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Could you be eligible for NHS Continuing Healthcare?

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 £200 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.

We are also able to support our clients access NHS Continuing Healthcare funding even if they have not started paying for nursing care fees.

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Key contact

Lisa Morgan

Partner

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 been instrumental in developing a niche legal department in Hugh James, which comprises of 40 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

Free no obligation assessment

We offer a free assessment to help 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.

Why should you use a solicitor?

Our team of specialist nursing care lawyers can help you whether you need to request a NHS Continuing Health Care (CHC) assessment, make an appeal for an CHC funding decision or you need to claim back nursing care fees that should not have been paid. We will always do our very best to get you the result that you are looking for. However, there are very strict deadlines so it is important that you fill in the form below as soon as possible to give you the best chance of success.

Our team have been working in this area for over 15 years and have been successful for over 6000 families in securing free funding. We have also recovered £200m for our clients. The most any one firm has recovered in the UK.

There are many firms who provide advocacy services in this area, so why should you instruct a solicitor?

  • We act independently and will also provide you with an impartial appraisal of your case
  • Solicitors are regulated by the Solicitors Regulatory Authority. This confers many benefits:
  • The SRA imposes a strict code of conduct and we must act independently and in our clients best interest
  • Regulation also provides clients with certain protections should things go wrong:
    • Solicitors must have professional negligence insurance
    • Solicitor firms must have complaints procedure if you are unhappy with the service received
    • The Legal Ombudsman can be contacted to investigate complaints if you are not satisfied with an internal complaints procedure

As solicitors we must be open and transparent about the cost to instructing us. We offer a number of funding options which will be provided to you in writing. It is important you fully understand the options available to you.

It is possible for you to pursue a claim independently without instructing a solicitor or advocate. However, it is a difficult process and we have many clients who have initially tried themselves and found the process challenging.

There are many companies who specialise in this area. However, as solicitors we are regulated and very experienced in what we do.

The team at Hugh James have more than 15 years of experience and have won awards from The Law Society and Age Cymru for their work.

Some of our clients question how non-medically qualified professionals can challenge health decisions. Whilst the people making decisions regarding eligibility for continuing healthcare are health and social care professionals, their decisions are being challenged and it is our job to demonstrate they are unsound by analysing medical evidence and applying it to the criteria. Whilst the process is not legal, it is a dispute resolution process and many Independent Review Panel chairs are former solicitors and barristers.

Due to Hugh James experience and depth of knowledge, we are respected by health and social care professions and panel chairs for the work we do.

The skills developed by lawyers – analytical, evaluating, interpreting and advocacy is key in being successful and it is of no surprise that all companies employ law graduates to undertake this work.

Unlike solicitors, unregulated advocacy companies are not obliged to provide clients with the best advice and be clear and transparent about their charges. They cannot advise on the option of court proceedings against health authorities for unsound decisions by way of Judicial Review, as they cannot by law undertake reserved legal activities. NHS Continuing Healthcare: Can you challenge an Independent Review Panel decision?

The other added advantage of instructing a solicitor is protection if something goes wrong. Sadly, we have seen first-hand, companies not providing accurate advice leading to clients losing the chance to proceed or companies no longer being in business. Solicitor practices are far more stable, but in the unlikely event that something does go wrong, clients can at least rely on solicitor’s professional insurance policy. They can also have recourse to the Solicitors Compensation Fund.

While we will ask the case proceeds as soon as possible, we have no control over the speed in which the health authorities progress the claim and it depends on the decisions made by the health authority. In our experience, it takes 24 months for a case to reach a retrospective panel. However, current assessment should be undertaken in a timely manner and are usually completed within 3-6 months. We will always keep you up to date as your case progresses.

Our team have been working in this area for over 15 years and have been successful for over 6000 families in securing free NHS funding through current assessment and/or retrospective reviews.

We provide a free initial assessment and we will advise you at the outset whether you have a case.

We have recovered £200m for our clients. The most any one firm or company has recovered in the UK.

Read what our clients say about our service here.

