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 here: Are you eligible for NHS Continuing Healthcare? 

How do I find out if I’m eligible for NHS continuing healthcare?

Contact the Hugh James Nursing Care team who will be able to conduct a free no obligation assessment.

Call us on 0800 652 5523 or complete our enquiry form.

How are patients assessed for NHS continuing healthcare?

A person is assessed by the Clinical Commissioning Group or Health Board. The assessment should consider the individual’s social and health needs. You or your representative should be fully involved in the process and should contribute to the discussions.

There are two stages to the process; a checklist assessment and the Decision Support tool. You can read more about the stages here:  Are you eligible for NHS Continuing Healthcare?

What happens if a person in a care home is found eligible for NHS continuing healthcare?

When someone is found eligible for NHS Continuing Healthcare then their care fees will be funded by the NHS. Care needs will be re-assessed after three 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; you should contact the Department of Works and Pensions for more guidance.

Why should I work with 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. The department was set up in 2006, since then we have successfully challenged many NHS care funding decisions to recover over £125 million in wrongly paid fees.

For more reasons our clients choose to work with us, see Why choose Hugh James Nursing Care for your NHS Continuing Healthcare claim.

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.


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

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.

To receive a copy of the questionnaire, simply call 0800 652 5523 or complete the enquiry form here.

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. Usually, a claim will be funded in one of the following ways:

  • Conditional 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.
  • 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.

If an assessment has been completed but a negative decision has been made, can I make an 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 even if the individual is now deceased?

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.

Can I act on behalf of someone else?

Yes, it is possible to act on behalf of a friend or relative.

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.

Hugh James is based in Wales; can I make a claim with you if I live in England?

Yes, we deal with a wide range of clients across England and Wales.

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