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Forum to assist all patients to obtain NHS care 'free at the point of need' which has been the statutory right of every resident British citizen since the 1946 National Health Service Act became law.


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WITHOLDING CARE FEES , A GOOD STRATEGY?

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ian

WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Sun 13 Nov 2011 - 0:26



Hello Everyone.

From recent posts on the general chat forum this is becoming a very prominent and controversial isssue.

This is not a academic question because the adverse side of witholding care payments has been highlighted in a number of cases recently on this forum. Nor is it a finger-pointing exercise on wrong advice in the general sense of the word. It isnt a easy question to answer because there are so many factors that must be taken into account. No two cases are the same and different circumstances can alter the answer.

But right at the outset let me make it very clear to withold payments is a very high risk strategy and it is one that I would imagine no solicitor would endorse. It is especially so if a contract to pay has been signed.

Generally in law if you are expected to pay for services, goods etc, and if you fail to do so or refuse to do so and unless you have a valid reason for doing so and one that can be substantiated, you run greatly the risk of being taken to court by the injured party with all that means.

It is no different in witholding care home fees and lets for the moment leave out the question if they are lawful or not.

Before I joined this forum and learnt from the many different people on here I would have said no doubt at all withold paying and let them dare go to court where the law will defeat them. But it isnt that simple.

I am very aware that Steve and many others did withold payments and did so successfully in the past.

I just wonder if something has changed. I have to pay heed to recent examples where people have been taken to court or threatened to be taken to court. I am at a great disadvatage in that I have no figures for cases successful in the past that used this strategy and how that relates to the present. Nor do I have figures for those who have been taken to court neither in their number or as to result one way or the other.

It is pretty clear however, that most cases are settled one way or the other out of court. I need figures so that I can see clearer if it is now very hard to succeed by refusing to pay care costs than it once was. I suspect that it has changed and very much so very the last few years. We are living in a economic climate that is very harsh and money is tighter everywhere. Local Authorities are not exempt from this situation and they are more keen than ever to make sure that all payments and debts are paid.

When faced with a situation like a care fee refusal it seems to me where in the past they might have been more reluctant to take someone to court; today they will. When advising someone we must now I feel be very aware of this position.

Simply put if you have signed a contract to pay for care with a care home you are legally obliged to do so and if you fail to do so then the injured party;ie, the care home will seek to ensure that you do so and that if you do not then they or the local authority will seek redress and this could mean through the courts.

Failure to do the above is a breach of contract on your part. Unless you had a issue with the standard of care at the home, which could constitute a breach of contract on their part and that if they did put this right then legally you could withold fees until they did so.

The contract would have to be legal and it can be made void or voidable by a number of things; which are duress,unfair influence and misrepresentation and something known as economic duress. But this would have to be substantiated and the length of time since it occurred would be relevant.
I know of cases where people where not told about the fact that they could claim CHC funding; just given a list of care homes and told to pick one. This is misrepresentation of a fact and would make the contract if proved voidable.

In these circumstances to withold payment would be I feel justified. But there are always risks.

Again it is possible to withold payments right from the start making very sure that you dont imply agreement with a move into care in some way or the other. Arguing that until the question of CHC fundingm is resolved you have the right to withold it and that it is the NHS duty still to fund and that it would be unlawful for LA/SS to do so until it was settled. Again its still a high risk move and it could go wrong. But it might be useful to make them speed up the process.

But isnt this not a complete picture? Havent I left something out? Something important? The LAW!

The motif at the top of our page and the reason for all our arguments. THE NATIONAL HEALTH SERVICES ACT 1946 and the right to free care at the point of delivery or need. Well yes thats right and we all know the line but hey wait a moment there hasnt really been a totally free NHS since 1951. Theres prescription charges, charges for glasses, dental charges, etc. All of which were brought in by government by the use of amendments and new acts.
In truth the governments ( and that means all of them ; perhaps with the exception of Wilson who at least took away prescription charges for a couple of years ) never kept to the NHS act of 1946.

I want to present three sections from the three health acts ( 1946,1977,2006 ) which I think give the government the legal right to circummnavigate the 1946 health and the core principles of the NHS that were made in the Beveridge report in 1942.

