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The Uk's Healthcare Law Service
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CASE HISTORIES
...(see also Testominals)
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Case History
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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CASE HISTORY
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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Case History
Re: JL - Continuing Care Claim
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:
"Before being admitted to hospital in 2007, my father and his wife Joyce, had been independent. Living in their own home doing shopping etc. During the first quarter of 2007 Jack was in N Manchester Gen Hosp twice: he attended out-patients' clinic, was admitted, then never lived independently. He was admitted with cellulitis, varicose ulcers and circulation problems. He had always been a quiet man, but, like many others in this particular ward, underwent a peculiar character change: he became violent and abusive: my brother and I are convinced that he was given something that caused this.
Once in hospital he declined heath wise. For a second time my brother and I could not make sense of the situation: Jack had been catheterised, clearly had become incontinent, and was dependent on drips/tubes etc. We had a talk with a doctor who suggested that Jack did not have long to live due to heart and circulation problems. My brother and I next received another bombshell, when one of Jack's doctors told us that he now had severe, advanced dementia and that the only answer was for him to be discharged into a nursing home. The family was then repeatedly harassed by Social Services inquiring as to whether they had found a suitable home. In between full-time jobs my brother & I found a place at Flixton Manor Nursing Home. All of a sudden my brother received a phone call informing him that Dad was 'on the road' to the N Home. On arrival the staff were of the opinion that he did not have long to live. Manchester SS had deemed him self-funding as he owned a property, and! would defer payment until their house was sold. (We later settled their fees.)
After some time at Flixton Manor Dad improved and the staff's opinion was that he may well have suffered a stroke in hospital, which was missed. He continued to improve, but confusion, mobility problems and incontinence still remained. My wife and I took the decision in May 2008 to move him to live with us alongside his wife. We believe that the £27,000 bill imposed upon us by this course of events was either wholly or partly wrong."
The main instructing family member, RL, commented:
"We felt that father's main need for care was a health need and, therefore, that the NHS should pay for his care. The NHS initially refused and we instructed Robert Campbell & Company who specialise in continuing health care cases to pursue the matter on his behalf and we were delighted to hear in April 2010 that continuing care funding had been agreed retrospectively.
We are delighted with this result and would recommend Robert Campbell and Company to any other families in this complex situation."
Robert Campbell added: "This is obviously an extremely satisfying victory for the family and, indeed, for us and we were very pleased to have been of service to some very good clients."
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Case History
Re: Mrs DH - Continuing Care Claim
My mum, DH, was born in January 1925. She suffered a stroke in July 2007 and was diagnosed with vascular dementia. I took care of her for six months but found myself unable to care for her. She then moved into a care home. Mum's dementia became worse and the care home had her admitted to hospital. The council began doing an assessment saying that they would work out what she needed to live on and everything above that they would pay towards the care costs. Additionally, the family were going to have to pay £50 per week top up to the care home.
Mum's dementia became progressively worse since December 2008 to the point where she was admitted to a hospital after striking a carer at the care home due to extreme paranoia, believing that everyone was trying to poison her.
I did not think it was fair for mum to pay care fees and I therefore instructed specialist solicitors, Robert Campbell & Co, with a view to making an application for NHS continuing care funding for mum on the basis that her main need for care was a health need.
Robert Campbell took up the case for us and contacted the local Primary Care Trust. After gathering copies of all relevant records, he produced evidence for us and took the matter to the Appeals Panel at the local Primary Care Trust where Robert arranged for us to be professionally represented. After approximately nine months, the matter was heard by the Continuing Care Panel and I have to say we were dealt with very fairly and the panel members took on board our evidence and what we had to say. I believe this was the case because we were professionally represented and accompanied by an expert witness of very high calibre.
We recently received a notification of the outcome of the panel and, although the decision appears to have been close run, I am delighted to say that the PCT have awarded continuing NHS care funding for mum which I believe is the just and proper result.
We would like to thank Robert Campbell and his staff for all their support and would not hesitate to recommend them to anyone in a similar situation.
Susan Rubiano
January 2010
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Case History
Re: Claim for Restitution of Nursing Home Fees for Mrs IPH
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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Case History
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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HISTORY
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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HISTORY
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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HISTORY
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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HISTORY
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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Robert Campbell & Co., Greenhills, Winsham,
Braunton
EX33 2LX
Regulated by the Solicitors Regulation Authority. SRA No.
00327671 |
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