Summary: Mr X complained that the Care Provider did not pass on Funded Nursing Care (FNC) contribution payments by deducting these from his wife’s (Mrs X) care home fees. We found the Care Provider was at fault as the care home agreement with Mrs X was silent on FNC and how these NHS-based contributions are treated against its overall fee structure and the services contractually agreed. This caused Mr and Mrs X uncertainty with respect to how the care home agreement operated. The Care Provider has agreed to apologise to remedy the uncertainty caused.

The complaint

1. The complainant (Mr X) complains on behalf of his wife (Mrs X) who has care needs who once resided in residential care at Churchfields Care Home which is owned and managed by Churchfields Care Home Limited (the Care Provider). Mr X complains the Care Provider refused to pass on financial contributions of Funded Nursing Care (FNC) to Mrs X by deducting these from her residential care fees. Mr X says the Care Provider’s care contract with Mrs X is silent on this issue and so does not entitle the Care Provider to retain FNC contributions from the National Health Service (NHS).
2. In summary, Mr X says that the Care Provider failing to pass on the FNC amount means Mrs X is being overcharged for the cost of her care. He says the matter has also caused him distress. As a desired outcome, Mr X wants the Care Provider to acknowledge it is overcharging for the cost of care and reimburse Mrs X for the FNC amount.

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The Ombudsman’s role and powers

3. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
4. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused a significant injustice or that could cause injustice to others in future we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended).
5. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended).
6. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended).

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How I considered this complaint

7. I considered evidence provided by Mr X and the Care Provider, as well as relevant law, policy and guidance. Both had an opportunity to comment on my draft decision. I have considered any comments before making a final decision.

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My findings

Background and Legislative Framework

Care Quality Commission (CQC) Fundamental Standards

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The CQC has guidance on how to meet the fundamental standards.
9. Regulation 19 concerns care home fees and requires registered care providers to give timely, accurate, and written information to service users on the cost of care and treatment before services commence, including clear terms on payment methods, amounts, contractual conditions, and notice of any fee changes. This obligation applies where residents fund their care in whole or in part and includes the provision of the contract itself.

Funded Nursing Care (FNC)

10. This is the contribution provided by the NHS to care homes with nursing in England and Wales to support the provision of registered nursing care to eligible residents. These payments are made directly to care homes, and the resident does not receive any money directly. The policy intention of FNC is that where an individual in a care home has been identified and assessed by the NHS to require registered nursing care, the NHS will be responsible for funding a defined contribution towards the costs of nursing care.
11. The resident should not be required to pay for this portion of their nursing care already covered by the NHS through FNC. In England, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care from the Department of Health and Social Care makes clear that contracts between residents and care homes should include transparent and fair terms governing how FNC payments are treated.

Consumer Rights Act 2015

12. The Consumer Rights Act 2015 (the Act) provides that written terms in consumer contracts must be fair and transparent, meaning they should be expressed in plain, intelligible language and not create a significant imbalance in the parties’ rights and obligations to the detriment of the consumer. Terms which fail these requirements may be unfair and contractually non-binding as set out under section 62(1) of the Act.

Competition and Markets Authority (CMA) Guidance

13. In the care home context, the CMA has issued specific guidance clarifying that terms relating to NHS-funded nursing care (FNC) must be clear about how such payments affect the resident’s overall fees. A lack of transparency, or a provision allowing a care home to retain FNC without adjusting the resident’s contribution, risks being considered unfair under the Act and therefore unenforceable. Specifically, its guidance to care homes states:
14. Paragraph 4.64: “Your terms, together with the upfront information you provide to residents about your fees, should clearly explain what FNC is, the resident’s potential entitlement to it, and how you treat FNC payments when the eligible resident is self-funded. In particular, you should clearly set out:
1. “The relationship, if any, between FNC payments and a self-funded resident’s own contribution to their overall residential fees (i.e. very clearly defining the services that are paid for by the FNC payments and those paid for by the resident).
2. “What will happen to a resident’s own contribution to their fees if there is a change in the amount of the FNC payment (i.e. where it increases, decreases or ceases).”
15. Paragraph 4.66: “If your terms do not clearly define the services that are paid for by the eligible resident and those paid for by the NHS, you are at risk of unfairly reserving the right to charge an eligible resident for nursing services which are covered by the FNC payments.”

Chronology of Events

16. In July 2023, Mrs X began residing at the care home. Her stay was governed by a contractual care agreement with the care provider.
17. Several months later, the Care Provider referred Mrs X for a Continuing Healthcare (CHC) which includes FNC as a partial contribution towards the cost of registered nursing care provided in a care home with nursing. The referral was accepted and found Mrs X was eligible. The Care Provider began receiving FNC contributions since November 2023 which were backdated to when Mrs X began residing at the care home. The rates for FNC are set nationally by the Department of Health and Social, as follows:
1. April 2023 to March 2024: £219.71 per week
2. April 2024 to March 2025: £235.88 per week
18. Between July 2023 and March 2024, the Care Provider’s records of FNC contributions received for Mrs X were approximately £10,300. From April 2024 to March 2025, they were approximately £12,300.
19. In March 2025, Mr X made a formal complaint to the Care Provider that it was not passing on the benefits of FNC to Mrs X by deducting the contributions from her care home care fees. He complained that the Care Provider was charging Mrs X nursing at the care home, but given this service was funded by the FNC, she was effectively being charged for services already paid for. He therefore asked for a refund of the care home fees for the nursing element.
20. The Care Provider responded to Mr X the same month and advised it was not the case that FNC contributions should be deducted from the care home fees. The Care Provider said this element of CHC was between itself and the NHS and so declined to refund the contributions. In the same response, the Care Provider notified Mr X that it would like a meeting to discuss Mrs X’s increased care and support needs because it no longer felt able to meet these. The result of the meeting was that Mrs X left the care home.