"" Health Service Act 1946
Section 1 ( 2 )
"" The services so provided shall be free of charge, except where any provision of this act expressely provides for the making and recover of charges. ""

NATIONAL HEALTH SERVICE ACT 1977
Section 1 ( 2 )

"" The service so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment whenever passed. ""

NATIONAL HEALTH SERVICE ACT 2006

Section 1 ( 3 )
"" The services so provided shall be free of charge in so far as the maing and recovery of charges is expressely provided for by or under any enactment whenever passed ""

The same section has been proposed for the new health bill.

What it has been saying is that yes the NHS is a free service except for these little clauses and note to how the words and depth of meaning changed with each new health act. These clauses in truth mean that the government could bring in anything by way of charges it wanted to and right here is the legal justification for it.

I want to thank Silly Sally who some time ago made reference to this section and I rather and foolishly tended to belittle its possible meaning. That was a very good point you made. Wish to thank Dr David Owen for the above sections layout

This is really worrying because if anyone tries to bring up a question of legality to withold paying care fees on the basis that the 1946 national health act said that all health care was free at the point of need and given that the National Health Act 2006 is the Active ACT in todays world. Then all they need do to counter that argument would be to use that section and that is the question of unlawfulness finished.

But there is still Coughlan and how vital this in my mind now is and bear in mind that it has to be referred to in THE National Framework for Continuing Health Care. Where there is a individual who has a primary health need equal to or greater than Pam Coughlan then it is the NHS who must pay for that care. Because Coughlan is still the law on this particular issue there could be justification from the beginning for witholding care fees and especially where the question of CHC funding has not been resolved. Coughlan is legally sounder than trying to argue the 1946 health act. Its history. On government legislation web-sites it has been omitted along with the 1951 health act. The 1977 NHS act is still there.

I cant even download the 1946 NHS act. I can download the United NATIONS Charter, The Magna Charta, almost everything else.

Right its all yours and lets have plenty of rational debate.

Just spoted one error in the para Failure to do so nt missing from didnt.

Kind regards Ian


woolwich819

Witholding Care Home fees.

Post by woolwich819 on Sun 13 Nov 2011 - 9:55

Excellent post. The only additiion that I would make would be that the 'Court' that currenlty appears to be causuing problems for me and some others is the Court of Protection; the loosely worded 'best interests' contrived by governemnt(s) has effectively put paid to this line of defence against fees and paying. I have to reluctantly concur with wiser heads that point out that picking throught the frameworks etc is the only way to attempt to recover fees. It'll be 'great' to see the 'usual suspects' clutching their hearts at the Cenotaph today, while those that gave so much are scrabbling around trying to get their money together to pay their fees - what a hypocritical hell-hole this country is. as the saying goes, "the more people I meet, the more I like animals"! Again, a good post that brings it all into focus,especially the legal semantics that will be applied by social services and the NHS.

sillysally

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by sillysally on Sun 13 Nov 2011 - 18:00

Excellent Ian. Thank you. Interestingly, I went looking in The National Framework Guidelines Appendix On the DoH site the other day for The Coughlan j'ment .... and found it was missing. Shocked

Guest
Guest

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Guest on Sun 13 Nov 2011 - 18:48

Thanks, Ian, for kicking alive the Debating Chamber.

I've got a few thoughts, from ancient history to EPAs/LPAs and then - as Woolwich819 mentioned - via 'best interests' and the Court of Protection.

Is it possible that we've forgotten about the existence of the CoP and also the MCA?

Is it possible that we've forgotten the origins of the National Framework 2007 and the revised version from 2009? Plus all those other guidance docs that came about.

Sillysally, where were you looking for the Coughlan judgment, in which version of the NF, and/or which particular guidelines? Can you post a link to whatever you found where Coughlan seems to be missing now? Not sure which Annex you're looking in, nor which version of the NF! If the Coughlan judment has vanished, it's serious. So please tell more.

VM pig






mergymraeg100

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by mergymraeg100 on Sun 13 Nov 2011 - 18:53

Excellent article Ian...thank you Very Happy VM pig looking forward very much to your few thoughts on ALL subjects mentioned.... bounce

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Sun 13 Nov 2011 - 20:33



Hello Sally,VM.


