Continuing Healthcare - Nursing Care

In the UK, you can recover nursing care fees through a current assessment or retrospective claim. Furthermore, eligibility for NHS continuing healthcare and NHS funded nursing care is based on an individual’s care needs and not on a specific diagnosis or disease.

Do you know that over £287 million in redress and £25 million in interest has been awarded to families who were wrongly denied care funding by the NHS?

Any individual admitted to a nursing or care home (or even residing in their own home) due to their physical and/or mental needs should have the care costs covered by NHS nursing home funding, irrespective of that individual’s current wealth or bank account balance.

Unfortunately, with approximately 40% of Britain’s 440,000 care home residents funding care themselves, thousands of families across both England and Wales have been wrongly paying care fees out of their own pockets.

If you or a loved one from your family or social circle has been paying home care fees themselves, they may be eligible for a fee recovery.

What is Nursing Care Fee Recovery?

Nursing care fee recovery for continuing healthcare and nursing care is the process of recovering money which has been wrongly ‘self-paid’ as care or nursing home fees. This fee recovery can be initiated through a solicitor if you believe that you have been paying for care yourself all this time, whereas it should have been through the NHS CHC .

Once you meet the eligibility criteria, your solicitor will work on your case, and when successful, get you the due amount reimbursed to you.

Understanding Continuing Healthcare and Its Benefits

NHS fully fundedcare, also commonly referred to as Continuing Healthcare (CHC), is a fully NHS-funded care package for people in England and Wales who have been identified to have significant ongoing healthcare needs:

It is available to individuals who are 18 years or older
It is for individuals who have been identified to have a ‘primary health need’
CHC covers the complete cost of care, including residential accommodation
It is not a means-tested method of providing funding
It is provided outside of hospitals, so that means in a nursing care home or the individual’s own place of residence

It’s important to understand how continuing healthcare through NHS funding for nursing could change the life of your loved one, not to mention the financial relief they receive. Here are some benefits to consider:

The affected individual receives the funding they need for day-to-day care as a PHB (personal health budget) which is given in the form of a direct payment. This is often managed by the individual’s family member or relative.
If the individual is being provided care in a nursing or care home, then the NHS will pay the care home provider directly. However, in both cases, neither the provider nor the family member can legally ‘top up’ the NHS funding.
There is no charge from the NHS whatsoever – all costs are taken care of by them.

Eligibility for Nursing Care Fee Recovery

Eligibility for NHS continuing nursing care which can often lead to nursing care fee recovery is based on the affected individual’s primary care needs. As mentioned earlier, these are healthcare-focused rather than disease or diagnosis-focused.

The eligibility assessment for NHS continuing healthcare and NHS funded nursing care involves two things:

A checklist – This is a screening tool to determine if the individual’s needs will require a DST.
DST – A Decision Support Tool is an assessment tool which examines 12 care domains, including behaviour, nutrition, cognitive abilities, and mobility.

Just to quickly reiterate as it is an important point of consideration: eligibility is not in any way determined by the person’s ongoing disease or diagnosis, as people with the very same health condition, diagnosis, or disease may have different care needs.

If you or a loved one has been previously funding themselves with no financial assistance at all, then you should speak to a solicitor to determine if you are eligible for nursing care fee recovery and that you get the full amount reimbursed to you without delay.

How to Apply for Continuing Healthcare Funding

As per the current NHS guidance available, the process of applying for CHC funding depends, for the most part, on the location where the individual requires assessment. This could be in the hospital as the individual awaits discharge, at home where he/she is being given full-time care, or a nursing/residential care home.

The application process works slightly differently in each of the three cases above, and may get a bit tricky at times. This is why it is best to consult a solicitor who can dramatically help speed up the process for you.

At Hugh James, we make it really easy for families and their loved ones to begin the NHS CHC funding or fee recovery process. All you need to do is complete a questionnaire and our solicitor will guide you from that point on.

Even though working with a solicitor is not required to complete the application process for NHS Continuing Healthcare (CHC) or NHS fullyfunded care (as it’s sometimes called), it can be quite complex when people attempt it on their own. However, working with an expert in the areameans you can significantly increase your chances of being eligible for CHC, ensuring that the complete stream of funding is opened up to you without any unnecessary delays or legal red tape.

Steps to Recover Nursing Care Fees

To recover nursing care fees in England, here’s what you can do:

Write a letter of complaint to the CCG (Clinical Commissioning Group) to get CCG funding for nursing care.
Request a retrospective review so that the CCG reviews the relevant care home along with the person’s medical records.
Complete a DST, an assessment tool which determines if the person’s needs actually qualify him/her for NHS continuing healthcare and/or NHS funded nursing care.
Attend an LRM – a Local Resolution Panel Meeting – where the CCG will schedule the meeting on your behalf.
Make an appeal in case you disagree with the decision to release funding or reimburse the wrongly paid fees.
Request a hard copy of all previous assessments and outcome letters.
Consult a solicitor well-versed in the area of CHC funding to understand what the next steps are and how to get the quickest resolution.
Challenge eligibility for CHC if you were deemed ineligible.
You can also claim a refund in case the ICB (Integrated Care Board) takes more than 28 days to decide your eligibility; from the 29^th day, you can claim a refund, asking them to refund any care costs until the date of the decision.

