Case Study: Ensuring Continued Funding for Care Following a Brain Injury

Summary

How a Community Care solicitor in Eastbourne, helped Lisa, a woman whose brother had acquired a brain injury from a teenage motorbike accident, fight for Continuing Healthcare for her brother.

The situation

Lisa came to see Caroline Philcox regarding her brother, Ben.  Ben was involved in a motor bike accident many years ago and he had always been looked after by their parents. After both parents died, 20 years after his accident, Ben moved to a specialist ABI (Acquired Brain Injury) care home that was in a different area of the country to his parental home.

The funding arrangements were shared between Ben’s home area Social Services and the NHS in the new area where Ben now lived.

Lisa first came to us because she had a letter from the home saying that there were care fee arrears of £20,000. Apparently, the NHS had stopped paying their share of the care home fees. This was the first Lisa had heard of it. She had been present at the NHS CHC review but her understanding was that funding would continue.  Now the family was faced with bills of over £20,000. Ben had no money to pay the care fees or the arrears; Lisa could not afford to pay this for her brother; and so reluctantly the care home served Notice. Ben was faced with the threat of having to move from a care home placement that he loved and where he was very well looked after.

What Martin Searle Solicitors did

Caroline saw from the correspondence that there had been notification that the NHS funding would change. We explained to Lisa that regardless of this, if the CCG (Clinical Commissioning Group) reduced their share of the funding then Social Services needed to make up the balance. The difficulty was of course that the family and Caroline were dealing with two public bodies, both of which simply passed the buck to the other. However, Caroline persuaded the Local Authority that the principle responsibility was theirs and that they should pay the fees in full and then negotiate themselves with the NHS CCG. Caroline explained that it wasn’t her client’s responsibility to be dealing with the alleged debt as the funding was a matter for Health & Social Services to resolve with the care home and not for Lisa.

The result

As a result of the correspondence and negotiations, Social Services agreed to settle the care home bill and to continue payments going forward. They agreed they would then have talks with the NHS and negotiate with them on the split of funding between Social Services and the National Health Service. The care home withdrew the Notice they had sent to Ben. Ben’s care home placement was saved for him and he and his family did not need to worry about how to find a new specialist placement.

If you need expert advice regarding Mental Capacity or Continuing Healthcare, our specialist Community Care Team can help. Contact us today on 01273 609911, or email info@ms-solicitors.co.uk.