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Most people breathe a sigh of relief when their assessment of eligibility for NHS Continuing Healthcare is successful. Just getting someone to accept that your family member has a primary health need that qualifies for NHS care can be the fight of your life. The comfort of knowing they are finally getting the care they need when they are at their most frail and vulnerable is immense. But this is very rarely the end of the matter. There will normally be an NHS Continuing Healthcare review after three months, and then again annually. The NHS Continuing Healthcare review is supposed to focus on whether the care package is meeting the person’s needs adequately. But in our experience, it very rarely does.

The NHS Continuing Healthcare review should not in most cases revisit eligibility

The National Framework for NHS Continuing Healthcare is quite clear. In most cases there should be no need to reassess for eligibility. Only where there is clear evidence of a change in the person’s care needs should it result in another eligibility assessment. This should be by reference to the Decision Support Tool from the previous assessment.

In our experience, however, the review is very rarely about ensuring that the care package is sufficient. In most cases, these processes are budget-led, not needs-led. This means there is a laser focus on whether the person still presents a “primary health need“. (This is not about the reason why an individual requires care or support, nor is it based on their diagnosis. It is about the level and type of their overall actual day-to-day care needs.) Many reviews will search out “evidence” that current care needs do not meet this high bar. Then they can justify another assessment with a view to withdrawing NHS Continuing Healthcare.

Is it possible that the care needs of someone this vulnerable can genuinely disappear?

It is not impossible. Sometimes, if someone has been particularly unstable, a period of intense care in the right environment can bring genuine improvement. In these cases, care needs may permanently reduce to the level that they are no longer intense, complex or unpredictable enough to indicate a “primary health need”. But in most cases, people who qualify for NHS Continuing Healthcare funding are suffering from multiple deteriorating conditions. Alzheimer’s. Cancer. Parkinson’s. Or they have permanent cognitive impairment from a disability, stroke or brain injury that impacts permanently on many aspects of their care needs, making them difficult for carers to meet. Short of a miracle, their care needs are never going to just go away.

A well-managed need is still a need

Often, reviewers will use evidence that someone appears more stable and settled as evidence that they no longer have a primary health need. However, the National Framework anticipates this. It warns assessors not to marginalise a care need just because it is successfully managed. Well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed the need will this have a bearing on NHS Continuing Healthcare eligibility. This will only be the case where active management of this need is reduced or no longer required.

However, time and again, we see this requirement ignored. Reviewers argue that, for example, a reduction of aggressive behaviours in care records is justification for withdrawing NHS Continuing Healthcare. Yet they fail to acknowledge what is going on behind the scenes. These behaviours often require copious amounts of time, skill and knowledge of the individual to manage. By failing to scrutinise risk assessments, behaviour support plans and care records, reviews ignore crucial evidence that the need is just as great, just better managed.

Has your relative had NHS Continuing Healthcare withdrawn following a review?

If so, you are not alone. We are dealing with these cases every day. We know how devastating it is to have someone accept your relative’s needs, only to snatch it all away again after 12 or even three months. As if they have miraculously just got better. And often just when you feel they have settled into their current setting. We feel the frustration of families whose views of their own relative’s needs count for nothing.

If this is you, please get in touch for your free initial assessment. We will review your NHS Continuing Healthcare experience and give you our honest opinion of whether we can help and if so, how. Often our clients tell us they just don’t recognise the person described in the document. So tell us the full story. The real story. And we can take it from there.

The NHS Continuing Healthcare Decision Support Tool (DST), contrary to popular belief, is not in itself an assessment of care needs. The regulations and guidelines governing NHS Continuing Healthcare are clear. When deciding eligibility, a multi-disciplinary team (MDT) must first undertake a comprehensive assessment of needs. The MDT must then use that assessment to complete the Decision Support Tool for NHS Continuing Healthcare. This is designed to help them accurately document and summarise the total care needs and their nature, intensity, complexity and unpredictability. It is this which must inform the Integrated Care Board’s final decision as to whether that person has a primary health need and is therefore eligible for NHS CHC.

However sadly, this is not how it usually goes. Here are the top five complaints we receive from clients about the way the DST has been misused.

How is the NHS Continuing Healthcare Decision Support Tool misused? Let us count the ways.

