NHS Continuing Care

A number of care home owners will already have received requests, usually from solicitors, for information about the eligibility of residents in their home for NHS continuing health care.

Requests of this sort are likely to increase over the next few months so it may be useful for owners and operators to understand the reasons for the approach and to consider what your response should be.

The issue concerns residents in care or nursing homes who are paying privately and the main or a majority part of the care they require is focused on addressing and/or preventing health needs. In such circumstances it may well be that their fees both in the past and in the future should be funded by the NHS. Even if the resident concerned has died, a claim can still be made for a refund of past fees.

The NHS have announced new deadlines for people wishing to make such a claim.

• For cases where the person believes they might have been eligible for NHS funding between the period 1 April 2004 and 31 March 2011 the deadline for individuals or their families and representatives to notify the relevant PCT will be 30 September 2012.

• For cases between 1 April 2011 and 31 March 2012 the relevant deadline to notify the relevant PCT will be 31 March 2013.

As a result of these deadlines, solicitors and other organisations representing current residents or executors of deceased residents are gearing up to make applications for an assessment of their eligibility for NHS funding, hence the letters from solicitors, the volume of which will almost certainly increase as the deadline dates approach.

The first point to make from a care home owner’s point of view is that no claim is being made against you for a refund of any fees. You may well however be asked to assist the proposed claim by providing details such as the fees paid and the relevant period of occupancy as well as information and records relating to the individual’s health care (such as the relevant care plan).

An individual is entitled to receive information constituting any personal data. However, you are not obliged to supply any information unless the person requesting it has made the request in writing and you have been paid the fee you have asked that person to pay (not exceeding the prescribed maximum explained below). You will have 40 days to respond to the request.

Clearly there will be some cost to care home owners in providing this assistance and the question arises whether you can claim this cost from the person requesting the assistance. The answer is that you can ask for your reasonable expenses to be covered, for example the cost of retrieving documents from storage and copying them and sending them to the person making the request. However, there are limits to the amounts you can ask people to pay. Where the documents relate wholly or partly to that person’s personal health records* the maximum fee is £50. If the personal data is not health related, the maximum fee is £10. VAT cannot be added to these fees.

The approach of these deadlines may also be an opportunity for care home operators to review whether any of their residents may benefit from making a continuing care application. In some cases it may be that a resident in your home is receiving treatment for a health condition but is finding meeting the fees a problem (for example, their house is waiting to be sold). It may be possible to put the funds of a resident in this situation on a better footing, and thus assist your cash flow, if a claim is made for continuing care within the deadlines mentioned above.

* A “health record” means any record which “consists of information relating to the physical or mental health or condition of an individual; and has been made by or on behalf of a health professional in connection with the care of that individual”.