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Public law and Regulation

Case reports and guidance on public law and professional regulation issues

09 OCT 2014

Dennison v Bradford Districts Clinical Commissioning Group [2014] EWHC 2552 (Admin); (2014) PLLR 081

Dennison v Bradford Districts Clinical Commissioning Group [2014] EWHC 2552 (Admin); (2014) PLLR 081
Queen’s Bench Division, Administrative Court, Davis J
23 July 2014

Summary

A CCG must reassess a person’s past eligibility for Continuing Health Care (CHC) funding where a Registered Nursing Care Contributions assessment preceded the CHC assessment and did not offer adequate rationale to judge CHC eligibility.

Detail

(1) The claimant brought a judicial review of the CCG’s refusal to review his mother’s eligibility for continuing health care (CHC) funding for certain periods prior to her death.

(2) From January 2006 until her death in October 2008, the claimant’s mother was a resident at a nursing home. From May 2007, she received some assistance from the CCG’s predecessor PCT to cover nursing costs, but otherwise funded accommodation and non-nursing care herself. Had the PCT assessed her as being eligible for CHC, the PCT would have funded her entire cost of residence.

(3) In September 2012, the claimant asked the CCG to review whether his mother was eligible for CHC prior to her death. The CCG agreed to do so for the period between January 2006 and May 2007 (when the claimant’s mother had not been assessed for CHC at all), but refused to do so between May 2007 and October 2008 (when the claimant’s mother had been assessed for nursing care). In October 2012, the NHS issued a document entitled NHS Continuing Healthcare Review Process, which permitted retrospective assessment of the claimant’s mother’s eligibility. The claimant seeks judicial review of this refusal.

(4) HELD: The court partially quashed the CCG’s decision.

(5) The October 2012 review process requires the PCT to determine whether the eligibility checklist had been completed appropriately and was clinically sound. The court then reviews the rationality and reasonableness of the determination.

(6) As a matter of policy, a further assessment of past periods of care is necessary where a Registered Nursing Care Contributions assessment preceded the CHC assessment. In this case, a review of the nursing assessment showed that it had not offered adequate rationale for decisions and had been filled out in a perfunctory manner. It was also clearly filled out prior to the CHC assessments. The documents established that the PCT declined to carry out a CHC assessment despite their policy mandating that they should have done so, leading the court to conclude that no reasonable PCT would have taken this approach.

(7) The court found that claimant’s mother was not adequately assessed for CHC until approximately ten months after she ought to have been (between May 2007 and March 2008), and the CCG must reassess her eligibility for this 10-month period, quashing its earlier refusal.

(8) A further assessment in March 2008 for nursing care excluded CHC eligibility before moving onto the nursing care assessment. This assessment constituted a proper determination of the claimant’s mother’s CHC eligibility. The court found there was no basis for judicial review of a refusal to reassess the claimant’s mother’s eligibility after March 2008.

(9) The court did not withhold relief due to the claimant’s failure to seek a remedy with the Parliamentary Health Services Ombudsman, finding that the case required consideration of the ambit of national guidance and was appropriate for court.

Claim partially succeeded.

Key Paragraphs

[6] – Reviews of NHS Continuing Healthcare assessments
[7] - Reviews of NHS Continuing Healthcare assessments
[12] – Adequacy of previous assessments
[13] – Reasonableness of decisions
[15] – Reasonable and rational action
[17] – Grounds for judicial review
[19] – Alternative remedy to the Parliamentary Health Services Ombudsman
[20] – Conclusion
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