Primary Health Need
Continuing healthcare, or CHC, is fully funded NHS care for adults who are assessed as having “a primary health need”. Proving a “need” exists can be difficult and as the process works to strict definitions. For example, being frail or suffering from dementia may mean you need care but without the need for medical/nursing input you may not be eligible for NHS CHC.
Local authorities are barred from providing medical care to any significant level and so, strangely, this is often the test often used to establish where funding responsibility lies. If your medical needs are too great to be met legally by a local authority then you should qualify for NHS CHC funding.
Continuing Healthcare Assessments
This 2-stage process should be fully completed within 28 days of your request, but this timescale is rarely met these days.
The assessments are completed by trained CHC nurses from the local NHS Clinical Commissioning Group, with oversight from a Social Worker at the 2nd stage. They will take evidence from both primary health records and any current career or nurses and score against 11 areas of health called domains.
In the final assessment the decision to recommend funding or not will be based on the:
- Nature of the conditions
- Intensity - the extent and severity of the conditions
- Complexity of the health needs
- Unpredictability
Outcomes
Following the assessment, you will informed whether the team assessing you will recommend you receive NHS CHC full funding or not. They may instead recommend a less generous payment known as Funded Nursing Care which is £187.60 per week paid directly to the nursing home.
Fast Track Assessment
Should your family member be approaching the end of their life, then NHS rules provide a “fast track” route continuing healthcare funding. A successful Fast Track application means that funding is provide immediately and without the need for the full assessment. This can spare family and loved ones upset and allow them to concentrate on spending time with their loved one.
Fast Track can be requested any “Appropriate clinician” and must demonstrate that there is a “rapidly deteriorating condition”. It is worth noting that the status of the Fats Track will be checked, normally within 30 days.
Appeals
It is possible to appeal against a decision from an assessment and ask that is reviewed. Should the local NHS be unable to settle the dispute the case can be sent to Independent Review to consider either issues with process or eligibility for funding.
Retrospective Reviews
Not all those who should be assessed are assessed and many can die before they have a chance to receive NHS funding. In such cases and where someone is still self-funding the NHS will conduct, upon request, retrospective reviews of eligibility.