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NHS care fees reclaim process was a ‘shambles’

The process for claiming back from the NHS care fees that were wrongly charged was a “shambles”, a specialist consultancy has claimed.

31 October 2012

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Care to be Different, a consultancy service that provides practical advice and information about NHS continuing healthcare, says they were contacted by a “deluge” of families for help and advice in the run up to the 30 September 2012 deadline, with many claimants reporting various difficulties in getting an actual claim lodged in time with the NHS.

Common complaints included that it was often not possible to get through to NHS continuing care departments on the phone, calls were not returned, emails went unanswered, NHS switchboard staff seemed not to know who was handling the claims, contact phone numbers had sometimes been disconnected and key contacts were ‘on holiday’.

The application process was also criticised for being long-winded, with many NHS trusts asking claimants to complete lengthy application forms, but failing to explain adequately the information required.

“Many NHS trusts asked claimants to complete application forms half a dozen pages long, the content of which will be measured against specific eligibility criteria for funding,” said the report. “However, the families completing these forms were not told what those eligibility criteria were in the first place.

“It means many claims will probably be thrown out – without the NHS bothering looking at any further supporting evidence – simply because the family concerned was not informed of the purpose behind the questions on the form.

“Families also report that some NHS trusts have taken weeks to send out a form, making it even more difficult to complete and return it before the deadline, and some trusts refused to supply details of previous assessments to help families complete the application forms.”

Other difficulties reported to Care to be Different included:

  • some NHS trusts saying that if a person was receiving the small weekly nursing ‘contribution’ towards care fees, instead of full funding, the NHS won’t look at their claim, despite the fact that the claim may be perfectly valid;

  • other trusts saying they will only look at the notes taken at funding assessments previously carried out for a particular person, and not at wider evidence, despite the fact it is these funding assessments that may have been carried out incorrectly in the first place, hence the incorrect charges for care;

  • another trust putting the onus on families to obtain all the evidence for a claim (medical records, care notes, risk assessment charts), something the NHS is supposed to do, before the NHS will even consider looking at the claim;

  • other families being told by NHS personnel that different NHS departments don’t have any communication channels between them, and that the families themselves must contact all the different NHS departments to obtain all the necessary information to ‘allow’ the NHS to carry out its obligations in reviewing a claim.

Care to be Different have also received reports of trusts asking if the claimant will benefit personally financially if a refund of care fees is awarded, and using that as a reason to refuse a claim, which the consultancy describes as “one of the worst examples of procedural impropriety on the part of the NHS”.

“The whole thing is one big shambles,” said the Care to be Different report. “Thousands of families will have missed the deadline, because the NHS did not publicise it effectively and mainstream media coverage came far too late.”

Angela Sherman, director of Care to be Different, has claimed previously that the care fees reclaim deadline is “wholly illegal” and in breach of consumer law, the Theft Act, the Equality Act and disability legislation.

“Not only is the current assessment process for NHS continuing care funding flawed, but it now seems that the retrospective review process is also seriously flawed.

“It remains to be seen whether the whole process will be challenged in the courts,” said Sherman.

For the full report, and details of what to do if you missed the care fees reclaim deadline, see www.caretobedifferent.co.uk/2012/10/what-to-do-if-you-missed-the-care-fees-reclaim-deadline

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