Care Review Bureau overturn Clinical Commissioning Group funding decision.

A family from Ipswich have recently been successful in pursuing a retrospective claim for NHS Continuing Healthcare after an Independent Review Panel appointed by NHS England overturned a decision by the former Suffolk Primary Care Trust not to award Continuing Healthcare funding to a terminally ill patient. The culmination of a three-year dispute that saw the case reviewed a second time by the Suffolk Primary Care Trust, the matter was then escalated to the Strategic Health Authority and ultimately referred to NHS England.

Darren Loud, general manager of the Care Review Bureau said ‘it is often the case that the overstretched Primary Care Trusts overlook details or score Continuing Healthcare assessments incorrectly which result in funding for Continuing Healthcare being withheld. In this case, we re-examined the facts around the Primary Care Trust’s decision and highlighted these to the appropriate authority’.

The Care Review Bureau were instructed to assist after Mr Norwood’s family contacted them in 2011 to discuss concerns over paying for his care. An initial investigation revealed that Mr Norwood had a severe and complex need for care, which was denied by the local authority. Together with the support of a specialist legal team, the case and supporting evidence was escalated via an appeal to the Strategic Health Authority following the failure of the local Primary Care Trust to follow the framework guidelines.

The Independent Review Panel convened to review and discuss evidence provided by the Care Review Bureau and concluded that the Primary Care Trust (latterly Clinical Commissioning Group) were incorrect in a late decision that Mr Norwood’s needs were low and non-complex.

Joe Rush, Care Review Bureau claim handler for Mr Norwood’s case said ‘we are delighted with the successful outcome of this review. Our experience and knowledge means that we are able to spot flaws in the Continuing Healthcare system and pursue the appeals process to its full conclusion. Mr Norwood’s family, in receiving a refund of monies, are simply getting the justice they deserve’.

The Care Review Bureau offer free and impartial retrospective assessments and dependent on findings can offer professional representation on a no-win no-fee basis.

According to documents from supreme court, seen by Financial Adviser, the court rules that councils must not cut back on care provision to save money.