1. The Decision Support Tool becomes an assessment in itself.

The MDT meets – often remotely, these days – to complete the DST. This “team” is often made up of just two people: a nurse assessor for the Clinical Commissioning Group and a social worker. It is increasingly rare that these professionals have observed the individual for any length of time in their care setting. They may well be examining their care needs in detail for the first time as they fill in the document.

2. The DST is based on very limited information.

According to the National Framework, the Multi-Disciplinary Team should gather evidence of needs from a comprehensive range of assessments relating to the individual. But this often doesn’t happen. Many DSTs are rushed, and rely too heavily on whatever information is available in the day-to-day care records.

3. The Decision Support Tool is completed behind closed doors.

We are finding that families are not always getting the opportunity to be fully involved in the assessment process. Their only chance to have an input may be in a preliminary telephone or Zoom conversation. The MDT then often scores the domains of the DST in private. Of course, this makes it easier for them to disregard or minimise the family’s views and evidence and downscore the needs. Many families don’t find out the outcome of the DST until they are notified of the eligibility decision. This is all contrary to the National Framework, which says the family should have the opportunity to be fully involved in the assessment process including the scoring.

4. Assessors “underscore” care needs without giving an adequate explanation.

They may justify this by saying: “There is evidence that x’s needs fit the descriptor for the higher scoring in the DST some of the time. But there is insufficient evidence from the care records that it happens often enough to justify this higher scoring”. It is very rare that the MDT asks, in line with the National Framework, for further evidence to get a more accurate picture of needs. Instead, the lack of care records simply becomes evidence of lack of care needs.

5. The Decision Support Tool misinterprets well-managed needs as no or reduced needs.

For example, the DST often fails to examine or record the content of risk assessments or care plans. Day-to-day care records may be incomplete – care staff are often too busy to fill them in comprehensively. It can create the impression that care needs are far lower than they actually are. This is very common in reassessments for eligibility. The DST can make it look as though the care need has permanently reduced purely because it is being well-managed. There may be fewer falls or fewer episodes of challenging behaviour. But this can be misleading, and fail to capture the amount of care going into keeping someone safe, calm and well. That is why it is always worth asking the question: what would happen if the current level of care were withdrawn or were not available?

Do some of these sound familiar?

Has the DST failed to capture the totality of your family member’s care needs? Or maybe you are waiting for an eligibility assessment and don’t know what to expect. There is lots of useful information on our Factsheets and Blogs. If you still have unanswered questions, why not contact us via the website? We can talk you through the services we offer. For example, we may be able to pre-empt problems with the DST by providing a thorough needs assessment and scoring of your own based on the records. We can even represent you in the meeting, if this is what you require. We pride ourselves on our specialist, client-focused service, giving as much or as little support as you want. And that can start today, with a free initial assessment of your case.

Posted by Rosalind Hughes, Just Caring Legal, on 06/02/2025

NHS Continuing Healthcare assessments should never happen behind closed doors. No matter the circumstances, people have the right to be present at their own assessments. And their representatives – family or professional – have the right to be in the room too. This may or may not include legal advisors. The NHS Continuing Healthcare system was never designed to be adversarial. But sadly, that is what it has become. The truth is, NHS Continuing Healthcare expert help can make a big difference to outcomes. Many of our clients have struggled along on their own for quite a while before deciding they need professional guidance and support. You can read some of their stories here.

Being present at an NHS Continuing Healthcare assessment is no guarantee you will get the right outcome

The NHS Continuing Healthcare assessment process is immensely complicated and detailed. People often find themselves overwhelmed, and struggle to put forward effective arguments to make the strongest case. Many people miss out on the funding they are entitled to. Not because they don’t have a primary health need. But because the system seems to make it as hard as possible for them to argue their case successfully.

Why is it so hard to get NHS Continuing Healthcare funding?

NHS Continuing Healthcare funding pays for all the health and social care care costs of anyone who has a ‘primary health need’. But the unfortunate truth is that there is no clear single definition of what a primary health need is. Assessors should look at the total care needs the person has – their intensity, complexity and unpredictability. But this leaves the assessment process for NHS Continuing Healthcare open to interpretation. It is just too easy to ignore or downplay people’s care needs. Additionally, NHS Integrated Care Boards (ICBs) have targets for saving money from their NHS Continuing Healthcare budgets. The result is a system that militates against people getting the funding they deserve. People have to jump through ever more hoops to prove that they should have the free care. Many thousands of people who apply for NHS Continuing Healthcare each year fail to receive it, or receive it but then have it taken away. 

