Social Care News

Audit Office warning over continuing healthcare claims backlog

A Wales Audit Office (WAO) report has warned that a backlog over Continuing Healthcare (CHC) claims is unlikely to be cleared by the June 2014 deadline set by ministers.

The claims have been made by families trying to claw back money paid for health and social care at home, or care home fees, which they believe should have been funded by NHS Wales.

According to the WAO report, only 13 per cent of retrospective claims had been processed by September 2012. The deadline for processing claims made before 2010 is now only one year away.

In August 2010, Welsh Government ministers introduced a new national framework to try to speed up the process as well as clarifying the rules under which people are eligible for continuing healthcare (CHC).

Slow processing of claims 'unfair' on families

The Wales Audit Office said in its report: "The claims are being processed by a national project or by individual Health Boards, depending upon the date of submission. The national project has made only limited progress and, despite additional funding, there remains a significant risk that a deadline of clearing all claims by June 2014 will not be met.

"No deadline has been set for the claims being dealt with by individual Health Boards, but there is no common process across Health Boards for dealing with these claims and, by September 2012, only 13 per cent of the 1,264 retrospective claims and disputes had been resolved."

It continued: "Failure to deal promptly with retrospective claims is unfair on the individuals concerned. Many of the retrospective claims that are still being dealt with by the national project relate to periods dating back many years and, given the timescales involved, more than four in every five cases are being pursued by family members on behalf of a relative who has died.

Find out more about CHC claims

• Read the WAO report
• Read the BBC's coverage of this story