Overview

Our Nursing Care department is one of the leading national experts in the recovery of wrongly paid care home fees; our specialist nursing care team have successfully recovered over £150 million for our clients since the department was set up in 2006.

If an individual is in a nursing or care home because of physical or mental health needs, the cost of their care should be covered by the NHS Continuing Healthcare funding scheme, regardless of the individual’s wealth. However, with around 40% of Britain’s 440,000 care home residents self-funding their care, thousands of families in England and Wales could be wrongly paying care fees.

Therefore, if you or a relative are paying care home fees, you could be due a refund.

 

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Key contact

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare. She has acted for hundreds of clients in England and Wales in challenging current and retrospective decisions to refuse NHS funded continuing healthcare to long-term nursing home residents. Her department has successfully recovered over £150 million in wrongly paid nursing fees, as well as savings for the future.

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Free no obligation assessment

We offer a free assessment to help decide you decide whether you’d like to proceed with a case to reclaim wrongly paid care fees or not.

Please contact us to receive a copy of our questionnaire through the post. Once you have completed and returned this to us, a member of our specialist Nursing Care legal team will assess your case and will discuss whether they believe you should be eligible for funding with you. There is no obligation on you to proceed with a legal case after this point.

NHS Continuing Healthcare

Gaining NHS Continuing Healthcare eligibility can be difficult. To qualify, you must demonstrate your needs are:

  • Complex, intense or unpredictable;
  • Not incidental or ancillary to the accommodation your local authority is under a duty to provide; and
  • Not of a nature typically provided for by a social services department.

There are two key stages when applying for NHS Continuing Healthcare eligibility:

  1. Checklist assessment:
    This is a screening tool which determines whether an individual’s needs warrant completing the Decision Support Tool.
  2. Completion of a Decision Support Tool (DST):
    This is an assessment tool which is conducted to investigate whether an individual’s needs are primarily healthcare needs that would qualify for NHS Continuing Healthcare. The assessment looks at the full range of care needs, but focuses on 12 care domains which include cognition, behaviour, nutrition and mobility.
    As part of the DST, the individual in question will be given a level of need in each of the 12 care domains. There are six levels, ranging from no needs to priority.

If a patient’s level of need is assessed as being priority in any area, eligibility for full funding is automatic (however you should note that the priority level of need is only applicable to four of the 12 care domains). If a patient’s level of need is assessed as being severe in any two areas, eligibility for full funding is also automatic.

It is still possible to be found eligible without a priority or two severe measurements, however the rules are open to interpretation. The higher the level of need, the more likely it is that an individual will be found eligible for NHS Continuing healthcare.

 

Retrospective eligibility

To claim retrospective eligibility, we need to show that an individual’s health and nursing care needs were more than what a social services department could provide. If that’s the case, then their primary need would be for health and they would have been entitled to full NHS funding.

Quotes

Thank you so much for all the brilliant work you have done on behalf of me and my mother, Dorothy Clement. You are such a very excellent lawyer. I am so delighted with how you have handled my claim

Mrs S. Cornwall

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We would like to thank you for all the work and guidance. You were very professional and yet very approachable and gave us confidence to continue with the case. Thank you once again.

Mr and Mrs P. - South Wales

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Thank you for superb work on mum’s behalf; an excellent result. Many thanks.

Mr L. Bristol

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Thank you very much for all your work in my father’s case for NHS Continuing Healthcare. Your work was without doubt instrumental to the successful outcome.

Mrs R. Northants

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I’m writing to thank you for all your help throughout this appeal process. I just wanted to let you know how friendly, supportive and professional the support was when I attended a nursing care appeal in December. It made what could have been difficult so much easier. All through this journey you have kept me well informed and it has always been easy to communicate on the telephone if I needed an explanation or some guidance. In the end the appeal was successful - I could not have done any of this by myself. So thank you so much.

Ms I | Sussex

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A huge thank you to Hugh James for their unstinting support and professionalism regarding my mother's care home fees. It proved to be a long and complex case but we eventually achieved a good result.

Mr Nicholls | Cardiff

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All in all, we wouldn’t have got what we did without Hugh James. If we hadn’t been successful, it wouldn’t have been for lack of trying.

Mr Gibson | Hampshire

Your questions answered

What’s the process for making a nursing care claim?
 

The process will depend on a number of factors, such as whether you are starting your claim from scratch or if you are coming to us to appeal a negative decision; whether you are claiming on behalf of a loved one who has since passed away or has just moved into long-term care.

If you believe that you or a family member has wrongly paid care fees, then the first step is to complete our questionnaire. This will be assessed by our Nursing Care legal team who will be able to advise on whether or not you have a case, and if so, what the process will be. This initial questionnaire is free to complete and there is no obligation on you to proceed with a claim should you decide not to.

How are nursing care claims funded?
 

