Families Forced to pay Thousands to Secure CHC Funding

Hannah Morris
Care Home Fees Associate Lawyer

NHS Continuous Healthcare (CHC) Funding allows for people’s care – either at home or in a care home – to be fully funded by the NHS. Although the rules for under-18s are slightly different, anyone who is deemed by the NHS to have a Primary Health Need can apply for CHC Funding. 

In 2007, a National Framework was established to ensure a “nationally consistent process for consideration of NHS CHC eligibility”. However, in recent years, this process has come under increased scrutiny.

Last week, the findings of a Mail on Sunday investigation revealed that desperate families have been paying out thousands of pounds in legal fees to try and secure CHC Funding for their loved ones after being told they weren’t eligible.

The investigation featured Andrew Gauld, a Second World War veteran with dementia, whose daughter had paid an upfront charge of £4,200 to a legal firm who told her there was a “good chance” their case would be successful.

Without all the details of Mr Gauld’s medical assessment, we cannot say whether he is likely to secure CHC Funding or not. But we do know that having dementia does not necessarily mean you will be granted CHC Funding, and there will be no way for Mr Gauld’s family to recover the legal fees they’ve already paid.

Because of the uncertainty involved in applying for - or retrospectively claiming - for CHC Funding, we work on a No Win, No Fee basis wherever possible. Read on to find out more or get in touch with our expert Care Homes Fees team.

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Why are People Struggling to Obtain CHC Funding?

In theory, CHC Funding should provide anyone who has a Primary Health Need with a package of care that ensures their individual care requirements are consistently met. In reality, the decision-making process involved in granting CHC Funding is much more subjective.

Although the National Framework tries to define what is classed as a Primary Health Need, there is no legal definition. As a result, CHC Funding assessments and any subsequent decisions made are largely dependent on local Clinical Commissioning Groups’ interpretation of the eligibility criteria. 

It’s also important to note that Clinical Commissioning Groups (CCGs) have a financial stake in any conclusions that are made regarding an individual’s care funding. Although they act as independent body of local GPs, CCGs are ultimately accountable to the Secretary of State for Health and Social Care and NHS England.

In a Channel 4 documentary released in October last year, a former CCG Assessor commented on the pressure he was under during his time in the role to actively find reasons why individuals weren’t eligible for CHC Funding.

For many people, the frustration of this process leads them to give up on it entirely, meaning they could be left wrongly paying thousands of pounds for social care.

How we can Help

Although the National Framework states that families don’t require legal representation at assessments, the process can be complicated, and the wrong decision could have significant financial implications.

As one of only a handful of UK firms with qualified lawyers specialising in this area of law, we understand that the process of obtaining CHC funding is particularly nuanced and will differ from person to person.

We will always conduct a free assessment of your situation and give honest advice as to whether you’re likely to be successful before going any further with your case.

If you decide to go forward with legal representation, one of our experienced team can accompany you at CHC funding assessment meetings to provide support and ensure that any information relevant to the eligibility criteria is fully presented.

There are no guarantees when it comes to securing CHC funding, and we won’t try and tell you otherwise. We operate on a No Win, No Fee basis wherever we can to mitigate this risk, so you won’t need to worry about paying any upfront charges.

Get in touch with one of our experienced Care Homes Fees Lawyers today for initial advice.

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