NHS Continuing Care

We all know that the NHS meets our needs for healthcare, and you may also be aware that social care is funded by either a local authority or the individual themselves. However, the NHS can meet the cost of all your care needs if you are assessed as eligible for NHS Continuing Healthcare.

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.

The Process

1. Free Consultation

Contact us on 01253-850777 or enquiries@ormrods-chc.com and one of our trained CHC nurses will take you through the CHC process.

2. Nurse Assessment

One of our CHC nurse advisers will meet with you and complete a full CHC report. They will then discuss the findings with you and give clarity.

3. NHS Assessment

We will formally request the start of the NHS funding process and coordinate to ensure all evidence is available and you can attend the meetings.

4. CHC Assessments

This 2-stage process can be difficult for families to navigate. We will both represent and support you throughout both these meetings.

Faq's



Do you have a question about a Equity Release? See our answers below to some of the most frequently asked questions we're asked. Something you can't find? Don't hesitate to get in touch, and we would be delighted to discuss them with you.

“My Mum has more than £23,250 in the bank so there is no point applying for NHS Continuing care”

This is common belief and causes many families to not make an application for NHS funding. Only Social care is means tested, if you or your family are shown to have a Primary Health Need then the NHS will be responsible for providing funds regardless of your financial position.

“We were told my relative wont qualify by the care home so not worth asking for an assessment”

The Continuing Healthcare assessment process serves many purposes as well as showing eligibility for funding. It will also ensure all care needs are being met and that the current placement is correct. But do remember that even if your relative isn’t eligible for full funding they make receive the Funded Nursing payment. If there is no recommendation for funding you will better understand CHC and established a base line should your relative’s health deteriorate.

“I have no power of attorney and my husband is no longer able to make decisions. Can I still ask for a CHC assessment?"

The simple answer is yes. The Care Act 2014 is centred around 6 principles designed to protect vulnerable people like your husband and we would expect both Social Services and the NHS to ensure he was correctly assessed in any case.

Sadly, this “best interest” approach is not always followed, and relatives have to make the request. In these cases, you are an “interested 3rd party” and your opinion MUST be taken into account.

“My aunt was assessed and awarded Funded Nursing Care contribution some time ago but the cost of the home has not fallen”

The weekly payment of £187.60 is made directly to the nursing home when a resident shows some but all the characteristics of a primary health need. Whether this contribution is set against the weekly cost for your aunt is dependent upon the contract that was issued. We would advise speaking via us to our partner firm Ormrods Solicitors to review the contract as your aunt may be due a substantial refund.

“Social Services have already completed an assessment without us present and tell us that my mother did not qualify. Mum can’t make her own decisions and as I hold power of attorney they say I will now have to pay all the fees from her money”

The CHC process is in 2 parts and it’s common for Social Services to perform the first stage known as a Checklist. However, if you hold a Lasting power of Attorney for either Health/Welfare or Property/Finance you would have a legal right to be involved in the process. Health/Welfare attorneys have an express right to be involved at all stages. Property/Finance Attorneys have to ensure any bills they pay are correctly charged- in other words was the process correctly followed.

“My father is being discharged from hospital into a care home and I’ve been told that he won’t be assessed straight away”

weeks paid care for your father after which the CHC assessment will take place. This deferment period is designed to allow your father to settle down and make sure any assessor sees him as he will be going forward and not as he was in hospital. You will not have to repay the cost of this stay.

“We were told that if we applied for CHC and mum was eligible we would have to move her from her current home. She is very happy there and we would not want to upset her”

This is misleading and far too common an occurrence. Full funding is available to your mum, if she has a “primary health need”, in whatever setting is suitable, that includes Care Homes, Nursing Homes and even her own home. There is every chance she would be able to stay where she is even if she was awarded full CHC.

Book a free consultation with our continuing care team: