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 Clinical Commissioning Group 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 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 recent case of Ms V, the PHSO ordered that a local CCG 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 CCG 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 CCG reviewed Ms V’s NHS Continuing Healthcare eligibility two more times. They found both times that she remained eligible. However, the CCG 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 CCG’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 CCG reimburse all the professional care costs incurred by Ms V’s family, which came to approximately £187,000. It also recommended the CCG reimburse the family for the care they had 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.