Continuing NHS Care Application - Mrs VME

VME had been diagnosed with dementia, immobility and required help with washing, dressing, bathing, hair care, toileting (she was doubly incontinent) and required turning every two hours in the night. She can only drink with thickening additive and could not communicate and would sometimes become violent and had arthritis.

Her medication included Fluoxetine. It was believed that she was in the last stages of vascular dementia.

Nonetheless, in 2008 the NHS refused her continuing care funding and the matter went to appeal.

Robert Campbell & Company, who specialise in healthcare law and, particularly continuing healthcare cases, were instructed by the family. They took up the fight having taken over from a local firm of solicitors in 2008.

After a long and arduous battle we were pleased that Mrs VME was found to be eligible for certain periods of the time since she was discharged from hospital in 2004 but, thankfully, she was granted eligibility from August 2008 onwards but it should be noted legal and medical opinion expenses could not be reclaimed although the Nursing Home fees were returned. 

We are most grateful to Robert Campbell & Company for their specialist input in this matter without which we do not believe we would have succeeded in this quest.

D A Martin 
18 June 2010

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MR T D H

Mr TDH was born on 2 October 1929 in Thorne and, after National Service, went to University and studied Physical Education and English. He taught for approximately 40 years and was married to his wife at the age of 24. His medical history included operations for a hernia in the 1960s, cataract operations in around 2001 and he became epileptic from 1992.

TDH first began to demonstrate memory problems around 2005 and was referred to the local Mental Health Service for Older People in 2006.

TDH was diagnosed with Alzheimers disease and commenced taking Arocet, an anti-dementia drug.

DH improved in the short term but then became unsteady of gait and then suffered a considerable deterioration in his condition and was admitted to hospital in January 2007 under Section 2 of the Mental Health Act.

TDH was discharged in July 2007 to a nursing home where he remains.

It was clear to the family on discharge that TDH's primary need for care was a health need but the Health Authority disagreed. The family instructed Robert Campbell and Company to pursue the application on behalf of TDH for fully funded NHS care and, after a battle lasting some two years, the PCT acceded not only to Continuing Care funding for the future but also for the full period during which TDH had been in care.

Upon hearing the news TDH's son, Nick commented: "Many many thanks for this. We are over the moon. I am only sorry my mother didn't live to see this day. Thank you once again".

A claim for the restitution of care fees plus interest and other losses is now being pursued with the PCT in order to recover approximately £22,000.

20 October 2009

Update  June 2010

Full restitution has now been obtained in respect of all care fees lost, plus interest.

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Susan Rubiano 
January 2010

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My mother suffered from almost total paralysis following a PND condition brought on by a skin cancer. She could only partially move her right arm, had poor trunk control, was doubly incontinent, suffered from double vision and could only intermittently ring the call bell and could not feed herself. Although apparently mentally alert, she could not cope with decisions affecting her care. She also suffered from clinical depression.

Despite all of this, the continuing care panel of our local PCT rejected my mother's claim for continuing care funding whilst she was alive. 

We consulted Robert Campbell & Company who specialise in continuing NHS care claims and they took the matter up under their capped fee scheme. Within a very short period of time I received a telephone call from the head of the PCT Continuing Care Department to inform me that my mother has now been assessed as eligible for continuing care funding, but only with effect from May 2009. I am considering whether to appeal against this. 

I firmly believe that this change in circumstances, whilst partially due to deteriorating health, is most certainly due to involvement of Robert Campbell & Company in this case and my own perseverance. Therefore I would like to express my thanks for the work they have done. 

RH 
July 2009

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Re: Mrs "ET"

In this case, the family produced an extremely helpful and detailed synopsis from the outset enabling us to obtain a preliminary expert opinion from our consultant geriatrician and form a very strong view on the merits. The family's contributions were as follows:

Mum, who was still managing to live independently including doing her own shopping despite being 93 and suffering from AMD, was admitted to Ward 4 of The Local Hospital on 11 October 2007 following a left sided "stroke". This was initially diagnosed as a TIA but subsequently revised to Infarction ( after CT scan ). She regained movement in her left side quite quickly and was walking the length of the ward and back, with a frame and 1 helper ( Physio probably ). She was doubly incontinent and suffered cognitive impairment and loss of short term memory. 

On 24 October 2007 she was transferred to Ward 15 ( Rehab ) where her treatment left a lot to be desired. She was left in bed for the vast majority of the time and developed a "Friction blister" on her left heel which had a "protective dressing". After she had been discharged to her Nursing Home we soon discovered that this was a pressure sore with necrotic tissue around the size of a golf ball. There was no dressing on her heel when she left Ward 4. She also developed a very sore and red bottom in Ward 15 as a result of being left in her own faecal incontinence waste for long periods ( even when family asked staff to attend to her ). This was described as "overflow incontinence", she also had significant rectal bleeding associated with constipation. The combination of the heel wound and the sore bottom were cited by staff as the reason they were unable to continue the walking she had started in Ward 4.

