What is NHS Continuing Healthcare Funding?
NHS Continuing Healthcare is a fully funded package of care which is provided by the NHS. If you’re eligible for NHS Continuing Healthcare and receive care in your own home or in a care home, the care services are funded by the NHS at no charge to you.
NHS Continuing Healthcare is different from funding from the Local Authority, which is means tested based on your financial circumstances.
For a free initial consultation to discuss eligibility, recovering care fees already paid, or any aspect of the NHS Continuing Healthcare process, get in touch with our Care Home Solicitors.
Who is Eligible for NHS Continuing Healthcare Funding?
In order to qualify for NHS Continuing Healthcare Funding, you must be able to establish that you have a “Primary Health Need”. In simple terms, an individual has a Primary Health Need if, having taken account of all their needs, it can be said that most of the care they require is based on addressing and/or preventing health needs. However, in reality it’s far more complicated than this.
How is Eligibility for Continuing Healthcare Assessed?
The question of eligibility requires health and social care assessors to analyse the nature and extent of the care that’s required to meet your day to day needs. This means it isn’t so much about your diagnosis, but more about how your needs present and what has to be done to meet them. The National Framework for NHS Continuing Healthcare has been developed by the Department of Health to assist assessors in coming to the right decision.
So What is the Problem?
NHS Continuing Healthcare Funding is very valuable and given that it depends on an assessment of your needs, it can be a very emotive subject. Difficulties can arise because of differences of opinion about an individual’s needs and what skill is required to meet them. Assessments are therefore often very subjective.
For this reason, there is sadly inconsistency in decision-making and NHS Continuing Healthcare Funding has often been described as a “postcode lottery”. Some people who contact our Solicitors for help comment that their relative isn’t eligible for Continuing Healthcare Funding, but they’re aware of another person with very similar needs who is eligible. Others can’t understand why they aren’t eligible, when it feels like things couldn’t get much worse.
There are also very complex procedural requirements for a Continuing Healthcare eligibility assessment to be robust. The Clinical Commissioning Group or CCG (the NHS body responsible for decisions on eligibility) may sometimes get things wrong.
Many people who receive care have never heard about NHS Continuing Healthcare Funding and this might be because the NHS hasn’t undertaken an assessment at the right time, or because health and social care professionals don’t actively promote its existence.
How our Care Home Solicitors Can Help You
Our national team of Care Home Solicitors have specialist knowledge of the care system and can provide you with expert legal advice about the options for funding your care.
Our clients approach us for a variety of reasons, whether for help to recover past care fees paid, or to appeal against a recent Healthcare Funding decision, or for legal advice about any aspect of the process and for representation at meetings or panels.
If you’ve already paid for care fees and are wondering whether this is right, we can help you decide whether to make a retrospective claim to recover the care fees paid. We can guide you through the process, including the completion of any forms and the provision of relevant documents and evidence to the CCG, with detailed submissions to support your case.
If the CCG is willing to proceed, it will sometimes complete an NHS Checklist, which is a method of screening claims to see if a full eligibility assessment is warranted. Our Care Home Solicitors can advise you of the implications of this as and when the need arises.
If the CCG decides that a full eligibility assessment is to be undertaken, then a Multi-Disciplinary Team will consider your case and reach a decision as to whether you’re eligible for NHS Continuing Healthcare Funding.
If your case is successful, then the care fees for the period of eligibility are refunded with interest and the CCG will make an offer. We can assess the suitability of interest calculations which are often complex, to advise you whether or not to accept the offer.
Important Note: At the moment, the earliest date you can ask the CCG to “look back” at your eligibility for NHS Healthcare Funding is 1 April 2012.
Our Solicitors can advise you whether it should be possible to arrange an up-to-date eligibility assessment and whether there is merit in doing so. Eligibility assessments should ideally be undertaken every 12 months, or sooner if there is a change in your care needs.
As with retrospective eligibility assessments, this usually starts with the completion of the NHS Checklist screening tool and if this indicates that you need a full eligibility assessment, then a Multi-Disciplinary Team will proceed to complete the Decision Support Tool, which is the document used to help them decide if you’re eligible for funding.
The NHS Continuing Healthcare Funding assessment process is very complex and not all cases follow a “one track” approach, which leaves many people wondering whether things have been done properly. Our flexible approach means that whatever the stage you are at with your case, we can advise and guide you.
For free legal advice call our Care Home Solicitors
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