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NHS Continuing Healthcare (CHC) Funding

What is NHS Continuing Healthcare (CHC) Funding?

If an individual who is receiving care (either at home or in a nursing environment) meets the relevant criteria for NHS Continuing Healthcare, they will no longer be responsible for any care fees. This can result in money that they may have worked hard for being retained, and can result in an individual saving thousands of pounds per year as well as preserving any property belonging to them, that may otherwise have been sold to pay for care fees.

The right to NHS Continuing Healthcare is NOT means tested and therefore can be awarded irrespective of capital or income, and is based purely on an individual’s needs. If eligibility is agreed, your care fees are no longer your responsibility.

How is an individual assessed in respect of their healthcare needs?

When an individual is either discharged from hospital, placed into care, has care at home or has a change of need an NHS Continuing Healthcare Checklist (HCC Checklist) should be completed to establish that person’s needs. The Checklist can be carried out by a District or Registered Nurse, Social Worker or Clinician from the local Commissioning Support Unit/Clinical Commissioning Group. The Healthcare Checklist is a screening tool and is used to determine whether the extent of an individual’s needs justify a full assessment, known as a Decision Support Tool (DST).

The Healthcare Checklist is a lengthy document which is designed to assess 11 areas of an individual’s health. These areas are known as “domains” and include:

Behaviour Continence
Cognition Skin
Psychological Breathing
Communication Drug therapies
Mobility Altered states of consciousness

Each of the domains are reviewed individually and given a grading from A – C (A being the most severe). However, the grading can vary and is dependent upon the view of the assessor.

Once the Checklist has been completed, a decision will be made as to whether a full assessment (DST) should be undertaken. If the assessor decides no additional assessment is required because a patient’s health needs are not sufficiently complex, it can be difficult to get a further NHS Continuing Healthcare Assessment, thus it is important to ensure that this assessment has been correctly undertaken.

If an individual has been assessed as possibly being eligible for CHC funding, a DST will be required. A DST is similar to the NHS Continuing Healthcare Checklist assessment, although it is more detailed and thorough. At the end of this assessment, again an individual’s needs will be considered and a recommendation will be made by the assessor as to whether the individual’s care needs are health related or social in nature. If it is decided that an individual has a primary health need then NHS Continuing Healthcare funding may be awarded. The NHS assessor will send their recommendation to an NHS Panel who will decide whether funding is to be awarded. Once again, it is extremely important to ensure that this assessment has been undertaken correctly.

As you may have gathered from what has been outlined above, the CHC and DST documents are complex and require specialist training. These documents underpin the outcome of a possible claim for CHC funding, and therefore it is important to ensure that evidence is correctly gathered, reviewed and presented at the assessment. Outcomes can vary considerably under different NHS Clinical Commissioning Groups (CCG) resulting in inconsistency based upon your postcode. Additionally, varying opinions between clinical professionals and the lack of evidence to support the assessment, can result in an incorrect decision being made for your loved one. Can you afford not to seek independent advice?

If my loved one is granted CHC funding, will it remain in place indefinitely?

Unfortunately this is not the case. There may, for example, be instances whereby a person may qualify for CHC funding, but he or she may then undergo a period of recovery, as a result of which their care requirements reduce, which may no longer entitle them to NHS Continuing Healthcare funding.

In order to ensure to that CHC funding is retained, if an individual is granted funding, a review will take place 3 months after the initial decision was made at which time. The NHS will re-assess whether the funding should remain in place. If so, a further re-assessment will take place annually (every 12 months).

My loved one’s medical position has not changed since they were granted CHC funding – is the review simply a formality?

No! As stated previously, this is quite a complex issue and decisions with regard to NHS CHC funding can differ within the NHS structure. In the circumstances, it is not uncommon for those who have been granted NHS CHC funding to learn it has been revoked at a later review stage.

How can Care Necessities help?

NHS Continuing Healthcare is a complex area. Challenging the funding can be extremely worrying and daunting experience for those who may not have had a need to consider healthcare funding previously, especially when you are very anxious about the care needs of your loved one.

Whilst the system is designed to help those in need, it does sometimes go wrong, and an incorrect decision made can have a significant impact upon an individual’s finances.

The team at Care Necessities can:

  • Attend Hospital discharge and DST assessments, providing expert guidance and support through this process
  • Provide advice as to whether your loved one may be entitled to NHS CHC funding
  • Obtain copies of any medical documents, which may be required to support a claim for NHS CHC funding
  • Provide advice as to what (if any) additional evidence could be gathered to support an application for funding
  • Prepare a letter to the NHS outlining any failure in process, and advising of the correct procedure
  • Attend NHS review hearings to fight your corner for funding
  • Draft Appeals to the NHS