Row over Care Home Fees as NHS Chiefs face £100million bill


The lengthy process of filtering through approximately 60,000 applications begins as thousands try to reclaim NHS Continuing Healthcare costs dating back years. Some families could be looking at receiving 6 figure awards.

Reclaiming Care Home Fees

NHS Continuing Healthcare is a package of care, arranged and funded exclusively by the NHS for people with complex on-going healthcare needs who are not in hospital.

Problems with Guidelines and Funding

Guidelines for carrying out assessments to fully fund NHS care home fees are difficult territory. The rules governing who can claim funding are open to interpretation, allowing the governing bodies to shirk their responsibilities. Those eligible must be over 18, have a complex medical condition and substantial on-going care needs.

A post code lottery may be developing in places where there are huge variations in the way the Department of Health guidance is applied. Many elderly people miss out on crucial funding and sell their houses to cover the cost. Critics have said that this is a problem the government must address, as they created the situation by not having a transparent process.

Struggling Clinical Commissioning Groups

There is a worry that cash strapped Clinical Commissioning Groups (CCGs) will move the care home fee assessments process away from an individual needs based exercise. They will instead impose cash limits on those who should receive funding.

CCGs are GP led groups responsible for designing local health services in England. They do this by buying or contracting health and care services.

The huge scale of the pay outs are potentially crippling for CCGs who are already showing cracks under the strain of increasing workloads. Key initiatives of local authorities may have to be put on hold to provide for emergency cash pay outs.

The difficulties mean that families are being treated unfairly by being made to wait years for a decision to be made.

Calls have been called for a centralised system, similar to that in Wales, to deal with outstanding cases. This could relieve some of the strain from CCGs taking their own caseload. This would also ensure consistency in decision making, something lacking in the current process.

Disputes over who should meet costs of care

In order to qualify for fully funded NHS Continuing Care, it is necessary to demonstrate a primary health care need which is over and above the provision that can be made by a Local Authority Social Services Department.

The Department of Health closed down the retrospective review process by imposing deadlines in September 2012 and March 2013. These deadlines now prevent any application being made for un-assessed periods of care prior to April 2012.

Claims can however still be made for on-going care needs after that date and it is still possible to appeal against a previous refusal of fully funded care although time limits may apply in some cases.

Janet Cooper, Head of Care Home Claims at Simpson Millar, said: “The distinction between health and social care is blurred and is the source of the most disputes as to whether the Local Authority or the NHS should meet the on-going costs of long term care, the difference being that NHS care is free whereas the Local Authority will means test."

"The Courts have ruled that a Local Authority can only legally provide a very low level of nursing care, but historically the NHS have always tried to shift the burden. The Department of Health has been criticised by both the Courts and the Health Service Ombudsman for setting the 'policy bar' too high and many people needing care are meeting costs out of their own pockets that should be met by the NHS. The whole system is confusing and unfair. Successive Governments have failed to grasp the nettle whilst elderly people have had to sell their homes in order to pay for care. Legislation is needed urgently to sort out the mess.”

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