My Assessment

Our Jurisdiction: Time Limits

21. By law, we cannot investigate a complaint, or part of a complaint, made to us more than 12 months of the complainant becoming aware of the issues, unless there are good reasons to exercise discretion in that respect. Mr W made both his complaints in March 2025, first to the Care Provider and then to the Ombudsman. As Mr X is asking us to investigate the Care Provider’s treatment of FNC contribution payments since July 2023, I need to consider whether this is when Mr X had first notice of the issues raised in his complaints. This is because, on the face of it, any issues complained about before March 2024 are late.
22. It is clear from records where Mr X gave consent for the Care Provider to refer Mrs X for a CHC/FNC assessment and the later acceptance of eligibility in November 2023 that this is when he knew it was receiving this contribution. That however does not in itself suggest a problem or is what caused Mr X to complain, but rather how the Care Provider treated the FNC contribution payments by not deducting these from the nursing portion of its care home fees. For the reasons given below, I do not consider the care home contract was transparent about this and which is a relevant factor as to when Mr X reasonably had proper notice.
23. Further, if I were to take the view that Mr X first had notice of the issues when Mrs X was admitted to the care home in July 2023, this would not enable me to look at the root causes of the complaint which ultimately fall on the contract signed prior to admission. In turn, it would be difficult to make sense of the complaint and investigate the more recent allegations of continuing fault over the 12 months prior to Mr X’s complaint to the Ombudsman. Considering this, together with the transparency point (above), I will exercise my discretion for the earlier parts of the complaint and investigate all matters complained about since July 2023. There are no practical issues affecting my ability to gather evidence since then as the Care Provider has provided all documents since this period.

Care Provider’s Treatment of FNC

24. As part of my formal enquiries to the Care Provider, I requested a copy Mrs X’s care home agreement, as this specifically should include clear and transparent terms about FNC. This is because:
1. The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care makes clear that contracts between residents and care homes should include such information and explain how FNC payments are treated.
2. As a matter of consumer protection under sections 62 to 64 of the Act, the terms must be fair and transparent. The CMA’s care home guidance expressly states that failing to explain the relationship between FNC and a resident’s fees can mislead consumers and create an unfair term, risking it being non-binding.
3. The CQC Fundamental Standards (Regulation 19: Fees) requires registered care providers to give written, upfront information on the cost of care, including terms and conditions, before services commence. Considering FNC is interlinked with the Care Provider’s nursing care services, the contract should specify how the payment will be treated in relation to the resident’s overall fees (e.g. deducted or retained) so that the resident can make an informed decision.
25. The care home agreement entered into between Mrs X and the Care Provider is silent on the issue of FNC and does not include any terms about this or how it is treated. The Care Provider said the care home manager in post at the time of Mrs X’s admission used an old contract where there is no mention of the FNC, though confirmed its usual contracts do make it very clear that it retains the FNC as a contribution towards the cost of nursing time and consumables. That Mrs X’s agreement did not address FNC in any way for the entirety she resided at the care home was fault by the Care Provider. The fault identified falls short of the CQC’s Fundamental Standards and this should have been clearly set out in the agreement prior to Mrs X’s admission to enable informed decision-making.

Injustice Caused

26. In my view, the fault has caused Mr and Mrs X serious uncertainty, as well as time and trouble. I therefore find they suffered a significant injustice as a result. I also considered whether it would be appropriate to recommend a refund of any care charges by the Care Provider. This is because the Care Provider’s care agreement did not specify how the FNC payment contributions would be treated. Given the care agreement is silent on this practice, there is ambiguity about whether the Care Provider has ultimately been charging for additional nursing fees (beyond those funded through FNC) which have not been set out contractually and agreed to prior to her admission.
27. However, my view is that the care agreement does not make any reference to nursing costs being charged by the Care Provider for Mrs X’s care. I am therefore unable to ascertain any specific amount Mrs X has been overcharged. Further, I am not satisfied on the evidence that Mr X had a reasonable belief following Mrs X being eligible for FNC that this would result in this being offset against the Care Provider’s care costs. This is most evident from the time Mr X took to raise this matter with the Care Provider and request a refund. I have not therefore made a recommendation to this effect. It may be this matter is better suited to courts as I have no powers to enforce an award of damages for an alleged breach of contract under consumer protection laws.

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Agreed action

28. Within one month of the date of my final decision statement, the Care Provider will send Mr and Mrs X a written apology which acknowledges the fault and injustice identified in this decision statement, as well as the specific actions it intends to take to prevent such problems from reoccurring. The Care Provider should provide evidence it has complied with the above actions.

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Final decision

29. I find fault causing injustice for the above reasons and the Care Provider has agreed to my recommendations to remedy this.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman