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8 May 2013 | Firm News | Article by Lisa Morgan

Welsh family welcomes Ombudsman’s report on nursing care fees

Cardiff and Vale University Health Board has apologised to the late Mrs Phyllis Williams’ family following a Public Services Ombudsman for Wales report which identified numerous failings and injustice in not funding the late Mrs Williams’ nursing care fees.

Phyllis Williams was a resident in a Cardiff Nursing Home from 2002 until she sadly died earlier this year. She suffered with vascular dementia and as a result was confused and disorientated. She suffered with diabetes and deep vein thrombosis. She was immobile, incontinent and not able to communicate her needs. She was totally reliant on the nursing home to meet all her needs, yet her family, helped by the specialist Nursing Care Team at Hugh James, had to prove she had ‘health needs’ which mean she is entitled to Continuing Healthcare and did not have to pay for her own long-term nursing care.

Continuing healthcare is where the NHS is responsible for, and fully funds, care – it mainly affects very ill patients, often elderly, in nursing homes; but can also apply if a person is in hospital long term or needs nursing care at home.

Lisa Morgan, partner at the Nursing Care team at Hugh James argues that this case is not common: “Under current policy, there should be a comprehensive assessment for people as soon as they are deemed as needing long-term care, which determines whether they are entitled to have their fees paid. That is not happening in many cases and families are losing out”.

Mrs Linda Simpson from Cardiff, daughter of the late Mrs Williams welcomes the Ombudsman’s report. She says ‘I’m pleased the health board has acknowledged their failures. The assessment process is complex and upsetting. I hope the health board will learn from their errors so that no-one is wrongly denied the NHS funding they’re entitled to’.

She goes on to say, ‘Our family should not have had to fight for the care my mother deserved and we hope this will stop others going through such a distressing time.’

This Ombudsman report, is the second such report against the Health Board. In 2008, the Ombudsman described the Health Board’s assessment of 75 year old Eileen Puc as ‘seriously flawed’.

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Ms Morgan, acted for the Puc family and said ‘It is disappointing that the Health Board has not learnt from their past failings and continue to wrongly deny very ill patients the NHS funding they are entitled to. The failings were so great in this case that the Ombudsman has asked the Board to reconsidering the late Mrs Williams’ case under the supervision of a suitably qualified and independent person, nominated by the Welsh Government’.

Mrs Williams was found eligible for NHS Continuing Healthcare in January 2012 following another assessment and the NHS met the ongoing care home fees. However, the Ombudsman has criticised this as eligibility is based on an individual’s needs and not an arbitrary administrative date. In light of the Ombudsman’s finding in this case he has recommended that the Health Board reviews all previous successful decisions to ensure in all cases the NHS funds the care from the point of the health need.

Key facts on NHS Continuing Healthcare

  • If you are eligible for NHS Continuing Healthcare, you do not make any contribution towards the long term care fees. The NHS pays the whole cost and it applies if a person is in hospital, care home or in their own home.
  • In Wales, if a person is not assessed as eligible for NHS Continuing Health care and has capital over £23,250, they have to pay for all the care fees.
  • When you fall below £23,250 you do not have to pay fees from your assets, but income from pensions and benefits must be paid towards the care fees.
  • Hugh James has recovered over £30 million in wrongly paid care home fees.
  • Hugh James currently represents over 6000 people claiming they have been wrongly charged nursing care fees in England and Wales.

Phyllis Williams – case study summary

Phyllis Williams from Cardiff who died in January 2013 (aged 91 years old)

In 2002, Mrs Williams entered Cartref Care Home in Llanishen as she was suffering with dementia and required long-term care. In 2005, she moved to Quarry Hall Nursing Home in St Mellons, Cardiff where she remained until she died in January this year.

Case History

  • In December 2009, Hugh James solicitors on behalf of Mrs Williams asked the Board to undertake a full continuing healthcare assessment on Mrs Williams. An assessment was finally undertaken in August 2010 which found her not eligible for NHS Continuing Healthcare. Believing this decision was flawed, Hugh James requested that the assessment be considered by the Board’s Independent Review Panel. In August 2011, the Independent Review Panel considered the assessment and upheld the decision that Mrs Williams was not eligible for NHS Continuing Healthcare despite noting a number of failings in the assessment process. However due to the time which had lapsed asked the Board to undertake another assessment of Mrs Williams’ needs.
  • Hugh James, on behalf of Mrs Williams, made a complaint to the Public Services Ombudsman for Wales as the decision made by Cardiff and Vale University Health Board was not compliant with Welsh Government criteria and was flawed.
  • Following another assessment, the Board agreed that Mrs Williams was eligible for full NHS funding in January 2012 and met her ongoing care costs until Mrs Williams sadly died in January 2013.
  • The Ombudsman upheld the complaint and confirmed that there had been numerous failings in the assessment process and stated that the delay in the assessment and the appeal process had caused injustice to Mrs Williams’ family.
  • The Board has apologised to the late Mrs Williams’ family and are undertaking a retrospective review of her health needs under the supervision of a suitably qualified and independent person, nominated by the Welsh Government.

The Hugh James Nursing Care team are the leading national experts in the recovery of wrongly paid care home fees. The team have recovered over £30 million to date and are acting on behalf of thousands of families across the UK. Find out more on our Nursing Care Fees Recovery pages, or contact us for more information.

Author bio

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 40 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

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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