A retrospective claim is needed when a person has died before the NHS continuing healthcare assessment was undertaken or completed, or where a direct request from a person or a family member is received to review their needs often in light of a change of circumstances.
The majority of claims will involve some element of retrospective review as payment is calculated from the date the decision of eligibility was made, yet the person’s needs may have been the same for a period of time before the decision was made. Retrospective claims need to spell out the period the alleged eligibility covers.
There have been various time periods and cut off dates for when a retrospective review could be considered.
No new cut off dates have been implemented – the last one was 31st March 2013 for periods of care from 1st April 2011 to 31st March 2012. Therefore no retrospective claims can be made for care periods ending on 31st March 2012. This does mean that care periods from 1st April 2012 and onwards can still be considered.
There was a complaint by Ruby Pearce against Torbay Primary Care Trust in January 2007 which highlighted the issue of patients or their families being forced to sell their homes to fund care costs after being turned down for NHS continuing healthcare funding. Ruby Pearce suffered from Alzheimer’s disease and was unable to do anything for herself except chew and swallow. She was awarded NHS funded registered nursing care by Torbay PCT but not full NHS continuing healthcare funding. Her son, Mike Pearce, has to sell the family home to pay for the cost of accommodating Ruby in a care home. Mike Pearce campaigned for 5 years to obtain funding for his mother insisting that her primary need was for nursing care rather than social care. Eventually the case was reviewed by the then Health Services Ombudsman which recommended that Torbay PCT should pay £50,000 to Mike Pearce in retrospective care fees.
If you need further information or assistance in applying for a retrospective review please contact me. I can undertake the whole review for a fixed rate plus a percentage of any recovery or I can provide letters and assistance in drafting an application for a fixed rate.
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