Continuing Healthcare CHC 5 Live report 7 May

monkeyspanner

Continuing healthcare discussed with care minister Norman Lamb.
Listen here http://www.bbc.co.uk/programmes/b042lgwk
It is about 38 minutes into the programme until the news at 60 minutes in.
This programme will be available to listen to until 14th May 2014

As of 19th May this report was still availble online

Biggles

Thanks, monkeyspanner.

I remember you had been into NHSCC in depth - Any thoughts on this one?

My mother's care was part funded by her savings, part by immediate care needs annuity.

She died in 2009 after a severe stroke and the NHS Trust, very belatedly, decided that she had qualified for NHSCC for the last six weeks of her life. The care home refunded me (as executor) the fees we had paid out of her savings.

Recently, I became aware that the annuity policy provided that, if a patient became entitled to free care, the payments would be made to the patient instead of to the care home. I approached the insurance company but they had no idea of her NHSCC approval, so had received no refund from the care home. They contacted the Trust but were told only the patient/family could be paid, on production of receipts.

I wrote to the Trust and they said that, as the money wasn't actually paid directly by the patient/family the wouldn't refund any of it. They claimed this was based on an opinion from the Department of Health.

I assume that, if the approval had been received while she was alive, both we and the insurance company would have been told that no more payments were due, so it would seem that my mother's estate is being punished by the Trust's six-month delay in approving NHSCC.

I can only see legal action being the way forward, but it would appear that I have to chase the insurance company, who are actually as much a victim as the estate is.

monkeyspanner

Hi Biggles
I remember your posts. I have not come across this situation before, but have tried to think this through logically. However, I am not legally trained so this will just be my personal thoughts.

-The liability for care home fees was your Mum's liability not the anuity provider.
-Your Mum had presumeably purchased an annuity out of her savings.
-When the need for care arose the anuity was paid in order to cover the fee liability to your mum's benefit
- When CHC was awarded ALL fees should have been covered by the NHS.
-Therefore ALL fees should in my opinion be refunded by the NHS.
-The fact that some of the fees were paid by the anuity is irrelevant as your mum's capital was used to pay for that anuity and the proceeds of that anuity were your mum's income.

Did you take out the anuity when your Mum needed care and presumeably you had no expectation of the CHC award at that time? I can imagine you will be facing another battle to persuade the NHS to pay. Perhaps you could ask a firm like Hugh James who specialise in this area for an opinion and ask the NHS to detail that part of the legislation which allows them to withold the return of fees. Hope this helps.

Biggles

Thanks, Monkeyspanner, that's much as I thought.

I have found, since, that the Parliamentary and Health Service Ombudsman has, in somewhat similar cases, found that the CCG should put the family back in the position in which they would have been if there had been no delay in the award. It looks like that might be the way to go if my powers of persuasion fail.