By Rosalind Hughes, founder, Just Caring Legal
Is your family member receiving NHS Continuing Healthcare? If so, they should have an NHS Continuing Healthcare care and support plan. Without one, it is impossible to ensure they have sufficient funding to cover their needs. Increasingly, NHS CHC funding is being capped at an arbitrary rate. without any clear plan as to how to obtain sufficient good-quality care for that price.
Under the NHS Continuing Healthcare framework, the Clinical Commissioning Group (CCG) is responsible for care planning, commissioning services, and case management. Once it has established that someone is eligible, the CCG should produce an NHS Continuing Healthcare care and support plan. This must identify all of the person’s care needs and propose a care package to meet these in full.
The lack of an NHS Continuing Healthcare care and support plan can lead to shortfalls in care
However, in far too many of the cases we are seeing, the CCG has missed out this vital step. In many scenarios, there is no NHS Continuing Healthcare care and support plan at all. Nothing on paper for the care recipient or their family can refer to. Where there is a plan, it often fails to provide sufficient detail. It means neither the person, their family nor indeed their care providers are clear about what exactly the care package should include. This can lead to all manner of problems. Care providers may ask families to “top up” the NHS CHC (which is illegal). Families may step in, thinking they must fill the gaps in care themselves. Often they give up their own jobs to do so. Or vulnerable people might just be left without the level of care they need – often with catastrophic consequences.
The Ombudsman has sounded the alarm on NHS Continuing Healthcare care and support plans
The PHSO, who handles complaints about NHS Continuing Healthcare, revealed the scale of the problem in a recent report. He stated:
“We have seen in several recent cases that too often care and support plans have not accurately identified a person’s needs in full. For example, a woman with significant care needs who had been receiving 24-hour NHS CHC-funded care had her overnight care removed. This was an arbitrary decision by the CCG which was not backed up by its own evidence on her care needs. As a result, her family had to pay £33,000 from their own funds for overnight care until our investigation resolved the situation.” Thanks to the ombudsman, the CCG later returned the money to the family.
“Sometimes, we have seen that a care and support plan has not been produced at all, meaning people have faced no choice but to self-fund some of their care. For example, one man received only a 15% contribution to his care costs from a CCG who had failed to produce a care and support plan. This meant he paid out almost £250,000 for care.” In this case, too, the CCG reimbursed this money after the ombudsman’s intervention.
“Others have had to draw on additional unpaid care and support from their families. For example, one family paid for private care and provided additional care themselves as a result of the CCG not producing a plan to support a woman to live at home. This CCG’s decision to place an arbitrary cap on the level of NHS CHC-funded care meant her family paid for £187,000 of care privately and provided care worth a further £90,000.”
Many struggling families are falling through the net
These families, believe it or not, were the lucky ones. Most never see the hard-earned cash they wrongly pay to meet illegal shortfalls in NHS funding. Only a fraction of complaints regarding NHS Continuing Healthcare make it as far as the ombudsman. More than 175,000 patients received referrals last year for NHS Continuing Healthcare. Yet between April 2018 and July 2020, the PHSO made decisions on just 336 cases. Of the 150 cases he investigated, he found failings in 55. That suggests that many thousands of individuals and their families are falling through the net. Are you one of them?
Is your family member eligible for NHS Continuing Healthcare, only for the funding to be insufficient to cover the care they need? Has the CCG refused to supply you with a full care and support plan? Have they threatened to cap their funding at an arbitrary figure, far below what the care provider charges? Perhaps you are having to make up the shortfall yourself?
If this sounds like you, please get in touch. As specialists in NHS Continuing Healthcare, we can commence effective challenges against CCGs that refuse to provide care and support plans. We can apply for refunds on behalf of families paying illegal ‘top up fees’. We can mount challenges if you have signed care home contracts for ‘extras’ when the NHS should be covering the full costs of care. And we will cut through the jargon and complexity and explain everything to you in a way you can understand, minimising your stress and maximising your chances of success.