A Guide To NHS Continuing Healthcare Funding


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Long-term illness and continuing care are two sensitive issues that can affect families across the UK. For patients that require ongoing care there can be high levels of stress involved in finding funds to cover the cost of care, however the NHS continuing healthcare scheme is a package of care arranged and funded solely by the NHS – it is designed to help patients that require ongoing care.

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In this guide Jennifer Turnbull and Hannah Meehan, who are part of Simpson Millar's Care Homes and Nursing team, outline the NHS continuing healthcare scheme and answer some common questions about accessing the NHS funding.

What Is NHS Continuing Healthcare?

NHS continuing healthcare is a scheme that ensures that a package of care is arranged for individuals that require ongoing care outside of hospital – the package of care is organised and funded by the NHS. A care package can be delivered in any setting required by the individual, whether this be at their own home or in a care home and is completely free for the individual.

The most significant aspect of the continuing healthcare fund is its provision of free care outside of a hospital setting, with this provision being of significant importance to those affected by long-term illness. It is in this regard that the continuing healthcare scheme differs from standard care provisions, as care arranged and delivered by a local authority will incur financial charges for patients that require care outside of a hospital.

Who Is Eligible For NHS Continuing Healthcare Funding?

The Government's national framework for NHS continuing healthcare funding outlines the eligibility for access to continued care funding. This framework outlines that anybody over the age of 18 that is assessed as requiring a certain level of continuing healthcare could be eligible for continued care. Access to funding is not dependent on:

  • A particular disease, diagnosis, or condition
  • Who provides care, or where the care is provided
  • The cost or type of care required

An assessment will take place to establish whether an individual is eligible for continuing healthcare funding, with this assessment establishing if an individual has 'primary health need'. The assessment is based around the nature, complexity, intensity, and unpredictability of an individual's condition.

Due to the strict nature of the assessments and the rules around ongoing reviews in successful cases, Jennifer highlights the importance of being aware of the guidelines that must be followed when claiming for NHS Continuing Healthcare Funding:

"When the NHS are assessing an individual for NHS Continuing Healthcare Funding there are a number of guidelines they must follow. These are contained in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care."

"When assessing a patient the NHS must complete specific documentation, including a Checklist and Decision Support Tool. This is to ensure uniformity and widespread application of the criteria. It is important that not only the health and care needs of the individual being assessed are accurately documented, but also that the correct procedures are followed."

Can I Appeal A Decision If My Application Was Unsuccessful?

If your assessment was unsuccessful and you feel that you have been incorrectly judged, you may be able to appeal the decision.

With the complexities that surround the appeals process for NHS decisions, Hannah comments on why it’s important to get advice early:

"We would always recommend seeking advice from a specialist team, like ourselves, when you are going through a process of applying for NHS Continuing Healthcare Funding, for either yourself or more commonly on behalf of a loved on."

"If the decision is of ineligibility – meaning you are not going to receive funding – there is an appeals process that you must exhaust. The National Framework Guidance states you have six months to appeal a decision, however we have noticed some Clinical Commissioning Groups are imposing very short deadlines of a number of weeks, rather than a number of months."

"If you are denied funding, it is vital you seek advice as soon as possible. As specialists in the subject, we are aware of procedural errors that can be raised in a formal appeal. This will ensure you have the best possible chance of appealing a decision and make sure you aren’t caught out by any unreasonable deadlines."

Can I Receive Legal Advice Regarding NHS Continuing Healthcare Funding?

Legal assistance and representation is not required to claim for NHS continuing healthcare and in many cases individuals proceed through a simple application process and are awarded funding without any issue – however there are some cases where individuals may feel unsure about making a claim, or they feel that their claim was unfairly denied.

As the claim process for continuing healthcare does not involve the court system, many individuals feel that they cannot turn to legal professionals in the minority of cases where issues arise, however Jennifer explains why this is incorrect:

"The NHS makes it clear in their correspondence that legal assistance is not required for a claim for NHS Continuing Healthcare Funding. While the process does not involve the Court system this is not to say that legal support, advice and assistance is not readily available. We are here to guide people through the process of making a claim, lodging a compliant or appeal."

"As specialists in this field we understand not only the requirements of the NHS but also the emotive nature of the claim and how a process like this can be extremely distressing for people. We are here to share the burden whilst also working together to achieve the best results possible."

Getting Help

With offices based around the UK, we are always on hand to offer emotional and legal support on a wide range of issues. Our care homes team is one of the most renowned in the country and are available to hear your case and provide advice today.

Whether you are looking for the hefty NHS framework to be put into jargon-free language, or you are looking to appeal a decision by the NHS, our team are able to provide tailored advice on your specific NHS continuing healthcare case.

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