Care Funding Services Explained

Advisory Service

In simple terms, we will act as your relative’s advocate throughout the NHS Continuing Healthcare Assessment process if they are going to be assessed for CHC Funding for the first time.

This means that you and your relative will have access to our specialist legal knowledge of the Assessment process at all times. You will also have access to our specialist clinical advice as we work collaboratively with a team of experienced nurses to support our clients.

Whilst we understand the legal requirements, our experienced team of nurses understand the clinical basis of the Assessment process.

If we believe that your relative is eligible for Funding, then we will offer to act on your/their behalf as their advocate and we will explain the costs associated with providing that service.

Once we have discussed terms, we will ask you to enter into an agreement with us.

In terms of our Advisory Service, the first step will be to arrange a date for the Checklist Assessment, through your Care Home. If the Checklist Assessment is positive your relative will be referred for a Full Assessment (using a Decision Support Tool). If the Checklist Assessment is negative, you may wish to send us a copy of the Checklist to review so that we discuss the next steps with you.

Once we have a Full Assessment date, one of our experienced nurses will attend the Assessment with both you and your relative. The nurse will come to see you and your relative ahead of the Full Assessment to understand their condition in more detail. Remember, at this stage we already believe that your relative will be eligible for Funding based on the information provided via our Clinical Review Service – see below.

The Full Assessment at a Multi-Disciplinary Team meeting (MDT) is the key. Our experienced nurses will ask the NHS Assessor to go through each of the 12 Care Domains and explain the “score” they intend to allocate to each Care Domain. If our nurse disagrees with the NHS Assessor about the “score” being allocated, they will put across their alternate view based on their clinical assessment of your relative’s condition and their view of what the “score” should be. In other words they will fight your corner, and ensure that the Assessment process is carried out fairly and robustly.

The advantage you have, is that all our nurses have years of experience in the Assessment process and know exactly how the NHS works and thinks.

Although we can never guarantee success, we have a very high success rate at Full Assessment meetings once we have established that there are good prospects of success.

Once the Full Assessment is complete, the NHS Assessor will make a recommendation for funding to a Panel within the CCG, who ultimately decide whether to approve funding. You will then be sent a copy of the outcome decision which we will review.

If the MDT denies Funding, and our nurse believes that the decision is flawed or wrong, we will discuss launching an Appeal on your behalf.

If Funding is agreed, you will be notified by the CCG who will arrange to make payments directly to the care provider. There will usually be a review, initially after 3 months, and then every 12 months after that.

Clinical Review Service

If you proceed with our Clinical Review Service, we will send one of our experienced specialist nurses to meet both you and your relative to carry out an independent assessment of their care needs, face to face.

Following the assessment meeting, our nurse will produce a detailed report which we will send to you setting out our nurse’s assessment of you relative’s care needs. This report follows the same format as the Decision Support Tool (DST) used by the NHS in determining a patient’s eligibility for NHS Continuing Healthcare Funding. The report will help you to understand, whether in our view, there is any realistic prospect of arguing that your relative should potentially qualify for NHS Continuing Healthcare Funding.

If our nurse’s report concludes that your relative may not qualify for funding at the moment, you will be able to use the report as a baseline and for comparison purposes, when monitoring important changes in your relative’s condition, in case they meet the funding criteria at any future re-assessment. Furthermore, the report will also give you the reassurance of knowing that the matter has been assessed objectively by a skilled nurse who has a wealth of experience in this specialised field.

If, following the Clinical Review Service, we believe that your relative could potentially qualify for NHS Continuing Healthcare Funding, we can offer further services to assist and guide you through the NHS process of applying for the funding (see our Advisory Service). Or, you can use the report to help you to apply for funding yourself.

Our Clinical Review Service is provided on a fixed cost basis, and can also be used prior to considering whether to appeal a decision where (a) funding has been rejected, or (b) existing funding is withdrawn.

Supported Assessment Service

It may be that you have already started the process of requesting an Assessment for your relative yourself. Or, you may have used our Free Guide to help you to start the process.

If you have already succeeded in progressing through the initial Checklist stage and are awaiting a Full Assessment date, or have a date scheduled for a Full Assessment, we can offer to assist you with our Supported Assessment Service.

