Care Review Bureau - News

Healthcare repayment delays ‘not good enough’

July 22nd, 2015 | BBC News

Work to clear a backlog of claims for the NHS to fund costs for ongoing health problems is “not good enough”.

Darren Millar, chairman of the public accounts committee, said feedback suggests health boards have not put enough resources into resolving this.

NHS Continuing Healthcare allows people with complex ongoing illnesses to apply for an assessment and all care needs are paid for by the NHS.

The Welsh government said more staff are being hired to focus on the claims.

For those found to be eligible, all care needs – including nursing home costs of up to £40,000 a year – are met by the NHS.

It is not means-tested and the funds are potentially available to anyone over the age of 18.

Local health boards are responsible for ruling on claims and paying the bill and Mr Millar expects an update from the Welsh government next week on efforts to address the long-standing issue.

In the past, many people did not claim the payments because they did not know they could or because they were told they did not qualify for the funding.

Over the past decade, more than £50m in wrongly-paid care home fees and interest has been returned to Welsh families – often after a lengthy delay.

While a central team based in Powys has helped reduce the backlog of appeals, solicitor Lisa Morgan said significant delays remain for those cases that have been retained by local health boards.

She told BBC Radio Wales’ Eye on Wales: “They didn’t have dedicated teams to consider retrospective cases and it’s clear that it wasn’t a priority for the local health boards.

“Unfortunately, families have been waiting a significant time for their case to be considered.”

The public accounts committee has looked into continuing NHS healthcare twice in the past two years. Its latest report made nine recommendations, all accepted by the Welsh government.

Mr Millar said: “What we need to see is some determined action from health boards and the Welsh government to put the necessary resources in so we can clear the backlog.

“Because there are cases which, regrettably, go back a number of years and in some cases people have passed away in the interim. That’s not good enough.”

In 2014, the Welsh government took steps to reduce the number of appeals and retrospective claims, meaning the national framework for decision makers was revised and staff training bolstered.

The Welsh government said: “Health boards are appointing extra staff to focus on retrospective claims and we will be investing additional resources in training to help staff get it right first time and avoid or reduce the need for retrospective payments.”

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