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NHS Continuing Healthcare Refunds Process: why does it take so long?

May 15th, 2015 | CRB article

The Care Review Bureau poses the question in respect of the retrospective claims process for Continuing Healthcare.
NHS Continuing Healthcare is a process that many people are unaware of and the Care Review Bureau has highlighted this point on numerous occasions and battled to raise its profile. Having established that many families have been paying for care in situations where the NHS are lawfully liable, it’s an ongoing situation we have been dealing with for a number of years.
The Care Review Bureau is helping many hundreds of families make a claim for care fees that should never have been paid. Incredibly however, we are still fighting cases that came to us in the very beginning of the Care Review Bureau – five years ago!
So why is this? Well, there are a number of reasons as per the Care Review Bureau experience, a few of which are listed below:
• disarray within different NHS authorities due to lack of consistent guidelines for Continuing Healthcare (CHC). The introduction of the National Framework for CHC in 2007 to combat different working practices of the Primary Care Trusts (PCTs) had only minimal effect in streamlining processes with PCTs too chaotic to implement framework legislation
• different authorities working to different budgets and having different priorities for funds
• staff changes; staff shortages; lack of accountability by staff when dealing with retrospective claims
• the change in 2013 of all PCTs to Clinical Commissioning Groups (CCGs) resulting in disorder, confusion and often a void into which our enquiries would relentlessly fall.
A recent successful case finalised last week for the Care Review Bureau a full four years after the client made initial contact with us. The ensuing period saw the Care Review Bureau battle with incompetencies within the local PCT; 14 months for them to arrange an assessment using the Decision Support Tool and taking one whole year to make the refund after it was agreed, being two examples. Our legal team invited the assistance of the Strategic Health Authority until they even failed to uphold legislation which resulted in the case being escalated to NHS England in order to prompt action and resolution.
We are assured by the NHS that recent claim cases are being handled far more efficiently and can take as little as 18 months to process. However with whispers that CCGs will be reverting to PCTs again the Care Review Bureau will watch with interest!

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