Irwin Mitchell’s Public Law & Human Rights team in Bristol successfully secured continuing healthcare funding from the NHS for a man with a severe brain injury.
Our client, Tim*, suffered a traumatic brain injury at work in 2008 and now requires 24 hour care and support. He experiences seizures and his cognitive impairments impact on his memory, behaviour and mobility. After an initial period of rehabilitation, Tim now lives in the community with his family and a team of specialist brain injury carers.
In May 2012, the NHS reviewed Tim’s needs using a Decision Support Tool (“DST”) and concluded that Tim no longer had a primary healthcare need and therefore didn’t meet the eligibility criteria for NHS continuing healthcare funding. As a result, his care needs would have to be met by his local authority and Tim would be charged for the care he received.
Polly Sweeney, Associate Solicitor in our Public Law & Human Rights team was instructed on Tim’s behalf to appeal the decision.
Polly undertook an extensive review of Tim’s medical and care records, and various professionals prepared reports. Polly and her team then carefully considered each part of Tim’s DST and identified areas where assessors had recorded Tim’s needs incorrectly.
We drafted written representations and submitted this evidence to the Health Assessment & Review team. An appeal panel meeting then took place in October 2013, where Polly argued on Tim’s behalf as to why funding should continue due to the extensive and complicated needs resulting from his severe brain injury, which are of a nature beyond what social services could be expected to provide.
The outcome of the appeal meeting was that Tim was found to be eligible for NHS continuing healthcare.
Commenting on the outcome of the appeal, Polly Sweeney said: “Although the appeals process took some time, we are pleased that the outcome was that Tim is eligible for continuing healthcare funding.
“In Tim’s case, the NHS had not properly considered the complexity, unpredictability and intensity of Tim’s needs, and wrongly based their decision on eligibility on the fact that a need is well managed or that the care provider is able to manage care – contrary to the government guidance on assessments.
“This is a common problem that we see in these appeals, and cases such as Tim’s emphasise the importance of seeking specialist advice when challenging continuing healthcare decisions to ensure that the regulations and guidance on eligibility are being properly applied.”
For expert advice on matters relating to healthcare law, please contact Polly Sweeney of Irwin Mitchell's Public Law & Human Rights team on 0370 1500 100 or complete our enquiry form.
*the client's name has been changed to respect his privacy.
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