Judicial Review application launched seeking major reform to Continuing Health Care system

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A potentially ground-breaking application for Judicial Review is underway to seek a significant overhaul of the UK’s Continuing Health Care (CHC) system.

The aim of the Judicial Review is to require the NHS to honour the payment of long-term health costs for eligible patients. If it proves successful, it’s estimated that this could cost the NHS £5 billion.

Rear Admiral Philip Mathias has launched a crowdfunding campaign to help finance his legal action which follows a much-anticipated report published by the Parliamentary and Health Service Ombudsman (PHSO) into failures of the present CHC structure and processes.

The purpose of CHC is to ensure that the NHS fully covers the long-term care and nursing costs of any patients with ongoing complex health needs, including degenerative diseases, provided their condition is the main reason they need help. This provision is not means-tested and decisions on eligibility should be based solely on medical evidence provided by healthcare professionals through a CHC assessment.

However, deep concerns have been raised by campaigners, including Rear Admiral Mathias, that there is postcode lottery attached to CHC between the various NHS clinical commissioning groups and that thousands of seemingly eligible patients are being denied financial support each year.

Among the issues surrounding CHC is the complexity and duration of the application process, as well as varying interpretations of eligibility among health professionals and a lack of transparency in how decisions are made. This is illustrated by a decline in the number of people considered eligible over recent years and is against a backdrop of the Government urging clinical commissioning groups to make significant savings in its CHC provision.

In some instances, the rejection of CHC referrals (36% in 2019) has led some people to sell their homes in order to fund treatment, and left others without access to essential care. Rear Admiral Mathias has already fought his own campaign to secure a £200,000 refund from the NHS after his elderly mother was charged for her health care. However, only a small minority of CHC decisions are reviewed by the Ombudsman and few are overturned.

Whilst the PHSO report is highly critical of the current delivery of CHC, it points to a slowly improving picture of the system. It also provides recommendations to make further progress and a pledge to monitor their implementation. In turn, the NHS has promised to respond to the recommendations and issues around eligibility.

This is a complex area and our specialist team can give advice and assistance on all stages of the process, from arranging for the appropriate assessment to be carried out and attending the CHC assessment as an advocate on your behalf, to challenging assessments which incorrectly refuse the funding. Our team often works closely with Independent Social Workers who can offer a unique social care perspective. Combined with our legal expertise, this gives clients the best possible service and chances of success.