During her stay in Ward 15 we were recommended by hospital staff to activate the Enduring Power of Attorney due to her impaired cognitive state, which we did. 

On 3 December 2007 she was discharged to her Nursing Home. The PCT conducted a CHC assessment shortly after her arrival at her Nursing Home which concluded that Mum did not qualify for CHC. However, when we reviewed her assessment with the PCT it became apparent that they were unaware of the pressure sore and they agreed to do a re-assessment which resulted in Mum getting CHC.

Mum had 2 emergency admissions to Hospital in December 2007 for major rectal bleeds both of which resulted in her needing to have 3 units of blood transfused. The cause was diagnosed, on her second admission, as Diverticular disease. 

The PCT assessor was subsequently involved in a car accident which resulted in the next re-assessment of Mum's condition being delayed until 23 April 2008. In their judgement the improvement of Mum's heel ( which was no longer necrotic and still slowly recovering ) meant she no longer met CHC criteria. After being notified of their decision the family lodged an appeal. 

Since leaving Ward 4 Mum has hardly ( if ever ) been on her feet again. Had she benefitted from continuation of the treatment and care started on Ward 4 we feel that she would have been able to return to her bungalow with an appropriate care package. Instead we have little doubt that she will never be able to walk again after 9 months ( and counting ) of muscle wastage. We cannot now see her being ever able to return to her bungalow. 

We took the matter on in August 2008 and spent several months gathering and evaluating records in order to prove that Mrs ET's primary need for care was a health need. Finally, in March 2009, the matter was heard by a review panel of the PCT whose remit was to review the process used in its decision making and the decision itself regarding eligibility made by the Trust and, having seen our evidence and heard oral submissions, the Trust found that Mrs ET was in fact eligible for fully funded NHS health care.

This was a long, hard battle but we were supported throughout by highly motivated and determined family members who believed that we would ultimately prevail. Mrs ET was admitted to a care home where she had to pay fees of £620 per week. She had assets at stake of over £300,000 and the victory has therefore been a very significant one for her and her family. We are delighted to have been of assistance. 


March 2009

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NHS CONTINUING CARE FUNDING
Case History

Re: Mrs H (Deceased)

Mrs H lived in West London. Aged 81, she was under the care of Central and North West London Mental Health Services although she was deemed able to be discharged from hospital to live in her flat.

Her son and attorney, Mark, lives in Paris but was determined to ensure his mum enjoyed the highest possible quality of life during her remaining years, which he strongly believed meant that she should be provided with a full domiciliary care package at home. Mark was adamant that his mother was not a suitable candidate for nursing home care as the one to one care she required was too intensive.

Accordingly, domiciliary care was arranged, and this was understandably expensive, running at upwards of £8,000 per month.

Westminster PCT assessed Mrs H on a number of occasions and came to the conclusion that her primary need for care was not a health need and, therefore, the Trust was not responsible for funding.

National Specialist Solicitors, Robert Campbell & Company argued the position on behalf of the applicant. In order to do this, all relevant records were obtained and an independent expert medical assessment which pointed out various inconsistencies in the Trust’s assessment and wholly supported the claim.

After argument, the Trust eventually agreed to grant eligibility but did so with effect from a date over a year after the family believed that Mrs H’s primary need for care arose upon her discharge from hospital to her flat. Robert Campbell & Co therefore continued to argue the matter on the basis that there should be full restitution of fees from the date of discharge on the basis that Mrs H’s primary care need arose then. The claim included not only the care fees expended but also interest and the legal costs involved.

In December 2008, Robert Campbell & Co successfully recovered just under £90,000 for the late Mrs H’s estate, Mrs H having sadly passed away some months earlier.

Son Mark said the family were delighted at the resounding victory achieved and particularly since this included the recovery of interest and the solicitor’s costs involved. When told solicitors costs are not usually recovered in these cases Mark said:

"To suggest that members of the public can effectively pursue their rights in these cases is patently absurd. Although I am more than capable of understanding procedure and conducting Internet research, the value Robert Campbell brought to bear on this case with his experience of these matters and knowing which ‘lever to press’ was incalculable and I am certain this result would not have been achieved without his input. Applying for continuing NHS care funding without specialist legal support puts the claimant at a massive disadvantage"

December 2008

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Re: Mr “TD”

Mr TD’s family contacted us in early 2008 when Mr TD was in hospital having to undergo a blood transfusion every three to four weeks.