Just checked the 2009 version directly on line and Coughlan is in the annex and still in the text.

Kind Regards Ian

Guest
Guest

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Guest on Sun 13 Nov 2011 - 20:48

2006 NHS Act: (my highlighting below)
“The services so provided must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”
Note the word ‘must’.

The NHS Constitution arrived, and I slightly dismissed it recently, but I’ve since read it again and the 2010 version mentions the second principle that guides the National Health Service:
“Access to NHS services is based on clinical need, not an individual’s ability to pay. NHS services are free of charge, except in limited circumstances sanctioned by Parliament.”

The Health & Social Care Bill 2010 – 2011 is lurking:
“The services provided as part of the health service in England must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”

So the wording is slightly different each time, altho’ the basics are very similar and have been since 1946/8 and then since 1977 (when the 1946 NHS Act first stepped aside, and that side-step was followed later in 2006 when both the 1946 and the 1977 Acts were despatched to history = repealed by the 2006 Act) and then from 2006 to today.

The predominant Act at present is the 2006 Act.

But we shouldn’t look to the future yet – we must only look at the present and the relevant past. Otherwise we can't challenge all of those retrospective decisions made about care and about care funding.

What are the ‘enactments’ mentioned as being ‘possible’ in both the 1977 and the 2006 NHS Acts that have made charging for more-than-just-so-called-social care possible? (I’m only offering this up for debate and not saying they are anything other than thoughts.)

You can’t look for solutions for today and tomorrow unless you delve into a bit of history to understand how we got to where we are.

Back tomorrow - or even after tomorrow - with a bit of my understanding of history - but only as I understand it to be. There's no rush - history takes time to change what we know about our yesteryears.

All up for debate and discussion.

VM pig

starlightblue

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by starlightblue on Sun 13 Nov 2011 - 21:09

Here we go again.

My thread - To Pay Or Not To Pay During An NHS Funding Dispute - was pulled presumably because Steve did not want this discussion - he has never answered my question on why an entire thread with valuable advice was pulled so I can only assume it was because the advice conflicted with his own.


What's missing from your otherwise excellent post Ian are 2 VITAL things that as far as I am concerned are paramoint and which supercede everything, inlcuding finance.

1. If the person taking up the care home place has capacity, thus they would be paying the bill - WHAT ARE THEIR WISHES? They have the absolute right to make the decision after all the options are clearly explained.

2. If the care home is good, and that person is happy and settled, not paying jeopardises that placement. Good care homes are like hens teeth.

THERE IS NO LAW THAT SUPPORTS TAKING UP A CARE HOME PLACE AND NOT PAYING FOR IT - unless of course, the NHS are paying.

As we have heard, some people have successfully refused to pay, others have not. Many of those who have not have suffered greatly in terms of the sheer stress and worry and time they have had to put in - only for that debt to not only still be there, but to have interest on top as well.

It's a VERY individual decision as to whether or not to pay and people who refuse to pay are dealt with differently across the country.

NOT PAYING CAN HAVE VERY SERIOUS IMPLICATIONS - ON YOUR WEALTH, YOUR HEALTH AND THAT OF YOUR LOVED ONE. IT IS NOT A DECISION TO BE TAKEN LIGHTLY AND IN SAME WAY THAT YOU WOULD NOT REFUSE TO PAY YOUR MORTGAGE OR YOUR RENT - YOU SHOULD NOT BE REFUSING TO PAY FOR THE PLACEMENT OF YOUR LOVED ONE WITHOUT FULLY APPRECIATING THE RISKS.

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Sun 13 Nov 2011 - 22:00



Hello Starlightblue

I am in agreement with your comments about that the wishes of the individual must come first providing they have the capacity and that causing problems with the care home could create a difficult position.

There is no law that justifies non-payment and thats the reason why no solicitor would support this course of action. The information regarding contract law is valid but there has to be a valid reason and it must be substantiated.

Without the above being so there is no way that anyone should think about fighting a case over non-payment of care fees in a court.