There are a number of different ways in which a claim may be funded. Which method of funding is most appropriate will depend on personal circumstances. We will always discuss funding with you before you become a client. Usually, a claim will be funded in one of the following ways:

  • Contingency Fee Agreement (no win, no fee)
    The majority of the clients we work with are on a no win, no fee structure and we will offer this whenever and wherever possible. This means that if your case is successful, we will take a percentage of the money you recover. If the claim is pursued and lost, you pay us nothing. The percentage we take and the terms will be explained in full before you are taken on as a client.
  • Legal expenses insurance
    You may have legal expenses insurance. This is most commonly found incorporated into existing insurance policies e.g. your home or motor insurance policies.
  • Trade Union
    If you are a current member of a trade union or other professional body, they may fund your claim on your behalf.
  • Private funding
    In this case you are responsible for legal expenses incurred on your behalf and will be billed on a monthly basis. You will be required to cover the legal costs of your opponent if your case is unsuccessful.
Why choose Hugh James for your nursing care claim?
 

We believe we are one of the leading national experts in the recovery of wrongly paid care home fees. Here are just some of the reasons why our clients choose to work with us:

  • We have recovered over £150 million in wrongly paid nursing home fees since the department was set up in 2006.
  • Our success and client stories are regularly featured in the press as we are recognised as leading the way in reclaiming wrongly paid care home fees. This includes The One Show, Dispatches, ITV News, The Telegraph, The Sunday Times and The Mirror.
  • We work in partnership with many of the leading older peoples’ charities, helping us to ensure our service meets the needs of the people we, and the charities, represent.
  • Unlike many other companies who focus on reclaiming wrongly paid care fees, we are a firm of solicitors regulated by the Solicitors Regulatory Authority (SRA) and comply 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, giving you complete peace of mind that your case is being dealt with by fully qualified lawyers who specialise in reclaiming nursing and care home fees.
  • The team is also one of the biggest teams focusing exclusively on this area in the UK with over 40 dedicated lawyers.
  • We promise to deal with your claim from start to finish and will not pass your claim on to a third party. We offer a complete service for you with dedicated team members to contact.
  • Head of the team, Lisa Morgan, won the highly acclaimed Law Society Junior Lawyer of the Year 2010 Excellence Award due to her work in this area. She was also recently awarded the Cardiff University Simon Mumford award. In 2017, the department was highly commended at the Age Cymru Awards in the large business category for its commitment to helping older people.
If an assessment has been completed but a negative decision has been made, can I appeal?
 

In theory, 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. You may also only be given a limited time to appeal a decision so it’s important you read any letters you receive carefully.

In the first instance you should direct your appeal to the Clinical Commissioning Group in England or Health Board in Wales. The review systems in England and Wales are different and can be complicated.

If you are a client of ours, we will conduct the appeal on your behalf with your authorisation.

Is it possible to make a claim if the individual who received the care has now passed away?
 

Yes, it is possible to retrospectively claim back money paid on care home fees even if the individual who received the care has now passed away. We have successfully done this for many clients.

What if you are not eligible for NHS Continuing Healthcare?
 

It is the local authority (social services), rather than the NHS who are responsible for care if you are found not eligible for NHS Continuing Healthcare. Unlike the NHS, social services are able to assess the individual’s ability to pay. This will mean that they will conduct a financial assessment.

There is an upper and lower capital limit. This means that if a person has savings which amount to more than the upper capital limit, they will have to pay the full cost of their care home placement until their savings reduce to that limit. If an individual has savings which are worth less than the lower capital limit, then a local authority social services department will fund the cost of care. A person who is in between the capital limits will have to make a contribution to their care costs on a tariff rate depending on how much they exceed the minimum.

Your savings include any money in bank and building society accounts, stocks and shares, and property (land and buildings). Any joint ownership is counted according to that person’s share.

The capital limits are different in England and Wales. Please check the Government website to find the capital limits where you live.

Which areas do you cover?
 

We deal with a wide range of clients across England and Wales.

Why do solicitors specialise in recovery of nursing care fees when you don’t need a solicitor to get NHS Continuing healthcare eligibility?
 

The application process for NHS Continuing Healthcare is very complex. Although you don’t need to work with a solicitor to get the funding, working with an expert in the field will significantly increase your chances of getting NHS Continuing Healthcare eligibility.

Clinical Commissioning Groups  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.

Many of our clients start working with us after starting to work through the process themselves, but struggle with the complicated system. Working with our team will give you the best chance of securing the correct decision.

There are a number of companies offering this service who do not have our experience and in some cases are not solicitors. A Legal Ombudsman report released in July 2011 revealed that thousands of people may be receiving sub-standard services from unregulated companies offering consumer financial products. Hugh James is regulated by the Solicitors Regulatory Authority (SRA) and complies with the solicitor’s code of conduct.

 

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