Health Board fined thousands for excessive delays into wrongly paid nursing care fees, ombudsman finds.

8 Aug 2018 | Firm news


The Public Service Ombudsman for Wales has ordered Powys Teaching Health Board to pay thousands of pounds to approximately 330 claimants for excessive delays in the investigations into wrongly paid continuing healthcare (CHC) fees.

CHC is a package of care funded by the NHS for individuals with a primary health need, regardless of the individual’s ability to pay for their care. Retrospective reviews of health care fees have resulted in thousands of families across Wales being reimbursed for incorrectly paid fees – even after their loved ones have died.

The report from the Ombudsman found that hundreds of people who paid fees between 1 April 2003 and 31 July 2013 are still waiting for retrospective assessments to determine whether they are due a reimbursement as their loved one’s primary need was for health and not social care.

Mr. Stephen Nicholls, who filed a complaint against the fees he paid for his mother’s care and is still waiting for his repayment five years later, was one of three cases referred to the Ombudsman.

Following a period of ill health, Mrs. Megan Nicholls was admitted to a care home in Cardiff in 2003. She resided in care until January 2015, when she sadly passed away, aged 87 years old.

Mrs. Nicholls suffered from Parkinson’s disease and Lewy body dementia so was totally reliant on care staff to meet her needs. She was eventually deemed eligible for NHS continuing care in 2013, after ten years of paying full care costs.

Stephen Nicholls from Penylan said: “I’m so glad that the Ombudsman has recognised how this mismanagement has impacted our lives. I fully appreciate the difficulties the public sector bodies face, due to lack of resources, but a five year delay is unacceptable.

“While we welcome this report, we’re still left frustrated that we haven’t come to a resolution. It’s so disappointing that my mum died before a conclusion could be reached. In an ideal world, we wouldn’t have had this distress towards the end of her life.”

This report from Ombudsman Nick Bennett, looked at three similar cases, all referencing the delays by Powys Health Board and published his findings as they were of public interest. The Health Board agreed to apologise and accepted the payment of a nominal £125 fee, to the three claimants within one month of this report being published.

It was also agreed that the Health Board would also pay the same amount within three months to the remaining people whose claim had not been reviewed by 7 September 2017 and who have been waiting for more than two years. During the investigation, the Health Board said there were still some 330 claims to be reviewed.

Hugh James represented Mr. Nicholls along with another family in this report and has also submitted a series of complaints on behalf of thousands of Welsh families.

Lisa Morgan, partner and head of nursing care department at Hugh James, said: “It’s alarming that so many people have incorrectly paid up to hundreds of thousands of pounds for healthcare costs. This regularly results in relatives having to sell family homes and make sacrifices in order to ensure their loved one receives the care they need.

“Mr. Nicholls came to us to appeal an assessment, but there are many people out there who simply accept wrongful conclusions or who don’t realise they can make retrospective claims – even if their family member has died.

“We welcome this report and the recommendations outlined by the Ombudsman, but there is still work to be done to make sure the fees are reimbursed to families across Wales. The fact remains that the Health Board has failed to comply with the Welsh Government guidance and we’re very pleased this has been highlighted.”

The Health Board are continuing to complete the retrospective claims with the hope of getting final decisions to families in the coming months. For more information on similar cases please visit the Nursing Care page.

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