In a recent article, the Financial Times highlighted the risk of litigation if a financial adviser fails to consider NHS Continuing Healthcare when selling a care annuity.
With the average amount paid per year now over £45,000, care fees are expensive. Where an individual has assets above the threshold to qualify for a contribution from the local authority (£23,250 in England, £50,000 in Wales) and are self-funding, they, or their families, may turn to a financial adviser for advice on making their money last.
NHS Continuing Healthcare is a complete package of ongoing care arranged and funded by the NHS for persons to meet physical and mental health needs, which have arisen as a result of disability, accident or illness. The package can be provided in a care home, hospital or in the individual’s home.
Not everyone will qualify for this type of funding and there is a robust assessment process that must be completed. Eligibility depends on whether or not it can be shown that the individual has a primary health need.
The National Framework governs the principles and processes of NHS Continuing Healthcare. Who is eligible for the full funding is not clear and the framework provides guidance and tools for assessors. The test looks at whether the nursing or health services required by the individual are more than incidental or ancillary to the provision of accommodation and whether the services provided go beyond that which a local authority would usually be expected to provide. The Framework also provides an appeal process if you disagree with a decision.
Sadly, many people are not assessed or are assessed too restrictively leading to incorrect decisions. This may be because of the previous experience of well-meaning carers, or hospital staff, who have developed their views based on their own limited experiences rather than on a detailed knowledge of the Framework.
There is also an increased number of individuals who are assessed by the assessors as eligible for the funding, but clinical commissioning groups will unlawfully not grant funding. The Framework states that this should only happen in exceptional circumstances and for clearly articulated reasons.
At Hugh James, our nursing care team specialise in reclaiming wrongly paid care fees. To date, we have recovered over £150 million for our clients. We work with a number of financial advisers to help them understand when a client of theirs may be eligible for NHS Continuing Healthcare.