From what Sally has brought to my attention and upon careful research the last defence to make in a court would be to involve the 1946 health act, or in fact any of the health acts as justification for non-payments on the claim that the health service act states that there is a right to 100 percent health care and treatment.

Read carefully those three pieces that I used in the debate and tell me that we really do have a right to free health without provisos? We need to keep to Coughlan, the MCA act ( good idea VM ) and their own framework, rather than witholding payments. You cant trust the 1946 health act or any other to protect you in this situation.

It sounds like this is what SBD tried too do on advice and paid the price.

I know that I did say at the beginning there may be a place for non-payment but I did say that it was a high risk strategy and I would advice anyone that was getting more and more likely to be taken to court in that situation, to withdraw from that position. NEVER, NEVER get into the position where you are taken to court and if you do end up in court dont make use of the health act. Use Coughlan and primary health care needs etc if you have to go down this particular road. Even maladministration involving the MDT/DST meeting. Anything but something that they will throw right back into your face.

Times change and they use clever tricks to change the goal-posts but we have to be able to change too and use our own tricks to counter them. The NF is their weakness and we have got to use it more and more.

Kind regards Ian

CJUK

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by CJUK on Sun 13 Nov 2011 - 23:00

woolwich819 wrote: the loosely worded 'best interests' contrived by governemnt(s) has effectively put paid to this line of defence against fees and paying.


Great post Ian

Ref W819
Are you aware that Government Guidance clearly states that "BEST Interests" includes the patient's own FINANCIAL Intersts.

Will this help your fight with the CoP?

It's a minefield out there. For example:

Documents obtained show that an Altzheimers patient was causing a disturbance at her home and taken to a Secure NHS Psychiatric Ward by an Approved Social Worker. The only authority for the ASW to do this is under the Mental Health Act(83) which was not used. (The patient was effectively kidnapped)

The NHS accepted the kidnapped patient and she was detained in a secure ward against the patient's recorded wishes, by an unregistered and unqualified trainee psychiatrist. (False imprisonment and criminal assault)

When the patient kept asking to go home she was given increasing doses of a deadly anti psychotic drug (chemical cosh)until she finally stopped asking to go home. (Criminal Assault)

She had recently been examined and declared in good physical help but was dead within the year of being given these drugs.

The Ombudsman (Ms A)refused to investigate and a judicial review was applied for because Ms A claimed that all the complaints were clinical and she could not investigate clinical complaints that occurred prior to 1996!

A copy of the external examiners report obtained under the FOI, stated MOST of the complaints were clinical (there were 17 complaints in total) BUT the word MOST had been changed to ALL in Ms A's submission to the High Court. The Judge accepted her statement that all the complaints were clinical and refused permission (with many thousands in costs awarded).

I'm still fighting.

Keep up the good fight everyone but take care

CJUK

Guest
Guest

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Guest on Sun 13 Nov 2011 - 23:41

speaking from experience of not PAYING, if i had my time again i would PAy. When my dad entered the nursing home, i did not sign any contract and never did,i even sent the invoices to the NHS to pay, but got totaly ignored!. then as time went by i received a letter form the Authorites informing me they were going for COP, because of the unpaid fees, it never got that far because my dad passed away, then the home demanded i tell them who the solicitors were acting for probate, i refused to tell them as i was not the excutor of the will, so it wasnt my place to do so. So another few months went by and then bang!! the letter from the homes solicitor telling us they were suing for unpaid fees, and also 1,000 a month interest being charged!. So this is my experience, because i kept dad in the home apparently that is looked at as a bound contract. I would have def paid if i knew this would have happened!, so if you are going to with hold fees, please think very carefully. Could i have done anyhting different i really dont know, appeal yes i should have because the fees would have been paid until resolved, i have learnt a very valuable lesson in all this. I hope this helps abit to get afew more views on this subject

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Sun 13 Nov 2011 - 23:46
















Hello CJUK

Glad you liked what i did in debate and I have several more issues that need to be dealt with.

I am very much aware of the official guidance view on the best interests of the patient,including that of finance. Its really about what are the best interests of the patient in relation to whats our best interests ( ie,LA/SS/NHS ).