How expert advice and guidance can make a difference to outcomes

With the system stacked against you, you need to do everything you can to maximise your chances of success. An advocate with medico-legal expertise can fight to ensure a fair hearing of your case. We will make sure your assessors consider the full range and extent of care need(s). And we will challenge decision-makers who fail to follow the National Framework for NHS Continuing Healthcare to the letter.

At Just Caring Legal, we understand the difficulties that families face during what is often such an all-consuming time. And we know many people have deep concerns that come with trying to access legal support – such as cost. This is why we offer a free initial assessment of your case. We will listen with care and compassion to your story. Then we can assess the merits of your case and discuss what, if anything, we can do to help. This could vary from writing a detailed letter to providing representation in vital meetings.

Here at Just Caring Legal, we have many years of experience advocating for families to ensure they get the care funding they are entitled to. You can read our testimonials here. So contact Just Caring Legal today and find out how our NHS Continuing Healthcare expert help can maximise your chances of success.

Why is the NHS Continuing Healthcare application process so difficult? That is the main concern families have when they get in touch with us. We get many calls from people thinking they must be doing something wrong. They believe that because NHS Continuing Healthcare is a government programme, with a National Framework of rules to follow, it should be relatively straightforward. Unfortunately for many people it is anything but. Instead, it brings months, even years, of bureaucratic wrangling that can take up all their time and energy and rob them of precious time with their vulnerable relatives. Meanwhile, their relative often has to pay for care that they should be receiving for free.

“In terms of complexity, the mental capacity required and the analysis skills needed, applying for NHS Continuing Healthcare funding was as complex as some of the nuclear deterrent policy I worked on,” according to Philip Mathias, a retired rear admiral of the royal navy. So horrified was he by the experience that he launched a campaign for Judicial Review in 2020 to end the “scandal” of the “dysfunctional and failing” NHS Continuing Healthcare process. Sadly, he was ultimately refused permission by the courts to proceed.

Why it’s not so simple

The NHS established Continuing Healthcare funding so that those who have a primary health need could have high levels of care outside hospital. This would be free at the point of use, in line with NHS principles. It is a simple concept. Yet there are several factors that make it far too complex. For example, there is a lack of clarity over what constitutes a primary health need. One case – now known simply as Coughlan – helped clarify the law regarding eligibility. And since 2007, the National Framework has also given guidance on how to decide if someone has a primary health need. However, there is no singular definition, This leaves plenty of room for interpretation and subjectivity to creep into the application process.

Another problem is that many people do not know their basic rights when it comes to the NHS Continuing Healthcare application. These include the right to be present at your own assessment and to have close relatives or friends there as your representatives. NHS Continuing Healthcare assessments should never happen behind closed doors. But many do, with applicants only getting to hear about the outcome afterwards as a fait accompli.

How this can have an impact on your NHS Continuing Healthcare application

Each of these factors means that it can be tricky to navigate the eligibility assessment system. Patients and their families may not be sure which arguments and evidence is most likely to lead to success. Decisions may be made without any input from those who know the individual’s needs best. This can have a major impact on the likelihood of obtaining the funding.

How to improve your chances of success

One of the best things to do is learn your rights, and do some research around primary health needs. Our Resources and Factsheets are a good place to start. The more informed you are, the more empowered you will be to hold your own in what are often extremely robust and in-depth discussions. You can find out more about how to maximise your chances of success here.

But you don’t have to navigate the process alone. At Just Caring Legal, our primary focus is on providing professional, compassionate guidance for people going through the NHS Continuing Healthcare application process. We can also help with appeals if you think you have been been wrongly denied funding. The problem is, appeals can take time. Meanwhile, you or your family member may be wrongly paying thousands of pounds a week in care fees. That is why with NHS Continuing Healthcare, it is absolutely vital to make as strong a case as possible at the initial application stage. If you are already at the appeal stage, however, don’t worry! We can help you make the appeal as robust as possible where we think there are grounds to do so.

