New Deadline For Continuing Care Claims

A1. The National Framework for Continuing Care and NHS-funded Nursing Care was introduced in 2007 to provide consistency around the eligibility criteria and assessment process for continuing care across all Primary Care Trusts (PCTs). The National Framework is now well-established, so the Department of Health wants to 'wrap up' all funding claims for care provided between 1 April 2004 and 31 March 2012.

By announcing the cut-off dates, it is giving people who want to claim the chance to have their cases looked at as soon as possible. A similar process has already taken place to deal with care funding claims pre-dating 1 April 2004.

Another reason for introducing the cut-off dates is that, from 1 April 2013, the responsibility for NHS Continuing Healthcare assessments will pass from PCTs to newly-formed Clinical Commissioning Groups (CCGs), now that the government's Health and Social Care Act 2012 has been passed. By introducing the deadlines now, the government is hoping to make the handover to CCGs easier and provide a clear process for dealing with retrospective claims in the future.

If you want to reclaim care fees that you or a relative may have wrongly paid in the past, it is important to come forward as soon as possible, whilst your PCTs still has the records needed to assess your case. Please contact Cheselden as soon as possible so we can review your claim.

A2. The government and the NHS carried out a detailed consultation process with various stakeholders before announcing the deadlines. These included the NHS Continuing Healthcare Stakeholder Group and the Association of Directors of Adult Social Services (ADASS). Several charities were also consulted, including Age UK, the Alzheimer's Society, the Spinal Injuries Association, Parkinson's UK and Marie Curie Care.

A3. It became mandatory for PCTs to assess continuing care cases using the National Framework from 1 October 2007. So if your claim relates to care provided after this date, the National Framework will be used to assess your eligibility for NHS Continuing Healthcare. If your claim relates to care provided between 1 April 2004 and 30 September 2007, the local assessment process and eligibility criteria used by your PCT at that time will be used to assess your case, provided these are Coughlan and Grogan compliant.

A4. By law, the Department of Health must give you at least 12 months after care was provided to ask for a continuing care assessment. This is in line with both the NHS complaints process and the process for escalating your complaint to the Health Services Ombudsman.

A5. You will need to consider the entire period of care you are claiming for and claim by the soonest deadline covering that time. For example:

• You are claiming for care provided between 1 April 2008 and 15 March 2012. You will need to claim by 30 September 2012 for the entire period of care to be assessed. If you claim after 30 September 2012, your PCT will only assess you for continuing care eligibility for the period 1 April 2011 to 15 March 2012 (provided you claim by 31 March 2013). They will not consider your claim for care provided between 1 April 2008 and 31 March 2011 if you claim after 30 September 2012.

If your care fees claim overlaps the changeover date from the use of local assessment criteria to the National Framework (1 October 2007), your periods of care before and after this date will be assessed separately as follows:

• Your entitlement to NHS funding before 1 October 2007 will be assessed using the local assessment process and eligibility criteria used by your PCT at that time, provided these are Coughlan and Grogan compliant.

• Your entitlement to NHS funding after 1 October 2007 will be assessed using the National Framework.
If you paid for care before and after 1 April 2004, your eligibility for continuing care funding will only be considered for the care you received after this date. This is because the government set a previous deadline for care claims pre-dating 1 April 2004, and this has now passed.

A6. No, your claim will not be affected.

A7. The Department of Health is working with Strategic Health Authorities (SHAs) and PCTs to make sure they issue clear and consistent communications about the cut-off dates in their local areas. They will aim to make sure that patients, their families and representatives, and organisations such as elderly care charities know about the deadlines and understand how they will be affected by them.

A8. Your claim may be considered if there are extenuating circumstances - which do not include a lack of awareness of the deadlines. These circumstances will be decided by individual PCTs. If your claim is simply too late, your case will not be considered even if this was because you did not see any of the Department of Health's communications.

A9. Your current eligibility for NHS Continuing Healthcare will not change. The National Framework will still be used by the CCGs to assess your eligibility for funding.