Nursing Care
WHEN SHOULD THE NHS PAY FOR LONG TERM NURSING CARE?
Or do you have to pay yourself and even have to sell your home to do so?
If you need significant nursing care , whether in a nursing home or even
in your own home, and if your PRIMARY need is nursing care (as opposed
to social care where nursing is merely ancillary or incidental to the
provision of residential accommodation) then the NHS should be funding
your care IN FULL and not just the relatively paltry Registered Nursing
Care Contribution (RNCC). This may even be so if day to day care is given
by experienced family members or by carers who aren’t themselves
nurses.
Nursing as an incidental part of social care has, by contrast, always
been self funding, subject to Local Authority funding being available
if your assessable capital falls below £21,500 (April 2007).
The dividing line between the two levels of nursing care has always been
a grey area bedevilled by inconsistencies of criteria applied by different
health authorities (SHAs) and also by overlap and inconsistency with criteria
for other benefits such as RNCC. Some criteria have been held by courts
to be unlawfully high and over restrictive and others often to have been
misapplied
Because of these inconsistencies, which have been even more marked in
the past, SHAs at the instigation of the Health Service Commissioner (the
Ombudsman), have agreed to review assessments going back as far as 1st
April 1996, but this may shortly be restricted to 2004 onwards.
So here is your opportunity! And where we can help.
Retrospective review - The first step is to gather evidence – obtain
copies of past assessments, and get legal and medical advice as to whether
they should be challenged
Current Care – ask for assessments to be made by your local PCT
and also possibly obtain specialist independent medical reports
If the outcome of either assessment is unsatisfactory , we at Hewetts
can, in conjunction with your nursing care provider/s, closely examine
the assessments against the relevant Eligibilty Criteria and where appropriate
1. seek review
2. if review outcome considered to be wrong, direct a complaint to the
Health Services Commission
3. if still dissatisfied, then to refer the issue on to the Ombudsman
and advise as to what evidence and representation is required at each
stage.
Keeping outside the court system and heading for the Ombudsman is usually
more successful and certainly far cheaper.
.
Contact Robin Gambles of our Private Client Department:
or his secretary on 01189 559603
Email: r.gambles@hewetts.co.uk