NHS Continuing Healthcare (CHC) funding can be very difficult to secure, with budgetary restrictions adding to the challenge. This page has been prepared by Autumna with the help of Farley Dwek Solicitors to give you as much information as possible in an abridged form.
According to the national framework for NHS continuing healthcare and NHS-funded nursing care: 'Where a person has been assessed to have a primary health need, they are eligible for NHS Continuing Healthcare (CHC) and the NHS will be responsible for providing for all of that individual’s assessed health and associated social care needs, including accommodation, if that is part of the overall need.'
What this means is that if an individual’s care needs are down to health needs (either physical or mental) as opposed to social needs, then the NHS is responsible for funding that individual’s care needs in full, regardless of the individual’s financial situation.
It’s important to note that CHC is only available in England and Wales.
The key to getting CHC eligibility is proving that care needs are a primary health need and not a social care need.
Social needs is the term for needs which can generally be provided by the local authority. For example, if an individual needs help with things like washing, dressing and preparing meals, then these would be considered social needs.
Defining primary needs is a bit more complicated. The Primary health needs test will be applied, which considers four key characteristics. Only one of these characteristics needs to be met for an individual to be eligible for CHC.
There are two stages to applying for NHS CHC:
For this first phase in the process, the NHS uses a screening tool to help practitioners identify the people who may need a full assessment of eligibility for NHS Continuing Healthcare.
If you need a long-term care home placement with nursing, or have significant support needs, a Checklist will be completed, probably by a variety of health and social care practitioners who have been trained in its use.
It is for each Clinical Commissioning Group (CCG) and local authority to identify and agree who can complete the tool but it should, as far as possible, include staff involved in assessing or reviewing your needs as part of their day-to-day work.
A positive Checklist means that you require a full assessment of eligibility for NHS Continuing Healthcare. It does not mean that you are eligible.
Whatever the outcome of the Checklist, it will be communicated clearly and in writing to you or your representative, as soon as is practically possible.
You shouldn't worry about being left without appropriate support whilst you are waiting for the outcome of the assessment process and you can be assured that your consent will be secured for every element.
If an individual passes the Checklist Assessment, the next stage is a Full Assessment to investigate whether a person’s needs are primarily healthcare based on 12 care domains: behaviour, cognition, psychological, communication, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness and other needs.
The Assessment will be completed by a Multi-Disciplinary Team (MDT) which comprises of at least two people from different healthcare specialisms. It should ideally include both health and social care professionals who are knowledgeable about your health and social care needs and who have recently been involved in your assessment, treatment or care.
The CCG will consult with the relevant local authority before making any decision about your eligibility for NHS Continuing Healthcare and in doing so cooperate with that local authority in arranging for relevant people to participate in the MDT.
The involvement of local authority colleagues as well as health professionals in your assessment process should streamline the process of care planning and will make decision-making more effective and consistent.
Note: As with any assessments that they carry out, a local authority should not allow an individual’s financial circumstances to affect its participation in a joint assessment.
It is possible to make a retrospective claim for NHS Continuing Healthcare funding on behalf of someone else assuming you have authority to deal with their personal matters, for example you have an Enduring/ Lasting Power of Attorney or deputy order.
You do not need a solicitor to claim retrospective CHC eligibility, however the complex nature of the process lends itself well to being handled by a law firm. If you decide to go down the route of instructing a solicitor Autumna recommends Farley Dwek, who provide specialist legal services in relation to NHS Continuing Healthcare funding.
Why not download Farley Dwek's free guide, full of handy tips and real life case studies, which details each step of the process from Initial Checklist Assessment through to Appeals.
If you are found to be eligible for NHS Continuing Healthcare, the CCG is responsible for your case management, including monitoring your care and arranging regular reviews.
You should always be encouraged to play an active role in your care, be provided with information or signposting to enable informed choices, and supported to make your own decisions.
Once you have been awarded Continuing Healthcare a review should be undertaken within three months of the eligibility decision being made. After this, expect further reviews to be made on at least an annual basis (but note that some people require more frequent reviews in line with clinical judgement and changing needs).
The most recently completed Decision Support Tool (DST) should be available at the review and used as a point of reference to identify any potential change in needs. Where there is clear evidence of a change in needs to such an extent that it may impact on your eligibility for Continuing Healthcare, then the CCG should arrange a full reassessment.
If this happens, a new DST must be completed by a properly constituted multidisciplinary team (MDT). Where appropriate, comparison should be made to the information provided in the previous DST.
Farley Dwek work with a team of specialist nurses who have vast experience working within the NHS, specialising in Continuing Healthcare Assesments. They can provide a Clinical Review to assess eligibility for NHS Continuing Healthcare Funding.
If you have already tried to fight the NHS alone and got stuck, Farley Dwek offer a Case Review service and will let you know if you have prospects and if they can get your case back on track.
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