Frequently Asked Questions
Do we have to use your services?
No. You have access to exactly the same complaints procedure that we do.
Why should we use your services?
Although it is called the NATIONAL Health Service, it should be more correctly called the LOCALISED Health Service. There is a set of rules and regulations published by the NHS centrally, but in our experience the way in which the rules are interpreted can vary significantly from one CCG (Clinical Commissioning Group) to another. For example, we had a claim refused at the very early stage because the CCG stated that as the patient in question was in a residential home, not a care home, they did not qualify for funding. This is simply not true, and we were able to direct them to the paragraph and clause of the national guidelines that backed us up. The case was re-opened as a result.
Wasn’t there a deadline for these type of claims?
The NHS did set a deadline for RETROSPECTIVE claims of September 30th 2012 but this does not apply to patients currently self funding in care homes. Patients are required to be assessed for funding “at least” annually. In our experience that just doesn’t happen. Currently tens of thousands of patients and their families are paying fees from their own assets needlessly.
Funding is available for qualifying patients and is not means tested.
My relative suffers from a form of dementia. Won’t they qualify automatically?
Unfortunately not, otherwise virtually every person residing in a care home would be funded, costing the NHS £5 billion per year. For patients to get funded the process is extremely complicated. Many factors are taken into consideration, in particular how one aspect of a patient's health will affect another.
My relative can afford to pay the fees. As they are fairly well off can they still be funded?
Absolutely. Continuing Health Care funding is not means tested. The sole criterion that they need to meet is to have a proven Primary Health Need.
What will CHC funding pay for?
The funding will cover the cost of basic care, and the amount of funding varies on a regional basis as you will appreciate. The funding will not pay for extras like hairdressing, trips out, treatment from private practitioners e.g. chiropodists, physiotherapists, etc.
What if the patient dies whilst the claim is being processed?
The claim will continue and we will claim back for as far as possible. Any funds go to the deceased’s estate.
How does the claims process work?
Very briefly, if we believe that there is a case to answer we submit our report, prepared by one of our independent experts, to the NHS stating why we believe the patient qualifies for funding and insist that the relevant CCG fulfil their Statutory Duty and assess the patient to see if they have a Primary Health Need.
Going forward - we claim for ongoing funding.
Looking back - we claim a rebate of funds that have been paid by the patient unnecessarily.
Should our claim be refused we study the reasons for refusal and prepare our appeal at local level. If we are still refused we take the case to the next stage, NHS England and put our case before an Independent Review Panel. If the panel find in our favour the CCG must abide by that decision.
However if the panel find against us we have the option to take the case to the National Health Ombudsman.
Once we accept a case, and until we are given sound reasons why funding should not be granted, we will pursue the matter as fully as possible.
In our opinion too many CCG's reject perfectly valid cases out of hand and work on the basis that people will become frustrated and simply give up. We never give up on a valid claim.
How long does the process take?
That varies tremendously and depends upon the patient’s state of health, and the attitude of the CCG they come under. Some CCG's are more patient friendly than others. Around nine months is about average, but as a result of pressure from us and firms like us the NHS are increasingly outsourcing the investigation of cases and we are noticing a quickening of the pace. We have also been able to get many CCG’s accept that funding claims for living patients should take precedence over those for the deceased.
Why do you require an up front fee?
Our one off fee of £750 including VAT is only a small contribution towards the cost of running a case, and please bear in mind that we are looking to get our clients funding worth thousands of pounds a month plus tens of thousands of pounds in refunds.
By making a financial contribution we can be confident that our clients are serious about making a claim, and will give us their co-operation when we need it. Please go to the "Our Fees" page for more details.
Why is your service only available to patients residing in England?
Because different rules apply in Scotland and Wales, and we do not have a presence in Northern Ireland.