Clinical Commissioning Group failed to provide an appropriate refund for nursing home costs

What happened

Mr V was living in a nursing home and was found eligible for NHS continuing care funding from spring 2013. However, as he had moved to another region, the CCG where he had previously lived only became aware in autumn 2013 that it was responsible for meeting his healthcare costs.

During this period, spring to autumn 2013, Mr V paid for the cost of the nursing home. Ms R submitted the invoices for the fees he had already paid to the CCG. The CCG said it had agreed with the nursing home that Mr V's care costs were £800 a week. Therefore, the CCG only refunded the invoices to Mr V up to this amount. After refunding this money, the CCG then started to pay the nursing home £800 a week for Mr V's ongoing care.

However, the actual fees the nursing home charged were £1,680 a week, and it disputed that it had agreed a lesser charge with the CCG. The nursing home invoiced Ms R for the outstanding costs which were not covered by the CCG's payments.

What we found

In accordance with the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care, the CCG was responsible for meeting the full costs of Mr V's care. The CCG had unnecessarily delayed sorting this out and had failed to give Mr V an appropriate refund. It was the CCG's responsibility to meet the ongoing costs of Mr V's care, but it took no action when Ms R told it that it was not meeting these.

Putting it right

The CCG apologised to Ms R for its failings and for the injustice it caused her. It paid Ms R £500 in recognition of the frustration she had experienced from the delays, and the CCG's poor handling of this case. The CCG also refunded Mr V the fees he had wrongly paid for his nursing home care (over £102,000) and agreed to continue to meet Mr V's care costs.