You can claim a refund of care fees for periods during which you or a loved one was eligible for NHS Continuing Healthcare but did not receive it. Do any of the following apply to you? If so you may have a claim.
You or a loved one have paid care fees in England because of complex and/or unpredictable care needs
These could be home care, residential care or nursing home fees. To qualify, the care fees must have arisen from a primary health need, whether diagnosed or undiagnosed. They may have been the result of, for example:
- a severe illness such as Alzheimer’s, other form of dementia, multiple sclerosis, chronic obstructive pulmonary disease, cancer, or Parkinsons;
- a physical or learning disability;
- the effects of stroke;
- an accident that caused injury;
- a severe mental illness.
If so, the person may have been eligible for NHS Continuing Healthcare. This is personal health and social care arranged and funded by NHS Clinical Commissioning Groups (CCGs). It is not means-tested and must cater for all assessed care needs.
You have been been told you/they were not eligible without an assessment being carried out
The CCG must assess someone for NHS Continuing Healthcare if it seems they may need it. Usually they should carry out an initial checklist assessment, which will help them decide quickly if the person should undergo a full assessment. The exception is for urgent care needs – usually due to a terminal illness – in which case the assessment should be a fast-track one. If the checklist suggests they need a full assessment, this should be carried out by a team of trained health and social care professionals. If you think there should have been an assessment, you can ask for one retrospectively.
You disagree with the outcome of an NHS Continuing Healthcare assessment
You may believe the assessment did not accurately reflect the person’s care needs, for example around behaviour, cognition or mobility or other domains. The NHS Continuing Healthcare assessment should have taken into account the views of the person receiving care, their family and carers where appropriate. It should not have happened behind closed doors. If you believe the assessment did not give a true picture of care needs, you may be able to challenge this with evidence of your own.
You have had NHS Continuing Healthcare funding withdrawn following a review
This will probably have been on the grounds of a reduction in care needs. Were you told the condition had “improved” or “stabilised”, even though you believe this was purely down to good care? Do you believe overall care needs are just as intense, complex and unpredictable as before? You may be able to challenge a review with evidence of your own.
You have been “topping up” NHS Continuing Healthcare to meet the needs of the care plan
While the legislation governing local authority social care expressly provides for “topping up” care fees (though only in specific circumstances) the NHS are not permitted to ask for NHS Continuing Healthcare top-ups for assessed needs. (You can, however, pay for additional private services over and above those you need – in certain circumstances.) Yet we know many recipients of NHS Continuing Healthcare are paying “top-ups”. You may be able to claim these back.
If any of the above apply to you, you may be able to claim a refund of care fees. You may even be able to claim on behalf of someone who has died as long as you have the legal authority to do so. However, because of Government rules you cannot now claim for a refund of care fees paid in England before 31st March 2012. In Wales, retrospective claims can cover no longer than 12 months back from the date of application for review.
Do you think you may be entitled to a refund of care fees? If so fill in our initial online questionnaire and Just Caring Legal will advise you further.