Chronic Delays in NHS Continuing Healthcare Claims Continue


The Law Of... understanding delays in continuing healthcare funding

More than 4 years have passed since Sir David Nicholson announced that deadlines for assessments of eligibility for NHS Continuing Healthcare were being introduced.

Chronic Delays in NHS Continuing Healthcare Claims Continue

The announcement brought about a close down of 'episodes of care' that occurred between 1 April 2004 and 31 March 2012. This meant that those who had not received an assessment for NHS Continuing Healthcare during this time needed to lodge their claim with the Primary Care Trust before specific cut-off dates (30 September 2012 and 31 March 2013). As a result of this, Continuing Healthcare teams found themselves inundated with 60,000 applications.

A Long Winded Process

There are a number of stages to the assessment process and it has been a hard slog for claimants, most of whom have waited years for their cases to be assessed. NHS England has instructed the Clinical Commissioning Groups to deal with all outstanding retrospective Continuing Healthcare applications by March 2017.

Although it is plausible that the Clinical Commissioning Groups may have considered all outstanding retrospective cases at 'Local Review Panel' by this deadline, this is not reassuring for those who are dissatisfied with the outcome of their claim and wish to appeal.

The appeals process varies from one Clinical Commissioning Group to the next as each has its own local review process. Families can expect to be offered 'Local Disputes Resolution', which might involve a meeting with staff at the Clinical Commissioning Group to discuss their concerns.

Following this, the individual or their representative can petition NHS England for an Independent Review Panel to consider the case.

This could add many more months, or in some cases years to an already lengthy process and the delays are very frustrating for claimants through what is already a very difficult and emotional time.

The Parliamentary and Health Service Ombudsman has said:

"Because the announcement of the final deadlines for claims has led to such a large number of requests for assessments, we know that the NHS will take a while to process them. We would expect the NHS to prioritise current cases (where the claimant is alive and needs ongoing care) over past cases where there is no longer a need for financial help with care needs."

"However, we would also expect NHS organisations to keep claimants informed about progress. And, of course, if your claim is approved, the guidance on redress requires interest to be paid for all of the time since the period of care commenced."

'Current' assessments for Continuing Healthcare Funding

According to the National Framework, assessments should take place every 12 months, or sooner if your needs have changed.

If you have an ongoing application, we recommend that you keep yourself updated about its progress by getting in touch with the Clinical Commissioning Group on a regular basis. If you have experienced delays or have not been given accurate updates by the Continuing Healthcare Team, you have the option of making a formal complaint and hopefully preventing this from occurring in future.

It is also important to bear in mind that a delay in arranging your Continuing Healthcare assessment should not prevent the Clinical Commissioning Group from 'looking back'.

Where you are found to be eligible for NHS Continuing Healthcare funding, this should be backdated to the 29th day after the date on which the original referral was received (this usually refers to the NHS Checklist screening tool).

Solicitor and Care Home Claims Team Leader, James Urquhart comments:

"It is unfortunate that in many cases, the Clinical Commissioning Groups are unable to stick to this time frame or respond in a timely manner where someone needs a new assessment."

"This is a deeply concerning issue as there are a lot of retrospective cases that still need to be considered and many individuals who are alive and waiting for an assessment may find that they are kept waiting for an extended period of time."

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