Rear Admiral Philip Mathias is motivated by his two-year battle with Wiltshire CCG to recover his mother’s nursing home fees, and says that the failure of regional Care Commissioning Groups (who control their NHS budget), to pay for patients' health costs under CHC is one of the 'biggest public scandals of modern times'.
The Alzheimer’s Society has long campaigned for dementia to be recognised by the NHS as a physical disease, the result of neurological changes to the brain, and that their residential care should be funded from the NHS’s Continuing Healthcare Budget (CHC). Continuing healthcare (CHC) and social care are paid from different budgets with CHC paid by the NHS, and social care is either means-tested and funded by local councils or privately funded.
If his case is successful it will be good news for thousands of families who had similar struggles but were unsuccessful. The Rear Admiral Philip Mathias says that the refusal of Care Commissioning Groups to meet their lawful requirements has caused ‘emotional distress and financial devastation to many thousands of old, ill and vulnerable people and their families.’
He adds, ‘The failure of Government Ministers and senior NHS leadership to take effective correction action is disgraceful and they must be held to account,' he said. ‘The total level of unlawful financial deprivation is staggering – possibly as high as £5 billion. ‘
According to Rear Admiral Mathias there is 'extensive evidence' that up to 10,000 people are unlawfully denied healthcare funding each year. 'The aim is to force the Government and NHS England to stop Clinical Commissioning Groups (CCGs) breaking the law and to make sure redress is provided to those who have been unlawfully denied CHC funding.'
Mr Mathias has launched a Crowd Justice Fundraiser to fund the first stage of the judicial review to defeat this 'scandal' where he describes a man who was deemed insufficient to quality for CHC funding: ‘'This man suffered from Parkinson's disease, ulcerative colitis, double incontinence, chronic kidney disease and he was unable to move or feed himself. His healthcare needs were deemed insufficient to qualify for CHC funding. The day after that decision was confirmed at an appeal, he died weighing 45kg.'
In 2017, to cut £383million from the CHC budget, the NHS had reviewed cases, sometimes without seeing the person concerned and had moved some into care homes charging lower fees or had reduced payments forcing relatives to top-up the fees. In 2018 The Commons Public Accounts Committee warned against cutting spending on CHC, saying that “too often” patients’ care is compromised because they are not made aware of the funding available or are not guided through the “hugely complicated” process of accessing funding.
If successful, the lawsuit could force the health service to pay back medical fees in the region of £5 billion. This would make it the biggest legal judgement since the mis-selling of payment protection insurance (PPI), which is the UK's biggest financial scandal to date.