Your story is terrible and they should be made to pay for what they did. I will come back to you on aspects on false abduction because I want to check something in relation to this.

There is so much in this that reminds me of the behaviour of a little known government department known as Fixated Threat Assessment Center. Sounds like something out of George Orwell 1984. Originally set up to deal with stalkers of well known public figures.

This has gone way beyond that so that anyone who comes to the notice of the authorities for being difficult, or a problem could end up being assessed and they could end up being detained just on the say so of two psychiatrists opinion. TO BE released only when they see fit.

I think it was the Labour government that set it up and cant you just sense images of the Reichstag and the cold winds of Siberia blow.

Take care my friend and kind regards Ian

Guest
Guest

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Guest on Mon 14 Nov 2011 - 0:03

ian wrote: Hello CJUK

Glad you liked what i did in debate and I have several more issues that need to be dealt with.

I am very much aware of the official guidance view on the best interests of the patient,including that of finance. Its really about what are the best interests of the patient in relation to whats our best interests ( ie,LA/SS/NHS ).

Your story is terrible and they should be made to pay for what they did. I will come back to you on aspects on false abduction because I want to check something in relation to this.

There is so much in this that reminds me of the behaviour of a little known government department known as Fixated Threat Assessment Center. Sounds like something out of George Orwell 1984. Originally set up to deal with stalkers of well known public figures.

This has gone way beyond that so that anyone who comes to the notice of the authorities for being difficult, or a problem could end up being assessed and they could end up being detained just on the say so of two psychiatrists opinion. TO BE released only when they see fit.

I think it was the Labour government that set it up and cant you just sense images of the Reichstag and the cold winds of Siberia blow.

Take care my friend and kind regards Ian


Ian, images of the Reichstag and the cold winds of Siberia are well known to some of us. (Trust me!!)

So, back to topic, can you post links to the official guidance view of best interests?

I may disagree with you here, but I'd rather know the ground on which you stand before doing so.

As for the FTAC of 2006 --- it's not exactly rocket science to work out the reasoning for that one. It lies in the word 'fixated'. That word still has relevance to this particular website too. Orwell would not have accepted it as a serious contender to 1984!

Ian, get back to the issues at hand - and stop deviating.

VM pig

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Mon 14 Nov 2011 - 0:13


Hello Trooper

Your case is a very clear example why witholding care payments in general isnt a good idea. Its a very high risk strategy at all times.

You say that because you kept your Dad at the home they class that as "" a bound contract "" I am not familiar with that term so will have to check on it.

If it is allowable in contract law in that form then it must be subject to conditions.
Even though no contract was signed their interpretation is based on that your actions implied agreement. However did you have any other course of action that you could have used. Was there a alternative? Did they give you the impression of an alternative.

If the answer is no then I think there is the possibility that this could indicate economic duress. In that you were not given any choice but to do what you did.

That could mean that the "" bound contract "" isnt lawful. Its void, or voidable.

If anyone asked me now after what I have learnt from recent people on this forum, "" should I withold payments "" I would say no. Go for straight appeal for CHC, use Coughlan and use the National Framework against them.

Am not sure that they would still have paid the fees while the appeal was going on. In theory they should do because your Father is still the NHSs patient until the question of CHC is resolved. But thats another grey area.

The amounts of interest might be worth looking at because off-hand they seem high,but I dont know what exact figures are.

Will check bound contract for you and will get back to you.

Kind regards Ian

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Mon 14 Nov 2011 - 0:44



Hello VM, CJUK

Sorry will get on with it.

The best link so far is www.NO5 COM/news/ publications/court of protection.

www.justice.gov.uk/guidance/protecting the.../....court/index.

Mental Capacity Act S1 (5) and something from THE COURT OF PROTECTION THEMSELVES: PARA:
7.70 CODE OF PRACTICE.

In the NO 5 Chambers article there is a long list of actions not in the best interest of the donor which amongst others include:

Not allowing healthcare or social care staff to visit the donar.
Taking out of hospital.
UNPAID BILLS;IE; RESIDENTIAL OR NURSING HOME FEES.
Spending money on things not obvious to the donors needs.

Have bookmarked this site so if these links dont work will post it in full myself.