He was bedridden since contracting cellulitis in October 2007. Since admission to hospital, he became incontinent and had a long term catheter in place and was also on a drip for hydration which, because of problems with veins in his hands, he then had to have through his stomach. Mr TD regularly needed oxygen as his stats were unstable and he battled pneumonia in November and again in December. Previously, he had a heart attack some 12 years previously and two strokes, the last of which left him with a form of epilepsy for which he took Epilim. Mr TD’s blood disorder was of the type that could turn to leukaemia and when his blood pressure dropped, he was very prone to infection. On top of this, he also contracted MRSA shortly after entering hospital.

In October 2007, Mr TD was assessed by the Local PCT as ineligible for NHS continuing care funding but eligible for 24-hour nursing care. The family did not agree and appealed the decision. Nursing staff kept insisting Mr TD was “stable” when it was clear to the family he was not and there was enormous pressure to have him discharged from hospital. The family were particularly concerned that Mr TD’s blood pressure could drop very suddenly causing an immediate need for transfusions which he would only be able to obtain in hospital.

The family resolved to fight the ineligibility decision “every step of the way”.

After persevering, in May 2008 the PCT decided Mr TD’s primary need for care was a health need and granted fully funded NHS care.

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Re: Application for Continuing NHS Care Funding – Mrs MK

Mrs MK was admitted to a care home in 2004, suffering with dementia and associated problems. Her health deteriorated and she became doubly incontinent and developed deep vein thrombosis and an ulcer which became infected with MRSA. She subsequently had several falls, injuring her eye and received a cut to her head.

Initially, the local PCT assessed Mrs MK as high band Registered Nursing Care Contribution but maintained that her primary need for care was not a health need and, therefore, she was not eligible for continuing NHS care funding.

The family were not prepared to let the matter rest and, armed with an Enduring Power of Attorney, Mrs MK’s daughter instructed Robert Campbell & Company to pursue an application for continuing NHS care funding.

In June 2008, the local PCT confirmed that, having conducted a multidisciplinary assessment under the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care guidance, Mrs King did at that point qualify for NHS Continuing Care funding on the basis that her primary need for care was a health need.

The issue that now arises is whether the family consider Mrs MK’s primary health need arose earlier than June 2008 as the care fees expended since admission to the care home in 2004 are approximately £120,000 and, if the primary need for care arose earlier, then an application for retrospective continuing care funding will be pursued. Any such claim would involve a claim for interest and a head of damage relating to the forced sale of Mrs MK’s house to pay for care fees.

July 2008

Note
Since dictating this it has been decided to pursue a retrospective claim for restitution of fees in the order of £120,000.

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Re: ‘MP’

Extract from excellent letter of initial instruction:

“Margaret’s primary need is obviously a health need. If she did not have dementia she would still be able to look after herself in her own home, doing her own cooking and cleaning and able to go shopping. She was perfectly independent and able to do all these things until the early months of last year (2007) and in fact she only stopped going to her hairdresser around April 2007.

Margaret failed a mini-memory state examination (score nil) at the end of March 2007. It was about this time that she started ‘seeing things’ such as imaginary visitors, people hiding in her kitchen and people sleeping on her couch but it did not seem to bother her overmuch.

The dementia seemed to progress very quickly. I took her to see her doctor in January 2007 because she had been incontinent at Christmas; she was bright and quite coherent but was developing memory problems. I arranged for carers to help her at the end of February, although she was opposed to the idea and carried on doing her own shopping, cleaning etc. She was until the middle of last year capable of independent living and in fact was happily living alone with carers visiting and using Meals on Wheels until her fall on 21 January this year.

There was no injury but she was admitted to hospital because she was dehydrated and also had a minor urinary tract infection. Shortly after being admitted she caught a hospital borne noro virus infection which seriously affected her with diarrhoea vomiting etc. She became (and remains) doubly incontinent, as her confusion increased rapidly. She also lost considerable weight. During the two months she was in hospital she lost 9.9 kg around 20% of her body weight (she continues to lose weight and is now down to 38.6 kg).

After the infection subsided she had various examinations and was seen by specialists including the hospital’s psychiatric nurse. She was rejected for rehabilitation or physiotherapy as she was unable to understand or follow instructions. Drips to rehydrate her were tried but abandoned as she pulled out the cannulae. She also pulled out indwelling urinary catheters. Prior to discharge she had a FACE assessment which describes her need for 24 hour care as critical.

While being considered for discharge the ‘NHS Continuing Healthcare Needs Checklist’ indicated that a full health needs assessment (DST) was required and this was duly carried out by the hospital multi-disciplinary team.

This has two ‘severe’ and five ‘high’ scores which according to the DST Guidelines requires ‘clear recommendation of eligibility to NHS Continuing Healthcare’ unless there are exceptional circumstances.