Common Challenges in Nursing Care Fee Recovery

In order to be eligible for CCG funding for nursing care or CHC funded nursing care, you must have a primary health need which significantly impacts your daily life. Important to note here is the fact that a primary health need cannot be defined by the health condition or diagnose itself.
The CHC eligibility assessment is conducted by a certified healthcare professional who will assess your care needs in 12 domains, which include: cognition, behaviour, emotional and psychological needs, nutrition, continence, mobility, skin integrity, communication, breathing, and drug therapies & medication. This can be uncomfortable for most people, where some people have also felt nervous and anxious as they have to answer difficult questions.
All in all, the CHC assessment and nursing care fee recovery process can be lengthy, cumbersome, and even tortuous. There are typically long waiting gaps where you must wait for the outcome or decision to be sent to you, and then wait even for an appeal to reach the Panel, should you decide to go down that route.
The process from start to finish, while ideally shouldn’t take more than just a few months, can often take years, as the affected person awaits a final outcome.

With professional legal support by your side every step of the way, you can be rest assured that each stage of the assessment, fee recovery, and appeals process (if required) is made easy, taking a huge emotional and financial burden off your shoulders. Don’t hesitate to contact our friendly and highly experienced solicitor today for a free initial consultation.

Free no-obligation assessment

Key contact

Lisa Morgan

Partner

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 25 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

Lisa Morgan

Partner

Head of Nursing Care

Email: [email protected]

Contact number: 0808 501 6986

Connect with Lisa Morgan

Expertise:

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 25 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

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David’s story

Our client David speaks out about how he navigated the complexities of reclaiming NHS Continuing Healthcare Funding for his mother. This video case study unveils the challenges endured by David’s family and their ultimate triumph in securing vital support for long-term care. From initial setbacks to fragmented assessments, David’s mum’s case sheds light on the arduous path many families face in accessing essential healthcare funding. Guided by the expertise of the Hugh James Nursing Care Team, this case study illustrates the power of perseverance and strategic advocacy. Explore the stages of the NHS Continuing Healthcare process, the obstacles encountered, and the remarkable outcome of reclaiming approximately £160,000 on behalf of David’s mum’s estate. This poignant narrative serves as a beacon of hope for families navigating similar struggles.

Read more about David’s story here.

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It is possible for you to pursue a claim independently without instructing a solicitor or advocate. However, it is a difficult process and we have many clients who have initially tried themselves and found the process challenging.

There are many companies who specialise in this area. However, as solicitors we are regulated and very experienced in what we do.

The team at Hugh James have more than 15 years of experience and have won awards from The Law Society and Age Cymru for their work.

Some of our clients question how non-medically qualified professionals can challenge health decisions. Whilst the people making decisions regarding eligibility for continuing healthcare are health and social care professionals, their decisions are being challenged and it is our job to demonstrate they are unsound by analysing medical evidence and applying it to the criteria. Whilst the process is not legal, it is a dispute resolution process and many Independent Review Panel chairs are former solicitors and barristers.

Due to Hugh James experience and depth of knowledge, we are respected by health and social care professions and panel chairs for the work we do.

The skills developed by lawyers – analytical, evaluating, interpreting and advocacy is key in being successful and it is of no surprise that all companies employ law graduates to undertake this work.

Unlike solicitors, unregulated advocacy companies are not obliged to provide clients with the best advice and be clear and transparent about their charges. They cannot advise on the option of court proceedings against health authorities for unsound decisions by way of Judicial Review, as they cannot by law undertake reserved legal activities. NHS Continuing Healthcare: Can you challenge an Independent Review Panel decision?

The other added advantage of instructing a solicitor is protection if something goes wrong. Sadly, we have seen first-hand, companies not providing accurate advice leading to clients losing the chance to proceed or companies no longer being in business. Solicitor practices are far more stable, but in the unlikely event that something does go wrong, clients can at least rely on solicitor’s professional insurance policy. They can also have recourse to the Solicitors Compensation Fund.

While we will ask the case proceeds as soon as possible, we have no control over the speed in which the health authorities progress the claim and it depends on the decisions made by the health authority. In our experience, it takes 24 months for a case to reach a retrospective panel. However, current assessment should be undertaken in a timely manner and are usually completed within 3-6 months. We will always keep you up to date as your case progresses.

