Care Review Bureau overturn Clinical Commissioning Group funding decision.

A family from Warwickshire have recently been successful in pursuing a retrospective claim for NHS Continuing Healthcare after an NHS Local Resolution Panel overturned a decision by the Warwickshire Clinical Commissioning Group (CCG) not to award Continuing Healthcare funding to a gravely ill patient.

Darren Loud, general manager of the Care Review Bureau said ‘it is often the case that the overstretched Clinical Commissioning Groups overlook details or score Continuing Healthcare assessments incorrectly which result in funding for Continuing Healthcare being withheld. In this case, we re-examined the facts around the Group’s decision and carefully formulated a detailed overview of our findings which in turn we presented to the appropriate authority’.

The Care Review Bureau were instructed to assist after the patient’s family contacted them in 2012 to discuss concerns over paying for her care. An initial investigation revealed that the patient had a severe and complex need for care, which was not identifed by the local authority. Together with the support of a specialist legal team, the case and supporting evidence were escalated via an appeal to the Local Resolution Panel due to the failure of the local CCG to follow the framework guidelines.

The Local Resolution Panel convened to review and discuss evidence provided by the Care Review Bureau and concluded that the CCG were incorrect in a late decision that the patient’s needs were low and non-complex. This conclusion lead to the ratification of a refund of £129,218.03.

Hannah Kane, Care Review Bureau claim handler for the case said ‘we are delighted with the successful outcome of this review. Our experience means that we are able to spot flaws in the Continuing Healthcare system and pursue the appeals process to its full conclusion. Our client’s family, in receiving a refund of monies, are simply getting the justice they deserve’.

Initial incompetencies within the NHS Continuing Healthcare system are further exacerbated by deliberate delays in the claims process. Many Care Review Bureau cases have been in process since 2010 and are still underway. ‘The Care Review Bureau’s legal team is very tenacious in the pursuance of these claims and we are all too aware of the tactics the NHS use to delay legitimate claims made against them’ said Grant Hardy, Managing Director of The Care Review Bureau ‘the claims process is long and drawn out.  The seemingly deliberate delays that some CCGs introduce into the process to avoid their responsibilities is upsetting for patients and their families but also has the knock-on effect of costing the tax-payer many thousands of pounds to meet the interest payments the CCGs face due to delayed settlement.  Our recent refund alone would have included unnecessary interest of over £17,000 and we believe this is just the tip of the iceberg’.

The Care Review Bureau has been advised by the NHS that NHS will have all retrospective cases for Continuing Healthcare resolved by May 2017 but as this date has been extended on several occasions it will continue to fight for justice on behalf of beleaguered customers and their families.

The Care Review Bureau www.claimforcare.co.uk 0800 009 6999

The Care Review Bureau specialise in assisting with the reclamation of wrongly paid care fees. The Care Review Bureau is the trading name of The Continuing Care Review Bureau.