By using this service, we will arrange for one of our experienced nurses to accompany you and your relative, as their advocate, at the Full Multi-Disciplinary Team meeting. You will provide our nurse with all the relevant documentation ahead of the meeting, and our nurse will arrange to meet you in advance to explain the process.

Our experienced nurses will ask the NHS Assessor to go through each of the 12 Care Domains and explain the “score” they intend to allocate to each Care Domain. If our nurse disagrees with the NHS Assessor about the “score” being allocated, they will put across their alternate view based on their clinical assessment of your relative’s condition, and their view of what the “score” should be. In other words they will fight your corner, and ensure that the Assessment process is carried out fairly and robustly.

We are often instructed at very short notice to provide support at a forthcoming Multi-Disciplinary Team assessment. However, unless we have had the prior opportunity to carry out our Clinical Review Service, our nurses will not have had the benefit of assessing your relative’s condition and care needs in advance of the assessment –  so there can be no guarantees of success; but you will still benefit from their support and experience, at what can often be challenging and adversarial meetings.

We offer our Supported Assessment Service on a fixed fee basis.

Reclaims Service

Our Reclaims Service helps families to reclaim care home fees and nursing home fees which have been paid incorrectly – perhaps because an individual in care was wrongly assessed as to their eligibility for NHS Continuing Healthcare Funding – or worse still,  never assessed at all!

In many cases, we act for the families of relatives who have passed away in care and often they have used their life savings, or had to sell their homes to pay for care unnecessarily and unfairly. Or a claim can stem out of an Advisory Assessment.

The process for our Reclaims Service is slightly different to the Advisory Service, because we are dealing with the issue of whether NHS Continuing Healthcare Funding should have been provided historically.

The process for claiming back care home fees incorrectly paid, follows a similar process to the Full Assessment. However, the assessment is done on a retrospective basis, using evidence from GP, hospital and care records, and any previous full Assessments that may have been carried out. Our specialist team of nurses will undertake our Records Review Service – a clinical retrospective analysis of the individual’s care needs, in order to advise you whether there are reasonable prospects of successfully reclaiming care home fees. The Records Review Service is provided on a fixed fee basis.

Once we have completed the Records Review Service, if we think that there are reasonable prospects of success, we may act for you on a Contingency Fee Agreement basis*, sometimes known as “No Win, No Fee”. That means that if we are unable to secure a refund, then you will pay us nothing. Our specialist solicitors will then present the arguments for reclaiming NHS Continuing Healthcare Funding to the CCG, for consideration at a Panel Meeting.

In some circumstances, CCGs agree refunds for part periods of care only, and our legal team then decide whether to appeal for refunds against those periods in dispute. There are also issues of interest payments due on the care costs paid, and again, our legal team are highly skilled at working out the often complex interest calculations, to make sure that the maximum entitlement is refunded.

Naturally, this assessment process takes longer because the NHS are also examining past records. If a refund of fees is denied, we will consider the reasons and may agree to launch an Appeal on your behalf.

To date our estimated average reclaim is £60,000 including interest.

Note: Some years ago, the Government imposed a deadline, such that any retrospective claims can now only be made for care costs paid after 31st March 2012. Care costs paid before that date cannot be reclaimed.

However, if you have already lodged a claim before 31st March 2012 which is ongoing, or has been rejected – we can help you reclaim payments made for care dating back to 2004.

In Wales, a similar deadline was imposed limiting claims to any period after 31st July 2013. However, their rules also state that the claim period under consideration will be no longer than 12 months from the date of the first application.

Free Assessment

Whether you need help with a current Assessment, or need help to recover previously paid care home fees, we can offer support.

The first step in either process is for us to undertake a Free initial assessment of your relative’s circumstances.

In order to complete a full Free initial assessment, you will need to contact us and provide  details of your relative’s care requirements and health needs.

If we don’t think that your relative will qualify for Funding at this stage, that’s by no means the end of the line. An individual’s health condition and health care requirements can change very quickly. We will be able to advise you on what to look out for in terms of your relative’s health, and you can contact us to discuss their condition as often as necessary, and our advice at this stage will always be free of charge.

