We are hearing more and more stories from clients about CCGs capping NHS Continuing Healthcare (NHS CHC) funding. This is very worrying: NHS CHC should be free at the point of use, in line with the NHS’s founding principles, and adequate to cover all assessed care needs. All CCGs have a statutory duty to follow this framework: topping up “is not permissible under NHS legislation”.
“Grand pianos and chandeliers”
A Greater Manchester resident contacted us recently to say her local CCG had capped her father’s NHS CHC payments at £800 per week. The problem was that his nursing home charged over £1,000 – average for the area.
“When I queried the cap with the CCG,” she told us, “the administrator said they only had to pay for my Dad’s assessed care needs and not “hotel-type” services. I asked what she meant by this, and she said some nursing homes in the area had “grand pianos and chandeliers” and there was no way the CCG would pay for that. She said we would have to fund the shortfall ourselves.
“I felt so insulted and angry. It wasn’t just the money – it was the principle. My father’s nursing home does have a piano but it certainly isn’t grand! It is an integral part of the care environment. Many of the residents find singing, playing and listening to music vital for their wellbeing. And there isn’t a chandelier in sight.
“In any case, my Dad is is bed bound and barely comes out of his room. He is in pain a lot of the time and completely immobile: he needs a hoist and two carers just to reposition him in bed. He spends all day watching TV or listening to the radio, both of which we provided for him. I find it really hard to figure out where the “hotel-style” services come in.”
Sadly, stories like this are more and more common.
According to the National Framework on NHS Continuing Healthcare, the only way you can legally top up an NHS Continuing Healthcare package is if you choose to pay for optional and additional private services. These should be over and above the services that are part of the care plan. They might include hairdressing or manicures. These should usually be provided by different staff to those meeting your day to day needs.
Many CCGs are seeking to get round the rule against NHS CHC top ups
They often do this by separating the cost of “care” from the cost of “accommodation”. They might dress it up by talking about “hospitality” or “hotel” services. Or they may mention “premium” or “luxury” accommodation that they argue is above and beyond “standard” accommodation.
This is a grey area from a legal point of view. Some CCGs have written policies that require NHS CHC top ups for a larger room, for example, or an ensuite bathroom. But such policies may well be in breach of the National Framework. This is especially so if the top up payments are for facilities that are a non-optional part of the care package.
Are you topping up NHS CHC?
Is your CCG capping your NHS CHC funding at a certain amount? Is it an amount less than you need to meet your family member’s needs? Have you been asked to pay an NHS CHC top up?
If so, call us now 0191 556 1078 or email us at firstname.lastname@example.org. You may be paying these fees unnecessarily – and you may well be entitled to a refund. As a solicitors’ firm specialising in NHS CHC funding we will look at the detailed circumstances of your case and fight for fair funding on your behalf.