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2 September 2022 | Case Study | Article by Lisa Morgan

Mrs M’s late mother was diagnosed with dementia and was a resident at a nursing home between 2004-2010

Our client, Mrs M instructed Hugh James to investigate a retrospective claim for wrongly paid care fees in June 2012. The claim was in respect of Mrs M’s late mother who had been a resident at a nursing home during 2004 to 2010.

The patient was diagnosed with dementia and was cognitively impaired as a result. She was also diagnosed with depression and at nutritional risk. In addition, she had painful arthritis, was immobile and experienced pain when being hoisted. Whilst pain medication was prescribed, this was not always effective. In addition, she developed pressures sores due to her immobility, low weight and double incontinence.

 

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We registered a claim on behalf of the estate with Coventry and Warwickshire CCG, formerly Warwickshire PCT, requesting a review of the patient’s health needs during November 2008 to September 2010. An assessment of the patient’s health needs was undertaken in November 2008. Therefore, the CCG would not revisit the period 2004 to November 2008 deeming this to be a previously assessed period of care.

Due to the influx of new claims made during 2012, there were protracted delays with the NHS progressing these cases, following a deadline announced by the Department of Health. As a result, an initial decision of eligibility was not received until October 2016.

The CCG’s decision was negative, and we submitted an appeal. Following the local resolution process, the CCG stood by their negative decision, and we contacted NHS England in March 2018. We submitted the CCG’s decision was unsound and requested an Independent Review Panel considered our appeal.

A panel took place in November 2020 and in April 2021, NHS England advised they agreed the CCG’s initial decision was partially unsound. They recommended continuing healthcare funding should have been in place during January 2009 to September 2010. The estate has since been reimbursed over £64,100 in care fees and interest.

Mrs M has stated:

“Hugh James were excellent dealing with my no win no fee claim for relatives health charges. Excellent service, professional, caring, compassionate diligent, and steadfast,. I couldn't have asked for better help. Thank you :)”

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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