So if you have questions about the NHS Continuing Healthcare application process, call or email us today for a free initial assessment of your case. We will advise you honestly and in plain English on the strength of your case. If appropriate, we can use the information to provide a range of services, based on the strongest medico-legal arguments on your behalf. This may be either by letter or as your advocate in a meeting. So get in touch. You have nothing to lose – and potentially much to gain.

By Rosalind Hughes, founder, Just Caring Legal

The NHS Continuing Healthcare system is designed to provide free health and social care outside hospital for people with a primary health need. It is not means tested. However, it is getting harder and harder to get as NHS Integrated Care Boards (ICBs) pull the purse strings tighter. While it shouldn’t depend on an individual’s finances, we know it often does. In a recent letter to the Guardian newspaper, Janet Maitland from East Finchley wrote that when her relative had to go into a care home, “the first request for information was not about his health but his financial position. So they learned immediately that he had savings and owned his flat. From that moment on, in every meeting about CHC funding, where I spoke for him as he does not have the capacity to do so himself, it was clear that the money was the most important thing about him. In the end, I was defeated by people determined to minimise every medical problem he has.”

Which brings us back to a point we make often here at Just Caring Legal when our clients raise exactly this issue. Never agree to a financial assessment for care before your care needs have been fully assessed.

If you are eligible for NHS Continuing Healthcare, your finances are irrelevant

It is only after a care needs assessment that the financial assessment (or “means test”) might come into play. We say might, because if your care needs go beyond what a local authority can be expected to provide, then the NHS must meet them in full. This is NHS Continuing Healthcare. Like all NHS care, it is free at the point of use to anyone who needs it. If you qualify for it, your property, savings and assets are all irrelevant so there is no need for a financial assessment.

You do not have to agree to a financial assessment for care

Financial assessments must only happen with the consent of the subject, or their representatives where they lack capacity. So if you have not received a health and/or care needs assessment, you should not consent to a financial assessment. If you think you or your relative might qualify for NHS Continuing Healthcare, then insist on an eligibility assessment for this first. You can find out more about the two-stage eligibility process through our factsheets, such as this one on what constitutes a primary health need.

Don’t listen to those who tell you you “won’t qualify” for “free care”

We hear it again and again. People trying to arrange care for their relatives receive the message that they “won’t qualify for free care” because they own property or savings. Do not let this put you off pursuing a claim for NHS Continuing Healthcare. Whether you qualify depends only on the level of your care needs. The problem is, the eligibility process is highly complex and flawed, as Janet described in her letter. There is far too much room for subjectivity, leading some assessors to downplay or ignore important needs. It means that many people are ruled out for free NHS care when they do in fact meet the criteria. In this way, NHS England denies thousands of people a year the free NHS care to which they are entitled.

Do you think your relative may be one of those wrongly denied NHS Continuing Healthcare?

You may feel that your relative should qualify but that their needs have not been fully or fairly assessed. If so, feel free to get in touch. Here at Just Caring Legal, we specialise in maximising your chances of securing NHS Continuing Healthcare funding. We also appeal successfully against ineligibility decisions and obtain refunds of wrongly paid care fees, often running into six figures. Call or email today for a free initial assessment of your case. Because our help might just make the difference between hanging on to the house and spending most of your life savings on care. In the meantime, remember: keep your lips tightly shut about your finances until the whole NHS Continuing Healthcare process is fully concluded.

By Rosalind Hughes, founder, Just Caring Legal

It is tempting to breathe a huge sigh of relief when your relative finally proves eligible for NHS Continuing Healthcare. But then, all too soon, comes the NHS Continuing Healthcare review. This is normally within three months of the initial decision, and then again every 12 months. According to the National Framework for NHS Continuing Healthcare, the rationale is to ensure the care package is still appropriate to meet healthcare needs. “It is expected that in the majority of cases there will be no need to reassess for eligibility.”

However, far too many Integrated Care Boards (ICBs) use the NHS Continuing Healthcare review as an opportunity to reassess eligibility. We hear almost daily of reviews that result in the removal of funding without any clear reason as to why the person is no longer eligible.

So what should you do if your relative is due for an NHS Continuing Healthcare review?

