Who Qualifies for NHS Continuing Healthcare?

Author:
James Urquhart-Burton
Partner, Care Home Solicitor
Date:
22/05/2019

If you live in England or Wales and have a Primary Health Need and are aged over 18, then you qualify for NHS Continuing Healthcare Funding (CHC Funding). A Primary Health Need arises when most or all of a person’s care requirements are focused on addressing or preventing illness or disability.

A Primary Health Need is deemed to be above and beyond what a Local Authority can reasonably be expected to provide. As a result, a Primary Health Need is quite different from managing daily living activities, such as eating, dressing and meeting hygiene needs, which are instead classed as social care needs.

NHS Continuing Healthcare Funding, also known as CHC Funding, is not means tested, but a full assessment of a person’s care needs will be carried out before a decision is taken. A Clinical Commissioning Group (CCG) will be responsible for assessing eligibility and deciding who qualifies for NHS Continuing Healthcare Funding.

For a no obligation discussion about eligibility for NHS Continuing Healthcare Funding get in touch with our Care Home Fees Solicitors.

Call us on 08002605010 or request a callback and we will help you.

Eligibility for NHS Continuing Healthcare Funding

Any individual over the age of 18 is eligible for NHS Continuing Healthcare Funding to meet care needs that have come about as a result of disability, accident or illness. As the NHS National Framework for NHS Continuing Healthcare states, the services provided as part of the package should be “seen in the wider context of best practice and service development for each client group”.

There are no restrictions on where this package of support can be offered (at home or in a care home) or on the type of service to be delivered.

What Happens During the Assessment Process?

The NHS Continuing Healthcare assessment process involves detailed consideration of your needs on a day to day basis. The assessors must consider a number of factors, such as:

      • Are your health needs more than just incidental to your personal care needs?
      • Do your needs present with intensity, complexity or unpredictability?
      • Does the type of care you need exceed what a Local Authority can provide?

To request an assessment and see if you qualify for NHS Continuing Healthcare, you can contact the Continuing Healthcare Team at your local CCG to ask for an assessment. Lawyers at Simpson Millar can also help you navigate the procedure and provide legal advice in this complex area.

For more information see How to Request an NHS Continuing Health Care Assessment

Do I Need Legal Representation during the Assessment?

The National Framework states that families are entitled to legal representation at assessments, but this is not mandatory. However, the assessment process isn’t entirely straightforward and the financial consequences of an incorrect decision could be considerable.

Our Care Home Fee Solicitors and Legal Executives are experts in this field and we can advise families about decisions, as well as represent them at Continuing Healthcare assessments. We can also act on a person’s behalf if they are appealing against a CHC Funding decision, regarding both current assessments of individuals or retrospective reviews of past periods of care.

We have a strong track record of securing backdated payments in cases where care fees have already been paid. Since 2013, our team has recovered more than £12 million in care fees for our clients.

For a discussion with no obligation call our Care Home Solicitors

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