How to Claim for NHS Continuing Healthcare
Continuing Care, or as it’s better known, NHS Continuing Healthcare, is a package of care which is arranged and funded by the NHS to meet the needs of adults who are assessed as having a Primary Health Need.
For eligible patients with significant healthcare needs, the NHS will cover the full cost of care, provided these needs are:
- Complex, intense and/or unpredictable
- Not solely incidental or ancillary to the accommodation that Social Services are under a duty to provide
- Not of a nature typically provided for by Social Services
If a care package is not yet in place, then the NHS will assist you to choose the right one and then fund it. If the patient is already in receipt of a care package, the NHS will consider whether it is suitable to meet the patient’s needs and if it is, then the NHS will pay the care costs.
We explain the NHS Continuing Healthcare Funding assessment process below. For more information see NHS Continuing Healthcare Funding explained.
NHS Continuing Healthcare Assessment Process
Not all claims for Continuing Healthcare Funding (CHC Funding) will be successful, and the Department for Health sets out guidelines in terms of how a person’s care needs are assessed.
Although the process of assessment and, indeed that of challenging a negative decision is pursued under NHS process rather than through the Courts, having a Care Home Fees Solicitor to advise you can often be the best course of action when dealing with this complex and time-consuming process.
The assessment process usually works like this:
- The authorities should refer the patient for a CHC Funding eligibility assessment but this sometimes does not occur for a variety of reasons. If you want to make a claim for Continuing Care, then start by contacting your local Clinical Commissioning Group (CCG) for an assessment.
- An NHS Checklist will be completed, which is effectively a screening tool to outline the specific needs of the patient. This determines whether those needs meet the threshold for full eligibility assessment
- Once through to a full assessment, this will usually take place with a Nurse and a Social Worker who will complete the Decision Support Tool and recommend whether you are eligible. For more information see the government publication NHS Continuing Healthcare Decision Support Tool.
Can I Claim Retrospectively?
The right to claim back care home fees occurs when the patient has been in receipt of care for a while, but the NHS did not carry out a CHC Funding assessment when it should have done.
If you want to claim back care fees following the death of a loved one who was in care, you can make the claim by proving you have the authority to act on behalf of their Estate. An example of this is if you are the Executor appointed in their Will, or if there was no Will if you are the next of kin who has taken out the Grant of Representation and are entitled to administer their Estate.
Where an assessment of eligibility for continuing care funding has taken place but the NHS has decided the patient was not eligible for continuing care you will usually have a right of appeal to be exercised within 3 months.
Our Care Home Fees Solicitors are experts in all aspects of NHS Continuing Care Funding and we can help you to make a claim, whether that be to request an initial assessment, present an appeal against a decision of ineligibility, or make a retrospective (backdated) claim.
How We Can Help You
Our Care Home Fees Solicitors can offer:
- Time – A lack of resources and a backlog of claims mean that funding assessments can take a long time to process. We can act on your behalf to carry out the time-consuming work involved in the assessment procedure
- Security – Care homes may act to discourage people from using a Solicitor, wrongly believing a patient to be ineligible for funding. By choosing Simpson Millar to represent you, we can ensure your relative’s needs are met and funded appropriately
- Assurance – Your claim is in the best hands with a specialist. We’ll act strongly on your behalf, as our track record shows - £12 million in care fees recovered for clients since 2013.
- Wherever possible, we will offer a No Win, No Fee agreement for your claim. We’ll be completely upfront about our costs from the very first discussion.
For a discussion with no obligation call our Care Home Solicitors
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