This assessment was fully discussed with my daughter and me before being signed off by the discharge co-ordinator. She pointed out that the recommendation was for fully funded care but it would need to be verified by the PCT.

Incidentally at the end of the DST is a statement that if there are delays the Panel may request up to date information. There is no mention of carrying out a further full assessment.

Around 10-11 March we heard that Margaret had been declined for fully funded care and received the material from the PCT on 25 March.”

After a battle, in June 2008 Margaret was awarded NHS Continuing Care funding.

Maurice Trimmer
June 2008

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I am attorney for my father who was admitted to a nursing home early in 2005.

At that time the local Primary Care Trust had conducted an assessment and concluded that my father did not qualify for continuing NHS care and instead assessed his registered nursing care contribution at the medium band.

Given my father’s condition I found this really quite extraordinary and in mid 2007 decided to obtain expert help in order to dispute this assessment. Having been recommended to specialist healthcare solicitors Robert Campbell of Robert Campbell and Company I passed over the papers and asked Robert to pursue the matter for us.

Robert initially wrote to the Trust demanding a fresh multi-disciplinary assessment be conducted and, after obtaining the medical records, obtained the report of an expert consultant geriatrician in support of the claim. He was clearly of the view that my father’s primary need for care was a health need, therefore, that he should be entitled to a fully funded NHS continuing care package. With Robert’s help we appealed this decision and were very pleased to hear, at the beginning of March, that continuing NHS health care was awarded from 1 October 2007 and we are now instructing Robert to pursue a claim for restitution for the period prior to this.

The family are most grateful to Robert Campbell for his help in this matter and there is no doubt in our minds that his knowledge, expertise and tenacity in this minefield of NHS law and practice enabled us to win the day. We have no hesitation in recommending Robert’s services to others in similar positions and hope that our success will give encouragement in what, to the uninitiated, is a quite daunting process. Whilst more that happy to provide this case history and testimonial, I wish to remain anonymous for personal reasons.

(Anon)
March 2008

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CASE HISTORY

Our mother went into a nursing home in February 2007 but, although she was very poorly and required a great deal of health care, the local Primary Care Trust refused to fund her placement. We were unhappy about this as we had read that, where someone needed care because of their health, this should be free on the NHS just as though they were in hospital.

We felt very strongly about this and decided to find a specialist lawyer who could represent mum. Fortunately we were introduced to Robert Campbell of Robert Campbell & Company, a firm of solicitors specialising in healthcare law and particularly Continuing Care claims.

Having conducted an initial assessment without charge Robert took over the case on his firm’s special fixed fee scheme and we were delighted when in August 2007 the Trust finally confirmed mum’s eligibility for a fully funded NHS Continuing Care package.

Sadly mum passed away but, although the Trust has refunded us £11,000 paid in care home fees, we have asked Robert to pursue a claim to recover the £6,500 paid out in home care fees prior to mum’s admission to the care home as we believe mum was eligible right from the day she required care.

We are most grateful for Robert’s help and support. Very few solicitors know of this area of law which is complex and requires specialist input. We would have no hesitation in recommending Robert Campbell & Company’ services to anyone else in a similar position to ourselves.

Anon, York
September 2007

See January 2009 up-date below.

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Mum (DECEASED) – AN UPDATE

Mum went into a nursing home in February 2007 and, although she was very poorly and required a great deal of healthcare, the local primary care trust refused to fund her placement. The family were unhappy about this as they had read that, where someone needed care because of their health, this should be free on the NHS as though they were in hospital.

The family felt very strongly about this and decided to find a specialist lawyer who could represent Mum. They were introduced to Robert Campbell of Robert Campbell & Company, a firm of solicitors specialising in healthcare law and particularly continuing care claims.

Having conducted an initial assessment without charge Robert took over the case on his firm’s special fixed fee scheme and we were delighted when, in August 2007, the Trust finally confirmed Mum’s eligibility for fully funded NHS continuing care.

Sadly Mum passed away and, although the Trust refunded some £11,000 paid in care home fees the family instructed Robert Campbell to pursue a claim for the £6,500 paid out in homecare fees prior to Mum's admission to the care home as they believed that her eligibility arose earlier than her admission to the care home.

In January 2009 the Trust wrote to Robert Campbell & Company confirming eligibility from April 2006 and Robert Campbell & Company are in the course of submitting a claim for restitution of fees for the ensuing period.

"Once again we are most grateful for Robert’s help and support. Very few solicitors know of this area of law which is complex and requires specialist input. We would have no hesitation in recommending Robert Campbell & Company’s services to anyone else in a similar position to ourselves."

Anon.
York

January 2009

See original case history

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