Our team have been working in this area for over 15 years and have been successful for over 6000 families in securing free NHS funding through current assessment and/or retrospective reviews.

We provide a free initial assessment and we will advise you at the outset whether you have a case.

We have recovered £200m for our clients. The most any one firm or company has recovered in the UK.

Read what our clients say about our service here.

We understand that instructing a solicitor may be daunting, but unlike advocacy firms, as solicitors we must be open and transparent about our costs. There cannot be any hidden charges.

Following a free initial assessment of your case, we offer a number of funding.

In most cases our clients are offered the choice of a ‘no win no fee’ Contingency Fee Agreement and an hourly rate basis. The Contingency Fee Agreement is popular with our clients as it provides certainty; they know exactly what we will charge if we win the case and it makes no difference how much time we spend pursuing the claim to a successful conclusion. In addition, there is peace of mind that if we pursue the claim and we lose, you do not pay us anything.

Retrospective cases

This is where money paid for care home fees is recovered.

If we succeed with a retrospective claim (monies are recovered), we take 25% plus VAT of the monies recovered.

It is common, as NHS Continuing Healthcare is based on the type and amount of care needs, that eligibility is only awarded for part of the period in care. Our average amount to recover is £30,000 and our average fee is £7,500 plus VAT.

Current assessments

Where someone is awarded free NHS funding.

If a current assessment awards full NHS funding, our fee is 25% plus VAT of the monies we preserve for you for the first four months, or until eligibility for NHS CHC is lost, whichever is first.

If, for example, the date of a current assessment is 1 June and eligibility is found and you were paying £800 per week, and over four months £12,800. You will pay us £3,200 plus VAT.

Hourly rate charging basis

All our clients are also offered an hourly rate option. Our current hourly rate is £200 plus VAT.

We will provide you with an estimate of costs. Giving an estimate at the outset of a case is difficult and is dependent on the circumstance of each case. Many of the factors which will influence the eventual amount of costs are unknown. Whilst it is difficult for us to say how long the claim may take and how much work we will need to do (since often this will depend on the way that the health authority deals with the claim) our estimate of our costs will be provided to cover the work for assessing all the medical records, advising on merit, requesting an assessment and appeals.

It is difficult to estimate how much time is spent on a case, but we suggest a typical case from start to finish will be 40-60 hours.

We regularly update you on the costs incurred. Our costs are payable win or lose on an hourly rate basis.

Will there be any surprise costs at any time

No. At the outset of the claim, we will write to you to explain the funding options. As a firm of solicitors, we must be clear and transparent about our costs.

Whilst we do not envisage you will be unhappy with the cost or service we provide, it is good for you to know that if you were unhappy, unlike unregulated advocacy companies, you can make a complaint through our internal complaints procedure. If you are not satisfied once you have been through our complaints procedure, you can contact the Legal Ombudsman.

The process will depend on a number of factors, such as whether you are starting your claim from scratch or if you are coming to us to appeal a negative decision; whether you are claiming on behalf of a loved one who has since passed away or has just moved into long-term care.

If you believe that you or a family member has wrongly paid care fees, then the first step is to complete our questionnaire. This will be assessed by our Nursing Care legal team who will be able to advise on whether or not you have a case, and if so, what the process will be. This initial questionnaire is free to complete and there is no obligation on you to proceed with a claim should you decide not to.

We believe we are one of the leading national experts in the recovery of wrongly paid care home fees. Here are just some of the reasons why our clients choose to work with us:

We have recovered over £250 million in wrongly paid nursing home fees since the department was set up in 2006.
Our success and client stories are regularly featured in the press as we are recognised as leading the way in reclaiming wrongly paid care home fees. This includes The One Show, Dispatches, ITV News, The Telegraph, The Sunday Times and The Mirror.
We work in partnership with many of the leading older peoples’ charities, helping us to ensure our service meets the needs of the people we, and the charities, represent.
Unlike many other companies who focus on reclaiming wrongly paid care fees, we are a firm of solicitors regulated by the Solicitors Regulatory Authority (SRA) and comply with the solicitors’ code of conduct.
The Hugh James Nursing Care team is the leading and most experienced team in the niche area of continuing healthcare, giving you complete peace of mind that your case is being dealt with by fully qualified lawyers who specialise in reclaiming nursing and care home fees.
The team is also one of the biggest teams focusing exclusively on this area in the UK with over 40 dedicated lawyers.
We promise to deal with your claim from start to finish and will not pass your claim on to a third party. We offer a complete service for you with dedicated team members to contact.
Head of the team, Lisa Morgan, won the highly acclaimed Law Society Junior Lawyer of the Year 2010 Excellence Award due to her work in this area. She was also recently awarded the Cardiff University Simon Mumford award. In 2017, the department was highly commended at the Age Cymru Awards in the large business category for its commitment to helping older people.

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Continuing Healthcare - Nursing Care