Pensioner "not ill enough to qualify for funding" according to NHS Trust refunded care home fees
A pensioner suffering from Alzheimer's disease has been refunded £110,000 in care home fees after Dorset NHS Trust wrongly claimed she was not ill enough to qualify for funding.
Dorset Health decided that Phyllis Waterman, 80, should not get free care despite having advanced dementia and being in a wheelchair.
Her brother Peter Waterman, 72, only discovered she was paying for her nursing costs by chance last year and launched a legal battle to reclaim the fees. He was initially turned down but appealed against the decision. Dorset Primary Care Trust has now been ordered by the High Court to repay the money.
There could be as many as 100,000 frail and elderly people paying fees unnecessarily. With costs averaging £675 a week, many are forced to sell their homes to pay them. Whether someone should be paid for by the NHS depends on their health. The law states that if they primarily need healthcare (rather than support/supervision/attendance), all of their bills should be met by the NHS, in which case they don't need to fund their care themselves.
National guidelines on continuing care are subject to interpretation by primary care trusts (PCTs) and families have to be very determined against some PCT's to press their case if they are to be successful. The first step is for a medical team to assess their health. If this doesn't result in NHS funded care, the PCT can be asked for another assessment. If that fails then the next stage is to appeal to the Strategic Health Authority to review the situation (or the local health board in Wales). If they still don't agree, the case can be taken to the Health Service Ombudsman (or in Wales the Welsh Public Services Ombudsman). Finally, application can be made for judicial review within three months of the Ombudsman's decision.
There is no reason why families whose relatives have died can't make a retrospective claim for fees to be reimbursed.
Leading medical negligence lawyer Adrian Desmond comments "This is all to do with rationing of state health funding and those who are willing to fight the hardest are likely to be rewarded wth a successful outcome if the care that is required is of a health nature. It is depressing that so often these claims are assessed against older people who have spent a lifetime contributing to the NHS through their taxes and National Insurance."
Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems we recommend that professional advice be sought.
SEE ALSO
Our people
Our cases
Making a claim
