Why is the NHS Continuing Healthcare application process so difficult? That is the main concern families have when they get in touch with us. We get many calls from people thinking they must be doing something wrong. They believe that because NHS Continuing Healthcare is a government programme, with a National Framework of rules to follow, it should be relatively straightforward. Unfortunately for many people it is anything but. Instead, it brings months, even years, of bureaucratic wrangling that can take up all their time and energy and rob them of precious time with their vulnerable relatives. Meanwhile, their relative often has to pay for care that they should be receiving for free.
“In terms of complexity, the mental capacity required and the analysis skills needed, applying for NHS Continuing Healthcare funding was as complex as some of the nuclear deterrent policy I worked on,” according to Philip Mathias, a retired rear admiral of the royal navy. So horrified was he by the experience that he launched a campaign for Judicial Review in 2020 to end the “scandal” of the “dysfunctional and failing” NHS Continuing Healthcare process. Sadly, he was ultimately refused permission by the courts to proceed.
Why it’s not so simple
The NHS established Continuing Healthcare funding so that those who have a primary health need could have high levels of care outside hospital. This would be free at the point of use, in line with NHS principles. It is a simple concept. Yet there are several factors that make it far too complex. For example, there is a lack of clarity over what constitutes a primary health need. One case – now known simply as Coughlan – helped clarify the law regarding eligibility. And since 2007, the National Framework has also given guidance on how to decide if someone has a primary health need. However, there is no singular definition, This leaves plenty of room for interpretation and subjectivity to creep into the application process.
Another problem is that many people do not know their basic rights when it comes to the NHS Continuing Healthcare application. These include the right to be present at your own assessment and to have close relatives or friends there as your representatives. NHS Continuing Healthcare assessments should never happen behind closed doors. But many do, with applicants only getting to hear about the outcome afterwards as a fait accompli.
How this can have an impact on your NHS Continuing Healthcare application
Each of these factors means that it can be tricky to navigate the eligibility assessment system. Patients and their families may not be sure which arguments and evidence is most likely to lead to success. Decisions may be made without any input from those who know the individual’s needs best. This can have a major impact on the likelihood of obtaining the funding.
How to improve your chances of success
One of the best things to do is learn your rights, and do some research around primary health needs. Our Resources and Factsheets are a good place to start. The more informed you are, the more empowered you will be to hold your own in what are often extremely robust and in-depth discussions. You can find out more about how to maximise your chances of success here.
But you don’t have to navigate the process alone. At Just Caring Legal, our primary focus is on providing professional, compassionate guidance for people going through the NHS Continuing Healthcare application process. We can also help with appeals if you think you have been been wrongly denied funding. The problem is, appeals can take time. Meanwhile, you or your family member may be wrongly paying thousands of pounds a week in care fees. That is why with NHS Continuing Healthcare, it is absolutely vital to make as strong a case as possible at the initial application stage. If you are already at the appeal stage, however, don’t worry! We can help you make the appeal as robust as possible where we think there are grounds to do so.
So if you have questions about the NHS Continuing Healthcare application process, call or email us today for a free initial assessment of your case. We will advise you honestly and in plain English on the strength of your case. If appropriate, we can use the information to provide a range of services, based on the strongest medico-legal arguments on your behalf. This may be either by letter or as your advocate in a meeting. So get in touch. You have nothing to lose – and potentially much to gain.
By Rosalind Hughes, founder, Just Caring Legal