Nursing Care FAQs
Who is eligible for NHS continuing healthcare?
If you demonstrate a primary health
need then the NHS must pay for your care in full, regardless of
your personal wealth. Read more.
How do I find out if I’m eligible for NHS continuing
healthcare?
The Primary Care Trust or Health
Board must take reasonable steps to ensure that an assessment for
NHS Continuing Healthcare is carried out. Staff should follow the
National Framework guidance to assess a person. The process is
different in England and Wales.
In England, the relevant guidance
is the Department of Health’s National Framework for NHS continuing
healthcare and NHS-funded nursing care. A copy can be obtained from
their website.
In Wales, the Welsh Assembly
Government produced a new Framework for Continuing NHS Healthcare
in May 2010. The relevant document is the Welsh Assembly Government
Circular: 015/2010. A copy can be obtained from their website.
How are patients assessed for NHS
continuing healthcare?
A person is assessed by the Primary
Care Trust or Health Board. The assessment should consider the
individuals social and health needs. You or your representative
should be fully involved in the process and should contribute to
the discussions.
In England, the first step is for a
checklist to be undertaken. If they feel a full assessment needs to
be done, at least two professionals should complete the Decision
Support Tool which is a tool to assist in making a decision about
eligibility. The system is slightly different in Wales.
The assessment will be looking at
the totality of the care needs but will in particular consider 12
care domains which include cognition, behavior, nutrition and
mobility.
What happens if a person in the
care home is found eligible for NHS continuing healthcare?
You will be funded by the NHS. Your
nursing needs will be re-assessed after 3 months from the date of
the assessment and annually thereafter. If you are in receipt of
benefits (Attendance Allowance or Disability Living Allowance)
these may be affected and you should contact the Department of
Works and Pensions.
Should I be paying my care and
nursing home fees?
If you demonstrate a primary health
need then the NHS must pay for your care in full, regardless of
your personal wealth. Read more.
How do I know if I have a nursing
care claim?
The first step is to complete our
online form or contact the nursing care team on
029 2039 1108 or email nursing.care@hughjames.com
giving us an overview of your situation. Using this information we
will be able to let you know if you have a claim.
You will not have incurred any
costs at this point; our free assessment will help you decide
whether to challenge the decision on your care home fees and there
is no obligation to proceed.
Why should I use the Hugh James
nursing care team?
The Hugh James nursing care team is
regarded as one of the leading solicitors in this area of law with
an experienced and specialist team who have successfully challenged
many NHS care funding decisions to recover over £18 million in
wrongly paid fees. The team works with clients across the whole of
England and Wales.
The department has received
widespread recognition for its work and won a Law Society
Excellence Award, which is a mark of excellence and quality. The
team are regularly turned to by the press as a commentator on this
area and their cases have featured on The One Show, ITV Tonight,
Which? magazine, Daily Mail and the Alzheimer’s Society magazine –
Living with Dementia. Our cases in the press.
Hugh James is regulated by the
Solicitors Regulatory Authority (SRA) and complies with the
solicitors code of conduct. The Hugh James nursing care team is the
leading and most experienced team in the niche area of continuing
healthcare.
Why do solicitors specialise in
recovery of nursing care fees?
Primary Care Trusts in England and
Health Boards in Wales can often make arbitrary NHS care funding
decisions based on the ability to pay rather than health needs. As
a result you may not receive NHS care funding even if you are
eligible and our nursing care fees recovery department specialise
in recovering these wrongly paid fees. Read
more.
What’s the process for making a
claim to recover nursing care fees?
There are lots of reasons why NHS
continuing healthcare decisions may be wrong. If you are paying for
your own care and have been refused funding then you may be able to
reclaim these fees. Read more.
How would my nursing care claim be
funded?
There are a number of different
ways in which a claim may be funded. Which method of funding the
claim is the most appropriate will depend on personal
circumstances. Read more.
What are the capital limits?
If you are not eligible for NHS
continuing healthcare then it is the local authority (social
services), rather than the NHS who are responsible for the care.
Unlike the NHS, social services are able to assess the individual’s
ability to pay. This will mean that they do a financial assessment.
Read
more.
Can I find out about successful
cases?
Hugh James nursing care team have,
to date, recovered over £18 million pounds for our clients.
Read
about some of our successful cases.
If an assessment has been done, can I challenge a
decision?
Yes. However, you cannot simply
appeal because you disagree with the outcome of the decision. You
can ask for a review of the decision to refuse funding if the
correct procedures have not been followed or the application of the
eligibility criteria have been incorrectly applied.
In the first instance you should
direct your appeal to the Primary Care Trust in England or Health
Board in Wales. The review system in England and Wales are
different and can be complicated.
Is it possible to make a claim
even if the individual is now deceased?
Yes, it is sometimes possible to
retrospectively claim back money paid on nursing care home fees and
we have successfully done this for clients. To date, we have
recovered over £18 million pounds for our clients. Please contact
our nursing care team for a confidential discussion on 029 2039
1108.
Can I act on behalf of someone else?
Yes, it is possible to act on behalf of a friend or
relative.
How can I claim back money that shouldn’t have been paid in
fees?
The first step is to complete our
online form or contact the nursing care team on
029 2039 1108 or email nursing.care@hughjames.com
giving us an overview of your situation. Using this information we
will be able to determine if you have a case for claiming back fees
already paid.
If a claim is successful, what
money can be claimed?
The person or the estate will
receive a ex-gratia payment from the Primary Care Trust or Health
Board. The aim is to place you back in the financial position you
would have been in had the correct decision been made at the outset
and to remedy any injustice or hardship as a result of the
incorrect decision. This will include the care fees paid and
interest.
Is there a time limit on making a
claim?
Cases should be made in a timely
manner. In England, a retrospective review can be done from April
2004. In Wales, the Welsh Government in August 2009 announced that
all claims where a person was in a care home prior to April 2003
needed to be registered before 4 December 2009. Therefore,
retrospective claims can be made from 1 April 2003 only.
Hugh James is based in Wales; can
I make a claim with you if I live in England?
Yes, we deal with a whole range of
clients across England and Wales.
