Family paid over £250,000 for care that should have been covered by the NHS

Date investigation closed: 8 October 2019

The complaint

Mr V complained that the CCG failed to properly assess his mother’s care needs and produce a care plan. He said the CCG did not offer enough funding to cover her care needs which meant his family had to cover the cost of additional care.

What we found

We found the failure of the CCG to produce a full care and support plan meant that Ms V’s care needs were not met by the care package it put in place. These failings had a profound impact of Ms V and her family. They were forced to pay for additional care, as well as providing additional care themselves.


Ms V had a stroke in 2016. She was assessed and found eligible for NHS CHC funding. The assessment found that she needed the assistance of two carers at all times to support her daily living and keep her safe. The CCG found that Ms V’s needs would best be met in a 24-hour care setting.

Ms V’s family wanted her to be cared for at home. The CCG offered a care package equivalent to the cost of a nursing home placement plus 10%, which resulted in the CCG providing enough funding for one carer for seven hours a day. This meant the family would need to provide additional care themselves, as well as paying privately for extra care.

The family complained about the care package. They submitted a record of the additional care costs they had incurred. The CCG reviewed Ms V’s NHS CHC eligibility two more times. They found both times that she remained eligible for NHS CHC-funded care.

However, the CCG did not produce a care and support plan setting out what Ms V’s care needs were. As a result, the CCG continued to fund only one carer for 7 hours a day, even though it had said that Ms V needed support from two carers at all times. 

The CCG had a policy that it would only fund care at home up to the cost of nursing home care plus 10%. However, in this case, the policy was wrongly applied. The CCG used the arbitrary figure of a standard nursing home placement plus 10% to determine the level of care. The CCG did not compare costs of a nursing home placement with the costs of care at home to fully understand the cost of care in each potential setting and determine the funding needed to provide the level of care Ms V needed.

Putting it right

We recommended that the CCG reimburse all the professional care costs incurred by Ms V’s family, which came to approximately £187,000. We also recommended that the CCG reimburse the family for the care they had provided to Ms V, totalling a further £90,000.