Thousands of families have to sell their homes and raid inheritances because the NHS has wrongly denied free care to seriously ill relatives.
Now he is forced to repay millions of pounds, often years after the patient’s death.
Simon Wilson recovered £250,000 in improperly paid care fees after lengthy legal battle. In 2012 he heard about NHS Continuing Healthcare, an underutilized package that covers the cost of caring for the seriously ill. By then, her mother had been in a nursing home for five years with chronic health problems.
His conditions included dementia, osteoporosis, choking, and frequent falls. But when Mr. Wilson, speaking under a pseudonym, asked that his mother be evaluated for funding, he was denied.
Wilson appealed against the decision, but it would be nearly another decade before an independent review panel heard the case. Late last year, nearly six years after his mother’s death, she was awarded the money.
NHS Continuing Healthcare can save families life-changing sums of money; the cost of nursing care averages £50,000 a year, according to LaingBuisson, a healthcare data provider.
If someone is in care due to medical necessity, the NHS is responsible for covering the cost, regardless of the person’s wealth.
But the likelihood of people successfully claiming NHS Continuing Healthcare has decreased. More than 50,000 people were assessed for standard NHS continuing care in 2021-22, but less than a quarter were deemed eligible, compared with a success rate of almost a third a decade ago.
Lisa Morgan of Hugh James Solicitors said it was becoming more common for people to be turned away as the NHS grappled with a tight budget. The law firm has sought the return of £200m in improperly paid nursing home fees.
Ms Morgan said: “It is so common for individuals and families to be forced to sell their houses and other assets to pay for care because the NHS continues to misassess cases.
“These people have paid their taxes and the NHS should be there for them in their hour of need.”
Ms Morgan recently secured NHS funding for a dementia patient who was paying £10,000 a month for care in a nursing home. “There is simply not enough awareness about ongoing NHS healthcare, and if people apply and are turned away, many assume the NHS must be right. That is not the case,” she added.
As Kathleen Pearson’s Alzheimer’s deteriorated, her son Paul and his wife, Jill, were told that she would have to self-finance the cost of living in a nursing home. Costs totaled £250,000 over seven years, and the family was forced to sell their house to pay the bill.
But the heartbreak could have been avoided.
Ms Pearson said her mother-in-law had not been adequately assessed during her first six years in care and neither the home nor the hospital had suggested that they could get help.
The Pearsons realized that Kathleen might qualify for Continuing Healthcare only in 2012, less than two years before her death.
Ms Pearson said: “The process for claiming funds is a long, slow battle and is designed to make you give up. It took years, and in that time you can’t fully process the pain and you are reliving the last and worst months of a loved one’s life.
“We managed to recover £30,000, but the nursing home records were incomplete with many gaps, preventing us from proving that Kathleen’s health problems had been serious for years. Our advice to anyone in a similar position is to keep your own detailed records.”
The chronically ill and their families you also have to deal with a zip code lottery. Funding is not determined by a central agency, but rather by integrated care boards, whose interpretations of eligibility can vary significantly.
Applicants in Oxfordshire have more than a 50% chance of success, compared with just 5% in West Berkshire, according to figures released by NHS England for July, August and September this year. Beacon’s Dan Harbor, who helps patients and their families appeal against NHS funding decisions, said his advice line received an average of 1,300 calls a month.
A spokesperson for the Department of Health and Social Care said: “Eligibility for continuing medical care is not determined by age, diagnosis or condition or financial means. It is assessed on a case-by-case basis taking into account all the needs of an individual. “.
“Where a full assessment has been carried out and an individual disagrees with the result, the national framework sets out options to address this. There is a robust appeals process in place to ensure the correct eligibility decision has been made.”
