On 15 March the Department of Health announced that it is to close the continuing care retrospective review process. The letter from Sir David Nicholson confirms that the Department of Health intends to introduce a close down for any new cases requesting assessment of retrospective eligibility for NHS Continuing Healthcare.
On 15 March the Department of Health announced that it is to close the continuing care retrospective review process.
The letter from Sir David Nicholson confirms that the Department of Health intends to introduce a close down for any new cases requesting assessment of retrospective eligibility for NHS Continuing Healthcare (CHC). The letter sets out the three separate deadlines that will apply in respect of retrospective review claims as follows:
| Time Period
|1 April 2004 - 30 September 2007||30 September 2012|
|1 October 2007 - 31 March 2011||30 September 2012|
|1 April 2011 - 31 March 2012||31 March 2013|
It is important that PCTs communicate the closure of retrospective reviews in a clear and effective manner. Communications can include using the local press, notice boards in hospitals and through local advocacy groups. This is a really important process since the PCT (or in future CCGs) will need to be able to demonstrate that the PCT appropriately communicated the closure period in order to prevent claims being brought after the deadlines.
The communications from the Department of Health confirm that late applications will only be considered in "exceptional circumstances". What these circumstances are will be down to the individual PCT/CCGs and the Department of Health has not provided any guidance on what may be considered as exceptional.
The SHAs are finalising communications toolkits for PCTs to use to communicate the cut off arrangements to ensure a clear and consistent message across the country.
Currently PCTs have the responsibility for assessing eligibility for NHS CHC. However, from 1 April 2013 it is likely that this responsibility will transfer to the clinical commissioning groups.
On the same day the Department of Health published guidance confirming the introduction of time scales within which an individual can seek review of a decision regarding eligibility for NHS CHC.
It is very important that any decision letter being sent out sets out the timescales and method of seeking a review to ensure that this can be enforced.
The deadlines are inevitably going to result in an increase in
applications to PCTs. We have become aware of probate
solicitors undertaking reviews of closed cases to assess whether a
person may be eligible for NHS CHC and anticipate that the closure
process will accelerate the uptake of this practice. As such,
PCTs should have in place clear and effective mechanisms for
dealing with retrospective reviews.