Reclaiming Residential Care Fees

Many of our loved ones have been unlawfully required to pay for their residential care, usually out of hard earned savings or from their last remaining asset (their home) which they wanted to leave to others in their will.

The NHS, for whatever reason did not undertake the necessary assessments to ascertain whether or not patients were eligible for NHS Continuing Health Care Funding which would have meant the NHS would have paid for their care on the understanding that the care was because of a “primary healthcare need”.

When this clear neglect of duty was unravelled, the Government commenced a scheme for patients to have their cases retrospectively reviewed.   Patients who had not been assessed from 2004-2011 were therefore eligible to make a formal request for a retrospective review.

This is where Seatons came in, not only were we appalled that the NHS could ignore their own guidance and simply not assess patients, but that the knock on effect of this was that patients were having to pay out their hard earned cash to save the NHS.

We took on hundreds of cases on a no win no fee arrangement so that our Clients did not have to pay out any more money up front to get what they deserved in the first place.

And what a success – it has been hard work and it has taken our dedicated team some 3 years plus to get the NHS to retrospectively review cases and quite often to Appeal the decisions made by them.  However, cases are starting to conclude and where the evidence is available, are concluding in favour of our Client.

A great example is the case of Mr W.

Mr W came to us in 2012 having heard the furore about this latest NHS scandal and wanted to know if his late mother would have been eligible.

We took down brief details of Mrs W’s medical history and diagnosis and it was apparent to us that there was a case to be answered by the NHS as on first reading, even without the pages and pages of medical notes from the GP, Hospital and Care Home, we could see that she had a primary health care need.

The NHS reviewed the case and unsurprisingly rejected it out of hand at first instance.  It was then that the gloves came off and we fought hard.  Having perused every single page of her medical notes from 1st September 2004 to 6th February 2007 we were able to produce a lengthy Appeal document to send on to the NHS for their consideration.

The Appeal document went through each of the 12 domains that are considered by the NHS in their National Framework and cited all the relevant evidence from the medical notes to support a particular score.  Having considered all of the domains and made our written submissions on the nature, intensity, unpredictability and complexity of the health needs of the patient we were able to cite case law, legislation and guidance to push the NHS in the right direction.

After nearly 3 years of the NHS denying responsibility and dragging their heels, we were able to secure a complete reimbursement for the entire period under review, and with the extortionate rates being charged for residential care on a weekly basis this was no small sum – totalling some £47,938.  On top of this the NHS had to pay interest.

All in all it was a costly exercise for the NHS no doubt wasting thousands and thousands of pounds of tax payers money to retrospectively review the case in any event and thereafter robustly defend their decision which was patently wrong from the start.

Whilst Mr W could not be happier with the outcome, it is obvious the entire process had taken its toll on him.  Without us by his side he would have given up long ago and would have been denied the reimbursement that he was so entitled to and the NHS would not have had to pay the price for their failures many many years ago.