We act on behalf of individuals, families and for advocates. We instigate current assessments, appeals and retrospective reviews. We have also acted for families in securing s.117 aftercare funding from the local authority and in cases where families are paying a top-up. We will also proceed with bringing court proceedings against health authorities by way of judicial review claims Link to NHS Continuing Healthcare: Can you challenge an Independent Review Panel decision? Blog | Hugh James.

We continue to appraise the case as it progresses and provide you with advice at each stage. We do not raise our client’s expectation and if we consider that your claim is unlikely to succeed at any stage, we will let you know. The NHS Continuing Healthcare appeal process is difficult for individuals and their families and it is not in our clients’ interest to proceed with a claim if it will fail.

Although the review process is effective and most claims settle, we cannot guarantee success.

If you remain dissatisfied at the end of the review it may be necessary at that stage to consider issuing court proceedings. The purpose of those proceedings would be to challenge the decision of the review panel. We should point out that challenging those decisions are not straight forward and the grounds for challenging are limited.

We are pleased to say most claims settle without the need to issue court proceedings. In the unlikely event that consideration needs to be given to issuing court proceedings we will discuss matters further with you at that stage and there will be no obligation on you to proceed.

How can we help?

We are the UK’s the leading law firm in the recovery of wrongly paid care costs. We have a 60% success rate and have recovered over £200m in wrongly paid care fees for patients and their families. Our biggest single recovery so far is £450,000, with an average settlement value of £30,000.

Our fees

We understand that instructing a solicitor may be daunting, but unlike advocacy firms, as solicitors we must be open and transparent about our costs. There cannot be any hidden charges.

Following a free initial assessment of your case, we offer a number of funding.

In most cases our clients are offered the choice of a ‘no win no fee’ Contingency Fee Agreement and an hourly rate basis. The Contingency Fee Agreement is popular with our clients as it provides certainty; they know exactly what we will charge if we win the case and it makes no difference how much time we spend pursuing the claim to a successful conclusion. In addition, there is peace of mind that if we pursue the claim and we lose, you do not pay us anything.

Retrospective cases

This is where money paid for care home fees is recovered.

If we succeed with a retrospective claim (monies are recovered), we take 25% plus VAT of the monies recovered.

It is common, as NHS Continuing Healthcare is based on the type and amount of care needs, that eligibility is only awarded for part of the period in care. Our average amount to recover is £30,000 and our average fee is £7,500 plus VAT.

Current assessments

Where someone is awarded free NHS funding.

If a current assessment awards full NHS funding, our fee is 25% plus VAT of the monies we preserve for you for the first four months, or until eligibility for NHS CHC is lost, whichever is first.

If, for example, the date of a current assessment is 1 June and eligibility is found and you were paying £800 per week, and over four months £12,800. You will pay us £3,200 plus VAT.

Hourly rate charging basis

All our clients are also offered an hourly rate option. Our current hourly rate is £180 plus VAT.

We will provide you with an estimate of costs. Giving an estimate at the outset of a case is difficult and is dependent on the circumstance of each case. Many of the factors which will influence the eventual amount of costs are unknown. Whilst it is difficult for us to say how long the claim may take and how much work we will need to do (since often this will depend on the way that the health authority deals with the claim) our estimate of our costs will be provided to cover the work for assessing all the medical records, advising on merit, requesting an assessment and appeals.

It is difficult to estimate how much time is spent on a case, but we suggest a typical case from start to finish will be 40-60 hours.

We regularly update you on the costs incurred. Our costs are payable win or lose on an hourly rate basis.

Will there be any surprise costs at any time

No. At the outset of the claim, we will write to you to explain the funding options. As a firm of solicitors, we must be clear and transparent about our costs.

Whilst we do not envisage you will be unhappy with the cost or service we provide, it is good for you to know that if you were unhappy, unlike unregulated advocacy companies, you can make a complaint through our internal complaints procedure. If you are not satisfied once you have been through our complaints procedure, you can contact the Legal Ombudsman.

Below are some examples of how we helped our clients

Family of 94 year old recover £36,000 in wrongly paid care fees

Mr F J Clow

Case Study: Mrs Hilda Underwood from Essex

Mrs Mabel Etherington from Essex

Reclaiming nursing care fees | A nephew’s story
View More

Your questions answered

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.

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 £200 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.

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

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.

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.

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.

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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