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Warnings on no-win, no-fee offers on NHS CHC claims

The question of NHS Continuing Healthcare (CHC) payments has been a challenging one for many.

Now the announcement of updated UK government guidelines have prompted renewed warnings from a group of organisations campaigning to improve CHC that they should be aware of their rights and be wary of no-claim, no-fee offers.

What is NHS CHC?

NHS Continuing Healthcare is a fully-funded package of care that some people are entitled to receive as a result of disability, accident or illness. It covers the full cost of the person’s care and residential accommodation and is available to adults living in England who have particularly intense, complex or unpredictable care needs.

It can be provided in a variety of settings outside hospital, including a home or care home. The NHS England website provides more information on CHC.

NHS CHS has a complex application process and is notorious for being difficult to achieve funding.

What has changed in the guidelines?

Making claims for past unassessed needs has been an option for some years. But now, amongst other things, the updated guidelines on Previously Unassessed Periods of Care (PUPoC) the transfer of responsibility from the applicant to the ICB to gather the relevant care records and documentation, and the introduction of a 12-month timescale to ensure all cases are completed in a timely fashion.

For further information, in-depth guidance and free resources on NHS funding for PUPoC visit beaconchc.co.uk/pupoc.

What are retrospective claims?

These retrospective assessments for PUPoCs are accessible for individuals who think they should have been considered for CHC funding at the time but were not, even if they did not apply at the time.

In November 2007 the opportunity to request a review where the majority of care had taken place prior to 1 April 2004 was closed.

A further ‘close down’ was announced on 15 March 2012, relating to requests between 1 April 2004 and 31 March 2012.

At the time this second ‘close down’ prompted a number of ‘no-win, no-fee’ claims firms to offer their services to potential claimants.

What is the CHA?

The Continuing Healthcare Alliance includes organisations including Parkinson’s UK, Age UK, the Alzheimer’s Society and Marie Curie. The Alliance has provided input to the updated guidelines.

Why is the CHA concerned about no-win, no-fee?

After the 2012 close-down, the NHS received nearly 60,000 new retrospective claims. The NHS was inundated with claims, with a huge 51,000 applications (85%) deemed ineligible, and fewer than 600 applications (10%) were approved as being eligible for funding.

The Alliance claims that many of the flurry of ‘no-win, no-fee’ claims firms were ill-informed of the assessment process, mismanaged expectations and encouraged applications regardless of spiralling legal costs, even though they knew only a small percentage would be successful.

In some cases, the assessments took up to 10 years to complete, locking families into contracts and making people unable to end their claim without paying a fee, and also being powerless to recover their care records, says the Alliance.

As a result of this experience, the CHA is warning people to think carefully before applying for the funding, and to seek expert advice before they make any applications.

What is the CHA advice?

The CHA recommends caution before starting the application process.

Dan Harbour, Managing Director of social enterprise Beacon CHC, said:

“We absolutely encourage people to apply for retrospective CHC funding where they believe they have a legitimate case. 

 “However, it is crucial that individuals are aware of and understand their rights. Due to the highly specialised nature of CHC, if you feel that you need advocacy or representation it is vital that you find an organisation with the right expertise in the field to support you. 

 “Bear in mind that no firm, regardless of credentials or experience, can guarantee a favourable outcome to an application. Free information and resources are available to support those who don’t require representation.”

Beacon CHC is a social enterprise whose team members have over 20 years’ experience in Continuing Healthcare advocacy and support. It operates the NHS England Free Information & Advice service, and delivers casework and representation services across England and Wales. Beacon’s mission is to provide high quality and independent advice for vulnerable people and their representatives, empowering and supporting them to achieve a fair outcome.


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