the CCG took over the funding of the patient’s package and the Attorneys successfully recovered over £100,000 paid when the CCG should have funded her package from the outset.
Fast forward to July 2018. The CCG conducts an Annual Review without notifying the Attorney. The Annual Review fails to consider all the relevant evidence, nor take account of the patient’s extensive medical history. The Annual Review is wrongly used as the basis to commission a full re-assessment of need and the patient’s NHS Continuing Healthcare funding is wrongly withdrawn.
We completed a forensic analysis of all the available evidence from medical and care records, witness testimony from the family, and the reasoning used by the IRP to justify overturning the CCG’s previous decisions in 2013. All of this culminated in well-structured and detailed appeal submissions, along with an Analysis of Records which explained why the CCG’s decision to commission a re-assessment following the Annual Review and subsequently to withdraw NHS Continuing Healthcare was fundamentally flawed.
After meeting with the CCG at the Local Resolution Meeting (LRM), the LRM Chair agreed that our extensive analysis demonstrated there had been no change in the patient’s condition to justify the withdrawal of her funding. The CCG agreed to overturn its decision and took over providing the patient with a fully funded package of NHS Continuing Healthcare again.
The evidence was clear. The patient’s acquired brain injury had left her with a severe cognitive impairment, an inability to communicate her care needs, a requirement to be PEG fed, which when considered in their totality, was clearly complex and intense to manage.
The Attorney is set to recover over £30,000 in care fees incurred.
When asked to comment on the difference the Community Care team’s approach made on both occasions where Lester Aldridge assisted to challenge the CCG’s decisions, the Attorney explained:
“I would highly recommend LA’s services with respect to health care. The service I have received has been excellent with regards to this matter. I have been very impressed with the diligence of the work undertaken and the quality of the submissions raised. A highly diligent, thorough and consistent quality of service. Insightful and comprehensive analysis of extensive medical and care records and reports”.
If you would like to discuss how to improve the prospects of successfully challenging the withdrawal of NHS Continuing Healthcare funding, please contact the community care solicitors by telephone on 01202 786161 or by email at communitycare@la-law.com.
