NHS Continuing Healthcare

Recent reports

The use of a top up fee where NHS Continuing Healthcare has been awarded is not permitted
NHS Continuing Healthcare

Two recent reports from the Competition and Markets Authority (CMA) and the Parliamentary and Health Service Ombudsman (PHSO) shed light on the murky world of how the NHS and care homes interact to care for your loved one.

As a general principle NHS treatment is free at the point of delivery: whether in hospital or at your local doctor surgery. It is also free if the care that you require amounts to a significant healthcare need and that could be in your own home or in a nursing home.

If awarded then it is meant to cover all the costs of an individual's care including the hotel side if in a nursing home. However it has become apparent that all too frequently the theory and reality do not meet.

In the first report, the Competition and Markets Authority recently took a large care provider to Court under Consumer Protection Laws because it was unfair and in breach of the NHS core principles, it charged its residents a top up over and above the fees covered by the award of NHS continuing healthcare.

In a second report the Parliamentary and Health Service Ombudsman criticise the NHS and its Care Commissioning Groups ("CCG") for failing adequately to assess patients for NHS continuing healthcare in a report entitled Continuing Healthcare: Getting it right first time.

The PHSO also pointed out their failings in ensuring that the CCG's covered all the assessed costs of their care such that there should be no top up payable.

Putting both reports together it sends the clearest message to both CCG‘s and nursing homes that the use of a top up where NHS Continuing Healthcare has been awarded is not permitted.

So, if you have a relative in a nursing home who has been awarded CHC funding you may need to have a conversation with both the home and your local CCG. In addition a refund may also be due for past care overcharged.

If you would like to speak to someone about this issue, please contact our Wills, Tusts and Probate Team on 01733 882800 or email via info@hcsolicitors.co.uk.

Henry Anstey, Partner 

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This article has been prepared for general interest and information purposes only; it does not constitute legal advice and should not be relied on as such. While all possible care has been taken in the preparation of this article, no responsibility for the accuracy and/or correctness of the information and commentary set out in the article, or for any consequences of relying on it, is assumed or accepted by the firm or the authors.