Why eight out of 10 claims for funded nursing care fail
Posted on 25th August 2023
Many people are paying for their nursing home care from their savings or by selling their home. This is despite provision for the NHS to pay for their care.
If you can’t look after yourself at home any longer, your local authority or the NHS should provide your care. If you don’t need nursing care your local authority will carry out an assessment to decide how much you should contribute. Your care will only be fully funded if your assets fall below £23,250. If you need nursing care, the NHS should pay.
Deciding who receives NHS care
In England your local NHS Integrated Care Board (ICB) carries out continuing healthcare assessments. Data shows that between April 2022 and the end of March 2023 almost 49,000 continuing healthcare assessments took place. Almost eight out of 10 did not lead to NHS funded care.
If you’re in this position it’s important to understand the NHS rules and challenge professionals throughout the assessment process. It’s best not to assume that clinical judgements are correct or that those carrying out the assessments understand the process.
When you should receive continuing healthcare funding
There’s a lengthy National Framework document containing rules concerning NHS continuing healthcare funding. However, many nurses and social workers don’t fully understand it. If you can, read the document thoroughly yourself so you know your rights. Helpful advice and resources are also available online.
The assessment of your ‘primary health need’ should take place at a multi-disciplinary team (MDT) meeting. The Framework says this must include at least one NHS clinician and one local authority social worker. Assessments should not be made on the basis of a visit to a care home by a single professional.
Two steps are needed in the assessment. One is clinical, based on an NHS decision support tool. The second is legal, based on the rules (paragraph 60) of the Framework. In some cases, the local authority can provide services to meet your needs. However, in most cases they can’t provide the level of care available in nursing homes. If you need care in a nursing home you should qualify for NHS funding.
Funding should be provided if most of your required care is to address or prevent health needs. If you aren’t satisfied with the process you can complain to the ICB and nursing and social worker professional bodies. If you’re successful you or your loved one will start receiving free care and might also get a refund.
This is obviously a very challenging process. Making sure you have Lasting Powers of Attorney in place can help if you’re in this situation. You can choose someone to act on your behalf if you no longer have the capacity to make decisions for yourself.
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