Compass CHC has helped a family recover more than £165,000 in care fees following a successful retrospective NHS Continuing Healthcare claim.
Compass CHC supported the family after the initial assessment resulted in an award of NHS-funded nursing care rather than full NHS Continuing Healthcare funding.
Mike approached Compass CHC for advice and representation on behalf of his mother, who was living with dementia and required 24-hour support for complex care needs. These included significant cognitive impairment, challenging behaviour, communication difficulties, nutritional decline and mobility-related risks. Her care fees were almost £5,000 per month.
Compass CHC advised the family to challenge the Decision Support Tool (DST) decision and pursue an appeal. After Mike’s mother sadly passed away, the case continued as a retrospective review.
With Compass CHC’s support, the family secured a successful NHS Continuing Healthcare funding decision and received reimbursement of more than £165,000 in care fees covering November 2019 to September 2022.
Louis Seymour, Legal Services Director at Compass CHC, said:
“This outcome demonstrates why it is so important to challenge an NHS Continuing Healthcare decision when it does not fully reflect an individual’s care needs. My advice to families is that it’s important to take advice on your options. An unsuccessful outcome at the Decision Support Tool stage, can be incredibly disappointing, but it’s not always the end of the road. Although retrospective claims can be complex and lengthy, the reimbursement provides important recognition that Mike’s mother should have received full funding for her care.”
Reflecting on the support his family received through the lengthy process, Mike praised the regular communication and persistence of the Compass CHC team. Mike said:
“Compass were extremely helpful and always offering updates, and chasing constantly. In the end an amazing result by Compass getting the ICB to realise they had made an error not awarding CHC.”
Learn more: How do I appeal an NHS Continuing Healthcare funding decision?
A retrospective review of NHS Continuing Healthcare eligibility may be requested for an unassessed period of care after 1 April 2012. An unassessed period of care is one that has not previously been considered by the relevant NHS Integrated Care Board.
Please note the Previously Unassessed Period of Care (PUPoC) process applies only to retrospective claims made to NHS Integrated Care Boards in England. Retrospective claims are handled differently in Wales, and our specialist advisors can provide guidance on claims for individuals who lived in Wales.
If you believe that you or a loved one may have been eligible for NHS Continuing Healthcare funding but did not receive an assessment, contact us for a free, no-obligation initial assessment. Our specialist advisers can explain the retrospective review process and help you decide whether to pursue a claim.
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