Kind regards Ian

Guest
Guest

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Guest on Mon 14 Nov 2011 - 0:45

ian wrote:
Hello Trooper

Your case is a very clear example why witholding care payments in general isnt a good idea. Its a very high risk strategy at all times.

You say that because you kept your Dad at the home they class that as "" a bound contract "" I am not familiar with that term so will have to check on it.

If it is allowable in contract law in that form then it must be subject to conditions.
Even though no contract was signed their interpretation is based on that your actions implied agreement. However did you have any other course of action that you could have used. Was there a alternative? Did they give you the impression of an alternative.

If the answer is no then I think there is the possibility that this could indicate economic duress. In that you were not given any choice but to do what you did.

That could mean that the "" bound contract "" isnt lawful. Its void, or voidable.

If anyone asked me now after what I have learnt from recent people on this forum, "" should I withold payments "" I would say no. Go for straight appeal for CHC, use Coughlan and use the National Framework against them.

Am not sure that they would still have paid the fees while the appeal was going on. In theory they should do because your Father is still the NHSs patient until the question of CHC is resolved. But thats another grey area.

The amounts of interest might be worth looking at because off-hand they seem high,but I dont know what exact figures are.

Will check bound contract for you and will get back to you.

Kind regards Ian


Ian, Don't complicate things for Trooper.

Trooper means that she was 'bound' because she allowed her Dad to remain in the care home. That implies acceptance of an albeit unwritten and unsigned contract. If Trooper had EPA/LPA in place, she was responsible for either coughing up the ££s or not consenting to her Dad staying where he was. Unless and until that CHC dispute was challenged and appealed and ... so on. That's nothing to do with contract law.

For anyone to claim that they were 'under economic duress' they would need to give precise and exact examples of the way in which they were forced to enter into a contract, albeit unsigned, and the way by which pressure was exerted. That's bloody difficult to do if all that pressure may have been verbal, rather than written down on paper.

That's not one of the main considerations when you have a relative about to move into a care home. So forget all about 'economic duress' unless you've got a file-load of paperwork to support your claim.

As for this fallacy of believeing that you remain a patient of the NHS until the dispute about CHC is settled, Ian .... it ain't so. That is a complete misunderstanding of what was included in the Delayed Discharges Act(s). And if you want the precise reference ....... you'll have to wait another day.

Trooper, it's clear that you were given bad advice. Simple as that. Unless you challenge each and every stage of the process, you will get nowhere. That's where you've arrived at, Trooper, all because of the sadly incompetent advice that you were given. Ian hasn't followed your story over the years, Trooper, so allow the poor lad his deviation from the normal understanding of your situation.

I've no suggestions to offer you, Trooper, just enormous amounts of sympathy.


VM pig

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Mon 14 Nov 2011 - 1:00



Hello VM

Thank you for clearing up Troopers position for me. NO I dont know a lot of the past history but I will have a look back. Thanks for clearing up the bound contract bit.

Would like the delayed discharge reference please when you have time. Because this is another confusing area I would appreciate it very much.

Would agree with your comments about Trooper being given bad advice and the only way being to go via the NF.

Kind regards Ian

ian

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by ian on Mon 14 Nov 2011 - 1:05



Hello Trooper

I will look back and read about your experiences. I am so very sorry for what has happened if there is anything I can do just let me know. We might be able to retrieve something out of this situation.

Kind regards Ian

sillysally

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by sillysally on Mon 14 Nov 2011 - 10:32

Can I make a blindingly obvious point please regarding charging for care. It seems clear that the 1977 and 2006 Acts permit charging for certain services. A trawl back through legislation will reveal the specifics instances, and also the general areas in terms of primary and secondary legislation.

In matters of CHC, the NHS via the National Framework and by using the Decision Making Tool seek to demonstrate that the patients needs do not amount to a "a primary health need" and therefore become mere "social need" or "personal care" which legislation suggests can be the the duty of the Local Authority or the patient to fund subject to the provisions of S21 National Assistance Act, but which seems to be largely ignored by the Local Authorities. The "wholly and ancilliary" tests of this section are supposedly linked into the National Framework by the Nature, Intensity, Complexity and Predictability "tests", but as these also seem rarely understood by assessors, the passing from NHS to SS becomes ever easier.

