People are often given little information about what support they are entitled to, or about how to claim available support. So what is NHS Continuing Healthcare? Simply put, NHS Continuing Healthcare is fully-funded care for those who have a primary heath need. It is for those who require social and healthcare. It is a mixed care package for those who require specialist support.
Is NHS Continuing Healthcare means-tested?
No, it is not means-tested. You should not, at any stage, be asked about your personal finances. Sadly, we know that some people are told that they may not qualify for fully funded care if they have a house or savings but they shouldn’t be factors at all. Your personal financial circumstances don’t matter. It is purely about a primary health need.
Who qualifies for NHS Continuing Healthcare?
If you have a primary health need then you may be deemed eligible for NHS Continuing Healthcare funding. You can read our fact-sheet on what a ‘primary health need’ may be in detail here. A primary health need could be mobility issues, severe cognitive impairment or a need that arises from a health condition that requires support beyond simply social care.
It is not about diagnosis, but about primary health needs (which may be a symptom of, or caused by, a particular diagnosis). For instance, someone with MS may struggle with mobility and need extra support, such as with regards to personal hygiene or taking their medication. It would be the mobility issues which would be defined as the primary health need, rather than the MS. This means that at different stages of a condition you may be more likely to be found eligible for NHS Continuing Healthcare.
What is the process of NHS Continuing Healthcare?
There are essentially two different processes to NHS Continuing Healthcare. There is the standard path which is the one that is likely to be a more long term plan, and then there is the fast-track process. The fast-track process is specifically for those who have a rapidly deteriorating condition and are quickly approaching the end stages of their life. The fast-track process allows a quick assessment and for people to potentially receive full care funding before they reach the end of life.
Generally, however, there are two main stages to the NHS Continuing Healthcare application. The first is the Checklist stage. This initial stage is designed to figure out if you may be eligible for NHS Continuing Healthcare. It is simply for working out who should receive a full assessment. The next stage is the ‘decision support tool’ which is conducted by the multi-disciplinary team which is usually made up of one social care worker and one healthcare specialist. At this stage, the primary health need is assessed according to a range of ‘domains’, such as (but not limited to): mobility and cognition. This however, is not designed to be a full assessment but should also be used in conjunction with a comprehensive assessment which also takes into account the nature, complexity, intensity and unpredictability of the primary health need(s). The National Framework should be followed to help determine this assessment.
Room for interpretation – and disagreements.
The qualifying factor for NHS Continuing Healthcare is hinged upon whether a person has a primary health need. However, there is no statutory definition as to what constitutes a primary health need. This means that it isn’t set in stone – which leaves a wide scope for interpretation and disagreements about who may be eligible for NHS Continuing Healthcare.
We know that this can present huge problems. One report by the Public Accounts Committee stated that “the number of people that were assessed as eligible for CHC ranged from 28 to 356 people per 50,000 population” which indicates huge variations across each local authority about the rates at which they grant NHS Continuing Healthcare. Local bodies are implementing a National Framework which isn’t definitive, and that is leading to people in certain areas being more likely to be given funding than others.
Furthermore, the majority of people aren’t informed about NHS Continuing Healthcare until late into their care, when they may have already paid care costs that they should not have. You can read our fact-sheet on the worrying statistics behind NHS Continuing Healthcare here.
Many people may be at risk of missing out on NHS Continuing Healthcare simply because they have never been told about the funding, or because of their postcode.
What Just Caring Legal can do for you.
Just Caring Legal specialises in NHS Continuing Healthcare and hopefully, this fact-sheet has helped explain what is NHS Continuing Healthcare. Rosalind Hughes set up Just Caring Legal to advocate for families to access NHS Continuing Healthcare and receive the funding that they may be entitled to. Roz’s medio-legal expertise means that she can create robust arguments and challenge any mistakes which are made during the application process or in the decision to deny someone elgibility for NHS Continuing Healthcare.