Should the NHS be paying care home fees?

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In this short article we look at a question that is often asked, ‘Should the NHS be paying care home fees?’

Under the NHS Continuing Healthcare Funding Scheme the Primary Care Trust (PCT) will pay the cost of a qualifying resident’s healthcare costs, regardless of their financial circumstances. The costs that can be recovered include not just healthcare but also personal care, accommodation and board in a nursing home.

The key to accessing this free healthcare is a multi disciplinary assessment, which produces a “decision support tool” (DST). This DST forms the basis of the evidence which goes before the Independent Needs Assessment Panel.

Where a resident thinks they might be entitled to free healthcare they (or a friend, relative or attorney on their behalf) are entitled to ask for the assessment to be undertaken. Generally the resident would be invited to contribute their views towards the assembly of the DST. Once the DST has been prepared the Independent Needs Assessment Panel will use it to arrive at their decision.

A resident can ask to see a copy of the DST and to review the Independent Panel’s decision in light of the information they have before them.

If unhappy with the panel’s decision the resident may either challenge the validity of the DST on the basis that it was defective, for example, because the resident had not been given the chance to have any input. Such a challenge would result in a new DST being prepared.

Alternatively the resident could ask for a fresh healthcare needs assessment to be carried out which again, would, once prepare, go before the independent assessment panel.

Finally, if the resident is still unhappy with the panel’s decision he or she may formally appeal the decision of the independent assessment panel, which could ultimately result in a judicial review of the decision making process.

The assessment is crucial in determining whether an applicant is eligible for a refund of care home fees previously paid on a private basis. If you wish to claim a refund of care home or residential home fees then contact us for a FREE review of the merits of your case. If we agree that you have a good case then we may be able to pursue your claim on a no win, no fee basis.

For more information about ‘should the NHS be paying care home fees?’ call us now on 0808 155 6389 or complete our dedicated Continuing Healthcare Questionnaire for a free case assessment.