As one of our most frequently asked questions, we have looked to shed some light on the query above.
NHS continuing healthcare funding is provided to individuals by the NHS to meet the costs of their care in full where it is established that their need for care is primarily a health need. The cost of care, including accommodation and what can sometimes be referred to as ‘board and lodgings’ when in a care home is also included.
NHS continuing healthcare funding is NOT means tested in any way, shape or form. It is irrelevant what assets the individual holds and whether they exceed the Social Services means testing limit of funds greater than £23,250.
The key principle relates to the core values of the NHS which is free healthcare at the point of delivery for all. Whether an individual should be paying for care should be assessed in a set manner:
Does the Individual Have Primary Health Needs?
If an individual has primary health needs, then they are entitled to NHS continuing healthcare funding to meet the costs of care in full. It is not required that they pay a penny towards the cost of their care and it is irrelevant whether they have funds exceeding the Social Services means testing limit or whether they own a home.
The first and only test is whether their needs are primarily health needs. If they are because they have the required nature, complexity, unpredictability, or intensity or any combination of the above, then they are eligible for NHS continuing healthcare funding in full to meet the costs of their care.
What Happens if an Individual is Not Eligible for NHS Continuing Healthcare?
Once, and only once it has been determined that an individual is not eligible for continuing healthcare funding to meet their care should there be any discussion about means testing. Where it has been determined that an individual’s need for care is not primarily a health need, the test then is one of means testing, namely do they have assets exceeding £23,250 on the basis of the current means testing Social Services criteria.
If they do, then they are not eligible for support or financial assistance from the local authority, and they are obligated to meet the cost of their care, in full, until such a time as their assets fall below the means-testing threshold. If their assets are below this threshold, then that will be the point at which Social Services will intervene and contribute to or meet the cost of their care in full depending on their particular circumstances.
NHS continuing healthcare funding and Social Services funding for care are two separate and entirely distinct matters. Social Services funding is means tested, NHS continuing healthcare funding is not.
Every individual in care should be assessed to determine whether their needs are primarily health needs or not. Only once this has been done in full and concluded should it be the case that they are financially assessed to see whether they should be meeting the cost of their care under the criteria for Social Services means-tested funding for care costs.
Unfortunately, very often individuals cannot be assessed when it should, in fact, be the case that their needs dictate that they are entitled to NHS funding in full.
Equally, a patient may not be entitled to NHS continuing healthcare funding at their point of entry to care, but if their health needs were to deteriorate, they might then meet the threshold for full NHS continuing healthcare funding. This can only be determined if an assessment is undertaken within the criteria of NHS continuing healthcare.
If you have any questions or queries regarding NHS continuing healthcare funding, you should not hesitate to contact the Compass CHC team directly.
Author: Tim Davies LLB