If, after speaking to you, we believe that your relative may be eligible for Funding, then we will discuss with you what other services we can offer, as described above.

We are happy to answer any questions you may have about the process at any time.

Lasting Power of Attorney

Before any assessment for NHS Continuing Healthcare Funding can take place, your relative will need to provide their consent, which includes sharing their personal information with different organisations involved in their care, and of course sharing information with us as their advocate.

As long as your relative has the capacity under the Mental Capacity Act 2005, they can provide that consent either verbally, or preferably, in writing.

However, your relative’s capacity could deteriorate very quickly, and once it’s determined that they don’t have the capacity to make decisions for themselves, their advocate will have to apply to the Court of Protection for a ‘Deputyship Order’ in order to gain “control” over their affairs.

This can be expensive, and most importantly it takes time, which delays the process.

If your relative sets up a Lasting Power of Attorney (LPA) whilst they still have the capacity, then this issue won’t arise.

Under an LPA your relative grants control over their affairs to another person, usually a relative or close friend who they trust. They can in turn appoint us as their legal advocate to help with their Assessment.

There are two types of LPA: one covering your relative’s Health and Welfare, and another covering their Property and Financial affairs.

We strongly recommend that (you and) your relative set up both types of LPA immediately to help the process of managing their affairs in the future.

We offer a fixed cost service* to set up both types of LPA.

What do our Care Funding Services cost?

We charge for our services in different ways: some of our services are provided on a Fixed Fee basis, whilst others are provided under what’s known as a Non Contentious Business Agreement (NCBA)*. Essentially that’s a form of “No Win No Fee”  agreement, where we will only charge you if we are successful in securing NHS Continuing Healthcare Funding. If acting under an NCBA, and we do not secure Funding –  then we will not charge you anything, save for the costs of disbursements, for example obtaining medical records.

If we are successful in securing funding prospectively, you will pay a one off fee, based on a percentage of what your Care Costs would have been had you not qualified for funding. Our charges will only be based on the next 12 months cost of your Care.

A number of companies offer advisory services, where they will charge you an hourly rate (which can range between £80 and £250 an hour) just to talk to you about the process, regardless of whether they can help to secure funding for you. We don’t do that.

Also, be aware of organisations being too quick to tell you that you have a good case and requesting money upfront. In our opinion it is virtually impossible to advise on prospects of success without having had the opportunity to obtain and review full care records before providing an opinion.

We offer to provide our Reclaims Service under an NCBA, once we have established that there is a likelihood of success following a thorough review of the care records, for which we do charge a fixed fee.

We will always discuss all the funding options in detail with you before we agree to act on your behalf, to make sure you choose the option which is best for you.

Why use us?

First and foremost, because we are recognised nationally as experts in the area of NHS Continuing Healthcare Funding and already secured £millions in funding on behalf of families.

We are also a firm of Solicitors, regulated by the Solicitors Regulation Authority. That means that we have to work to a very strict code of conduct and ethics. It also means that we are covered by Professional Indemnity Insurance, which protects you at all times.

Other companies offering advisory services, who are not solicitors, will be operating on an unregulated basis, which means that they do not have to comply with any regulatory standards. It is also unlikely that they will have Professional Indemnity Insurance covering the advice that they may provide to you.

Some companies will tell you that it is not necessary to use a firm of solicitors because the advice you require is not ‘legal’ advice. That is true. But as solicitors, we have built up a wealth of experience and expertise in securing NHS Continuing Healthcare Funding on behalf of our clients over many years.

Equally as important –  we work collaboratively with a team of experienced nurses who have all worked for the NHS for many years in this specialist area. By combing the expertise of our solicitors and nurses, we believe we can offer you an unparalleled ‘one-shop stop’ service.

We also sometimes hear other companies saying that solicitors aren’t allowed to attend Full Assessment meetings or Appeal Meetings. That is simply NOT true. Under the NHS National Framework, anyone acting as your appointed advocate has the right to attend the meetings with you. The NHS might not like us attending, but that’s because they know that we have the expertise to ensure that you don’t have the wool pulled over your eyes!

Case Studies

Please read some of our Case Studies to see how relevant they may be to your current circumstances.