1. Make sure you get adequate notice of the review meeting so that you are able to attend. Often we hear of families receiving a fait accompli that a review has taken place and their relative now needs to go through the eligibility assessment process again. But such a vital meeting should never happen behind closed doors. Representatives should have every opportunity to attend.
2. Re-familiarise yourself with the Decision Support Tool (DST) from the original application. The likelihood is you are all too familiar with the lengthy DST and the domains it covers. The National Framework makes clear that your relative’s most recent DST should be the main point of reference at the review. The ICB must use it to evidence any claim that needs have reduced. If you haven’t got a copy, ask for one before the meeting so you can go through it.
3. Be aware of what the National Framework says about when reassessment for eligibility should happen. ie “Where there is clear evidence of a change in needs to such an extent that it may impact on the individual’s eligibility for NHS Continuing Healthcare”. If the ICB is pushing for reassessment, make sure they state clearly the evidence of a significant change in needs.
4. Be clear on the distinction between underlying needs, and how well those needs are managed. We cannot overstate how crucial this is when it comes to reviews. For example, say your relative has dementia, which causes severe behaviour issues such as resisting care. Maybe the care setting can only manage this successfully through covert medication. Does this mean the underlying need has gone away? No. Without covert medication, the behavioural needs would be just as high. And covert medication is a last resort, with its own onerous requirements for safeguarding, monitoring and review. The National Framework is clear. Only where the successful management of a need has permanently reduced or removed that need should it be relevant to the question of eligibility.
5. Know that even if the ICB believes your relative’s needs have changed, this is not sufficient grounds to remove a care package and/or full funding. The National Framework states that it must arrange to carry out a whole new DST with a full multidisciplinary team to establish this with a clear rationale. Even if there is a change in eligibility, existing funding must remain in place until alternative arrangements are put into effect.

Remember, help is only a phone call away

Hopefully, forewarned will be forearmed. But we know that sometimes when it comes to NHS Continuing Healthcare, that isn’t enough. Trying to assert your relative’s rights and get a rational answer can feel like you’re on the wrong end of the battering ram. So if you’re feeling dazed and confused, why not get in touch? We will give you a clear and honest evaluation of your case. We may be able to send you away with enough ammunition to carry on the fight yourself. Or you might need us to bring out the big guns.  Whichever, it will be your call. So why not call or email us today?

By Rosalind Hughes, founder, Just Caring Legal

NHS Continuing Healthcare funding covers the full costs of care for people who have a ‘primary health need’. It covers both health and social care and applies whether people are in residential or nursing care or receiving care at home. However, applying for NHS Continuing Healthcare for care at home is fraught with problems. This is because providing a high level of care at home is often more expensive than in a residential setting. We are hearing from more and more people that their local Integrated Care Board (ICB) is refusing to cover the full costs of care at home.

What the rules say on capping NHS Continuing Healthcare

However, the National Framework on NHS Continuing Healthcare is clear. It says funding should cover the cost of meeting all of a person’s assessed care needs. Leaving someone without all the care they need is a safeguarding issue: it puts that person at risk of potential harm. They and their family should receive a care and support plan setting out their full care needs and how these will be met. The NHS may put a limit on funding for care at home as a way of encouraging a person to agree to go into a care home. But such an approach is fraught with problems, as the Parliamentary and Health Services Ombudsman has found.

A family received a £250,000 refund for home care costs that should have been covered by NHS Continuing Healthcare

The PHSO is the last resort for families in dispute with their CCG over NHS Continuing Healthcare. In the case of Ms V, the PHSO ordered that a local ICB should pay a family over £250,000 for care the NHS should have paid for in full.

Ms V had a stroke in 2016. She was eligible for NHS CHC funding. Her needs assessment found that she needed the assistance of two carers at all times to support her daily living and keep her safe. Ms V’s family believed it was in her best interests to stay at home. The ICB offered a care package equivalent to the cost of a nursing home placement plus 10%, which resulted in only enough funding for one carer for seven hours a day. This meant the family would need to provide additional care themselves, as well as paying privately for extra care.

The family complained about the care package. They submitted a record of the additional care costs they had incurred. The ICB reviewed Ms V’s NHS Continuing Healthcare eligibility two more times. They found both times that she remained eligible. However, the ICB did not produce a care and support plan setting out what Ms V’s care needs were. As a result, it continued to fund only one carer for seven hours a day.