The fact that primary health need and social need have no legal definition or force (ie they do not appear in documents which are either primary or secondary legislation) is the means by which this sting is performed.

IMHO, those areas, along with challenges to the way the NF has been used in each case and decision, and the impact of Coughlan (which says the NHS is liable where there is a "primary health need"- something much different to the basis on which the NF assesses CHC!) plus a few other areas also being raised in this thread are still valid routes to take.

sillysally

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by sillysally on Mon 14 Nov 2011 - 18:23

Arghhh!! The last para. should, of course read (...... NHS is liable where there is "primarily a health need" etc etc)

sillysally

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by sillysally on Tue 15 Nov 2011 - 12:50

ian wrote:

Hello Sally,VM.


Just checked the 2009 version directly on line and Coughlan is in the annex and still in the text.

Kind Regards Ian




Have looked again and correct, it is now there. However, the version I downloaded from the same site 18 days ago certainly is missing the Coughlan appendix. How very odd.

greenflamingo

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by greenflamingo on Tue 15 Nov 2011 - 19:54

Ian
Read your piece about people not being informed about the CHC process - us being one of them. I have started a new thread on the Chat forum. Hope you can contribute.

GF

greenflamingo

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by greenflamingo on Tue 15 Nov 2011 - 20:04

The fact that primary health need and social need have no legal definition or force (ie they do not appear in documents which are either primary or secondary legislation) is the means by which this sting is performed.

Totally agree with that SillySally. I have today requested under the FOI Act that our Adult Care Services provide a precise list of what constitutes "social needs" in a nursing home environment.

Personally I suspect it is help with washing/dressing, eating/drinking and perhaps some social activities - all the things that our PCT are trying to say were my father in laws needs. The stuff they desparately play down like Mobility, Drugs, Breathing, Skin therefore must be health needs. If social needs are helping someone to live independently who is immobile, incontinence, dying from lung and heart disease, and suffereing from disease related malnutrition I fail to see how someone can be classed as "mainly social needs".

But hey common sense and the L.Authority/NHS doesnt come into it Smile





Esquires
Moderator

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by Esquires on Wed 16 Nov 2011 - 9:52

Just a couple of observations:
1) The 'primary need' concept arose because in 'Coughlan' Lord Woolf observed "...here the needs of Miss. Coughlan were PRIMARILY health needs for which the NHS is as a matter of law responsible"
It was this statement which prompted me to produce with Pams help, a summary of her daily care regime now known as 'Pamsday' to demonstrate that my late father's care needs were also 'primarily health needs' because they were essentially identical to Pam's. The best answer the NHS could concoct: "every case is decided on it's own merits"!! They were completely baffled when I pointed that "things equal to the same thing are equal to one another!" - but you really need an 11+ to understand that!

2) Under contract law a debt does not exist simply because someone says it does and everyone has the right to be heard before a court of law if they dispute a claim. A valid defence for rejection would be to show that the putative debtor was not liable and (ideally)that responsibility for settlement rested with another party.
An alernative defence may well be provided via. the 'Unfair contract terms act' Steve.

starlightblue

Re: WITHOLDING CARE FEES , A GOOD STRATEGY?

Post by starlightblue on Wed 16 Nov 2011 - 16:28

Esquires wrote:Just a couple of observations:

2) Under contract law a debt does not exist simply because someone says it does and everyone has the right to be heard before a court of law if they dispute a claim. A valid defence for rejection would be to show that the putative debtor was not liable and (ideally)that responsibility for settlement rested with another party.
An alernative defence may well be provided via. the 'Unfair contract terms act' Steve.


All the time the debtor is availing themselves of the service being supplied to them, and continues to do so, they are, by implication, agreeing to the contract.

So they must either remove themselves from said services, and then maybe argue over what has already been supplied, or continue to use the service being supplied and therefore become liable to pay for it.

You cannot have it both ways.

I beleive The Unfair Contract Terms Act only applies to a contract that is in existence, therefore, if you are saying this may be a get out, you are acknowledging that a contract DOES exist - unfair or otherwise.
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