Helping NHS with the retrospective claims burden

In March last year, Sir David Nicholson issued a final invitation to anyone who’d considered challenging the NHS’ decision not to fund their loved ones’ Continuing Health Care (CHC) costs. 

Care eligibility guidelines dating back to 2004 were inconsistently applied across the country, meaning that some families who found themselves stuck with the costs of a loved one’s care now have a case to claim that money back from the NHS. What Sir David was saying, essentially, was 'claim now or forever hold your piece'.

Following that last chance call, there have been 60,000 claims and counting. In hindsight, it could be argued that the decision was ill-timed and failed to appreciate the level of response or the size of the resulting administrative burden.

Significant Risk

If the thinking behind the decision was to draw a line under the on-going retrospective claims for the NHS, protecting emerging CCGs from contingent liability in the process, the line is still a long way off and the protection has not yet materialised. In fact, a micro-industry has sprung up around placing and chasing these claims; and for hard up families, the consequences of becoming eligible for a pay-out can be significant.

With CCG’s now publishing their risk logs, we find that a significant majority list retrospective claims as one of their top concerns. What was a significant molehill has grown to mountainous proportions.

Estimating the contingent liability of all retrospective claims should have been the responsibility of Primary Care Trusts, the outgoing organisations that were replaced by CCGs in March. The task wasn’t completed in time, meaning the job of assessing each claim has fallen to the newly formed CCGs. Exacerbating what would have already posed a significant problem, these newly created teams are operating without many experienced staff, following a whole raft of voluntary redundancies.

Medical teams in a legal environment

The claims are complex, touching on different bits of healthcare legislation, and the penalties for CCGs in mishandling them can be severe. Many teams appear overwhelmed by the gradient before them. In some cases we see data administrators dealing with solicitors every day, unaware of the impact of their precise words or with little understanding of the potentially pivotal nature of information they might divulge.

Many claims are handled by ‘no win, no fee’ firms, and have undoubtedly been rigorously assessed to determine their likelihood of success. Experts, probably recently redundant NHS professionals, have screened and decided where and how the case might be awarded, for how much. They’ve submitted the claim because they believe they’ll win.

Bray Leino BroadCare is already supporting a growing number of CCGs through this process, generating huge savings in cost and efficiency. With state of the art data management systems and access to teams of specialist staff, we’re delivering immediate savings, assessing and processing claims, while offering the flexibility to adjust our resources and services based on the specific needs of each CCG.

NHS West Kent, NHS Medway, NHS Swale, NHS Dartford, Gravesham and Swanley and NHS Berkshire have all recently benefitted from this support.

In the post Francis era, we’re helping the NHS to ensure it is not those who shout loudest that are heard, but those whose claim is most meaningful.

To find out more about the services Bray Leino BroadCare offers the NHS, visit: www.brayleinobroadcare.co.uk