According to the PHSO, the ICB’s approach was wrong. It should have compared the costs of a nursing home placement with the costs of care at home. This would have allowed it to fully understand the cost of care in each potential setting and determine the funding needed to provide the level of care Ms V required. The PHSO recommended that the ICB reimburse all the professional care costs incurred by Ms V’s family, which came to approximately £187,000. It also recommended the ICB reimburse the family for the care they themselves provided to Ms V. This totalled a further £90,000.

Have you had NHS Continuing Healthcare for care at home capped?

Are you struggling to get sufficient funding for your relative’s care at home? Perhaps you are having to meet the shortfalls in care yourself?  If so, call or email us today. As specialists in NHS Continuing Healthcare, we can help you mount effective challenges against inadequate care and support plans. We can support you in claiming refunds for the costs of meeting unlawful shortfalls in care. And we will carry out an initial assessment of your case for free. So you have little to lose. And potentially much to gain – the most important being peace of mind that your relative is no longer being put at risk.

Is someone you know at risk of losing their care home place due to NHS Continuing Healthcare  shortfalls? If so, you are not alone. Catastrophic failures in the administration of this vital NHS care funding can lead to a plethora of safeguarding concerns within care settings. Some of our most vulnerable citizens are actually at risk of losing the roof over their heads.

NHS Continuing Healthcare shortfalls happen where local Integrated Care Boards (ICBs) fail to pay adequate funds to cover the full costs of providing care.

Under the system of NHS Continuing Healthcare, the ICB is under a duty to meet the cost of all assessed care needs in full. This is the case regardless of any savings or assets the person may have.

The care needs of people living with progressive conditions such as MS and dementia tend to become increasingly labour-intensive. Care homes may become unable – or unwilling – to meet the more intense one-to-one care needs for the amount the ICB has offered to pay. However, we know that in some cases ICBs refuse to pay the going rate for the extra care. In the worst instances, stalemate can result in vulnerable residents being turfed out of the only home they have known for years. Distraught families sometimes don’t realise this is happening until their relative receives a notice to quit.

ICBs may be in breach not just of NHS Continuing Healthcare rules – but also their duty of care

ICBs are under a duty to engage with care providers over the management of changing care needs. Failure to update and fund care plans at the going rate is in clear breach of the rules governing NHS Continuing Healthcare. It also represents a safeguarding issue of the very highest order. That any vulnerable individual should be under threat of losing the roof over their head, never mind the day-to-day care they desperately need, is unthinkable.

It places vulnerable people at risk of emotional, psychological, not to mention physical harm.  Failing to fund intensifying care needs not only puts them in grave danger. It also puts our NHS – and our country – to shame.

Every ICB is under a legal duty to review care needs and ensure funding covers all essential care

Unfortunately, we are aware that stories like this are happening up and down the country. Every ICB is under a legal duty to assess and review care needs as necessary. And it must ensure that NHS Continuing Healthcare funding covers all costs in full so that recipients remain safe and adequately cared for. It is actually illegal for care homes to ask relatives to “top up” NHS Continuing Healthcare. This is why NHS Continuing Healthcare shortfalls are nothing short of catastrophic.

Is someone you know facing NHS Continuing Healthcare shortfalls?

Is your family member’s health, wellbeing and sense of security at risk due to a shortfall in NHS Continuing Healthcare funding? Perhaps their care facility is threatening to serve notice to quit? Or are they asking for “top ups”?  If so, then call us today for a free initial discussion of your case. We are specialists in liaising with ICBs and care homes over NHS Continuing Healthcare and also in dealing with potential safeguarding issues. We can advise you in honest, straightforward terms about whether you have a case. And if you require, we can cut through the bureaucratic red tape and act on your behalf.

Don’t let your loved one become another statistic due to NHS Continuing Healthcare shortfalls. Take steps to safeguard their future – today.

By Rosalind Hughes, founder, Just Caring Legal

Has your vulnerable relative been forced to “top up” their NHS Continuing Healthcare funding with additional fees? If so, they may well be due a sizeable refund. An investigation by the Competitions and Markets Authority (CMA) ruled that many such payments are illegal under consumer protection law and should be repaid.

