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9 November 2023 | Case Study | Nursing care case studies | Article by Saran Estebanez

A Family’s Success Navigating Continuing Healthcare and Reclaiming Care Fees

Mrs Norma Whitton became a resident at a care home in June 2012 in Hampshire at the age of 67. She remained at the home until she sadly passed away in August 2016.

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Hugh James was instructed by the family in early 2013 and we approached the former Hampshire Primary Care Trust requesting they initiate a retrospective review of Mrs Whitton’s health needs.

Mrs Whitton was severely cognitively impaired on entering the care home and was diagnosed with Lewy Body Dementia. She was unable to communicate and experienced pain when being transferred.

Mrs Whitton had swallowing difficulties, was at risk of aspiration, choking and experienced significant weight loss. In addition, she was completely immobile and developed severe contractures. Mrs Whitton was also doubly incontinent and at risk of skin breakdown developing recurrent pressure sores throughout the period.

The claim became fragmented and progressed through varying stages of appeal, following negative decisions of eligibility.

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Following an appeal to West Hampshire Clinical Commissioning Group in late 2021 and finally a NHS Independent Review Panel with NHS England in late 2022, the NHS agreed Mrs Whitton met the eligibility criteria for the remaining period of claim.

In total, the NHS agreed Mrs Whitton had a primary health need for a period of almost three years. Due to the fragmented nature of the claim, reimbursement has been made in four separate payments and Mrs Whitton’s family have recovered over £167,500 in wrongly paid care fees and interest.

Mrs Kim Hubbard, daughter of Mrs Whitton said:

“Having a loved one who is chronically ill is in itself an emotional ordeal. To then have to navigate the minefield that is Continuing Healthcare, (CHC) together with the bureaucracy of the system causes unnecessary stress and will always detract from putting all your energies and focus on the only priority which in this case was my dear mum, Norma Whitton.

I cannot thank Hugh James enough for representing us as a family, and for their professionalism, support and guidance during the whole process. They approached the sensitive details with care and consideration and kept us updated throughout. Had it not been for their extensive knowledge and understanding of the CHC process and the system, I am in no doubt that the case would not have been brought to a positive conclusion.

We cannot thank Saran and her team enough for achieving justice and securing a positive outcome and establishing after many long years, that my Mum always had a Primary Health Need”.

For further information, visit our nursing care fees recovery page to find out if you or a family member are eligible to reclaim care home fees.

Author bio

Saran Estebanez

Senior Executive

Saran has been specialising in the niche area of continuing healthcare funding since 2007 and has acted for hundreds of clients in England and Wales in securing NHS funding, challenging current and retrospective decisions to refuse NHS funded continuing healthcare to long-term care home residents.

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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