Elderly Wigan relatives wrongly denied £3.5m of care funding

Families in Wigan have been paid more than £3.5m over the past eight years in redress claims after they were wrongfully denied NHS funding for their elderly relatives’ care costs.

Wednesday, 25th November 2020, 7:51 am
Updated Wednesday, 25th November 2020, 7:54 am
Wigan Life Centre, home to the borough CCG

They applied for NHS Continuing Healthcare funding, available to anyone who needs care home support due to long-term physical or mental health needs.

And, after appealing, the NHS refunded the care fees families’ were initially forced to pay.

Some 65 per cent of claims in Wigan were successful, way above a national average of 20p per cent.

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Wigan’s clinical commissioning group (CCG), the NHS body which assesses care funding eligibility in the borough, has paid out £3,581,490.20 since 2012.

This is more than any other borough in Greater Manchester – although Salford CCG did not provide data on the amount of redress paid as requested.

The figures come from a series of Freedom of Information requests submitted by Top 100 UK law firm Hugh James to CCGs across England and Wales.

The research also revealed that Manchester CCG refused 96 per cent of claims, paying out just £192,456.20 to families wrongfully denied NHS care funding.

Lisa Morgan, partner and head of the nursing care team at Hugh James said: “It’s good to see that other CCGs in Greater Manchester are beginning to face up to mistakes which have been made by reimbursing families for the denied care funding.

“However, we would like to see far more families being successful in the city – the number should be much higher than four per cent.

“The NHS needs to be aware of the lasting effects denying healthcare can have on not only the patient, but on their families as well.”

The law firm says the NHS care funding should be provided to all who need it.

However, around 40 per cent of Britain’s 440,000 care home residents self-fund their care, so many could be wrongly paying out for this care themselves.

If families have paid for care since 2012 and their relatives’ needs are primarily for health, they can ask the NHS to undertake a retrospective claim to establish if fees paid should be refunded – but the process can be lengthy and complex.

In Greater Manchester, nearly £9.6m was paid to families following appeals.

Wigan CCG paid out more in redress than anywhere else in the region.

A spokesperson said: “Wigan Borough CCG has a well-established Local Resolution process for NHS Continuing Healthcare (CHC).

“Where an individual, or their representative, disagrees with the outcome of a consideration of eligibility for NHS CHC funding the Local Resolution Process is implemented. The CCG believes the process is robust and transparent.”

Bolton CCG paid out the second highest total – £2.7m since 2012 – followed by Tameside and Glossop CCG which paid out £948,961.36 in redress.

Bury, Oldham and Stockport CCGs each paid around half a million in redress.

Trafford CCG has paid £313,590.19 in redress since 2012 and Heywood, Middleton and Rochdale CCG paid £201,711.39 in total following appeals.

Salford CCG did not provide data on the amount of redress paid, but told Hugh James that out of the 237 cases opened since 2012, 20 have been successful.

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