 NHS CHC “top ups” are illegal

The CMA forced one care home provider, Care UK, to pay back more than £1 million in refunds to NHS-funded residents at their “premium” care homes. The action in 2020 was part of a wider investigation into such practices in the care sector.

The company broke consumer protection law by charging an unfair additional fee for its premium homes: the practice is unfair and contravenes NHS rules, the CMA said. Under these rules, residents funded through NHS CHC must not have to pay towards their essential care.

Care UK’s “premium” homes are so called because they offer enhanced features such as additional communal facilities beyond those found in its “standard” homes. Residents in receipt of NHS CHC were paying in most cases more than £300 a week extra to receive care there. The CMA’s Executive Director of Enforcement Michael Grenfell said, “Older people receiving Continuing Healthcare funding are some of the most vulnerable in our society and should not be expected to pay extra fees towards their essential care.”

Charging NHS CHC “top up” fees, though illegal, is widespread

This was a crucially important ruling. Here at Just Caring Legal we are well aware of these sharp practices. In reality, most residents in receipt of NHS CHC have a very high level of care requirements. They are often bedbound and immobile. They can have extreme psychological needs. Most are unable to make use of communal “extras”, like coffee bars, gyms or cinema rooms.

What is more, we have found that many Integrated Care Boards, which manage NHS CHC,  place arbitrary caps on funding. In many cases, the amount they are willing to pay doesn’t cover the costs of complex care. Hence the request for additional fees to top up NHS CHC.

Always query requests for extra payments

If your relative is NHS CHC funded and their care home demands additional fees, always query it. Don’t agree to anything until you are clear. What exactly is this extra funding paying for? Does it clearly cover aspects of care that are not part of your relative’s day to day needs? Is your relative in a position to make use of these extras? If the care home cannot answer these questions to your satisfaction, they should not be asking for this money. And doing so could amount to financial abuse, a significant safeguarding issue in care homes.

Have you or your relative already agreed to pay additional fees?

If so, get in touch. We are specialists in NHS CHC refunds and can advise you on whether these additional fees are likely to be illegal. We will also consider whether your relative’s circumstances might have made them vulnerable to the risk of abuse and acting against their own interests. So call us today. With our expertise in this area, we can maximise your chances of getting this hard-earned money back as quickly as possible.

By Rosalind Hughes, founder of Just Caring Legal

Just Caring Legal specialises in appeals and refunds for people assessed as ineligible for NHS Continuing Healthcare. As I listen to the stories, I often spot a particular flaw in their NHS CHC assessment process. In so many cases, the family never knew the assessment was taking place. Or they were not accommodated or encouraged to attend. This is clearly contrary to the National Framework for NHS Continuing Healthcare. The Framework is clear: NHS Continuing Healthcare assessments should never happen behind closed doors.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare provides care outside hospital for people who have a ‘primary health need’. However, trying to claim on behalf of vulnerable relatives can be complex and stressful.  You may be passed from pillar to post and wait months for a decision. You may find vital meetings have taken place without your input. Decisions on eligibility can feel arbitrary, unjust, just plain wrong. And assessment processes all too often fail to adhere to the National Framework. Meanwhile your relative continues to pay for care that they may be entitled to receive for free.

What is a person-centred approach?

The National Framework says assessments should follow a “person-centred approach”. The framework is very clear about what this looks like. The individual and their representative should be able to understand the assessment process. You should receive advice and information to maximise your ability to participate in an informed way. Decisions and rationales should be transparent from the outset for individuals, carers, family and staff alike. In other words, NHS CHC assessments should never happen behind closed doors.

Who can be a representative?

In this case, representative means any friend, unpaid carer or family member who is supporting the individual in the process. It also means anyone acting in a more formal capacity such as a welfare deputy or attorney. Or it could mean an organisation such as a legal firm representing the individual. The main point is that assessments should only happen with the full and transparent involvement of those who know the person and their history the best.

Has your relative’s NHS CHC assessment taken place behind closed doors?

If so, you may well have grounds to appeal. Not sure where to start? You can find loads of useful information in the Resources section of our website. If you still have questions, why not talk through your concerns with us? We talk only plain English and will explain how we can help. And if appropriate, we will fight your appeal all the way to the end. That is what we do every day here at Just Caring Legal. So call or email us today for more information.

By Rosalind Hughes, founder, Just Caring Legal