Tim Davies, Managing Director and (non-practicing) solicitor of Compass CHC has put together five handy facts about NHS continuing healthcare funding to help you understand the process.
Continuing healthcare funding, also known as CHC funding, is free healthcare provided by the NHS. The package of care is available to people who have significant ongoing healthcare needs, known as primary health needs, and it covers 100% of care costs.
To be eligible for NHS Continuing healthcare funding, it must be established that your need for care is primarily health related. Additionally, these needs must be assessed as being either complex, intense and unpredictable in their nature or a combination of the same.
1. Continuing healthcare is available in any setting outside of hospital
This package of care can be received in any setting outside of hospital including care homes, hospices or even within your own home. It is incorrect to state that a person can only be eligible for continuing healthcare funding if they are in a nursing home. Their health needs, not their location, is the key factor.
2. Receiving a specific diagnosis doesn’t guarantee funding
A person’s health needs – not their diagnosis – determines whether they are eligible for funding so having a diagnosis of dementia, Parkinson’s, Alzheimer’s or another degenerative condition is not an automatic entitlement to free care. However, the progressive nature of dementia, Parkinson’s or Alzheimer’s means that as symptoms worsen some people with the condition may qualify for continuing healthcare.
To determine if someone is eligible for NHS continuing healthcare funding, the patient must be assessed as having a primary health need. This assessment is undertaken by a multi-disciplinary team of healthcare professionals who use a ‘Decision Support Tool’. The Decision Support Tool (DST) is a document which helps to record evidence of an individual’s care needs to determine if they qualify for continuing healthcare funding.
3. Continuing Healthcare Funding is not means tested
It doesn’t matter what your income is or what savings you have, if you meet the criteria, you are entitled to free NHS CHC funding. NHS continuing healthcare funding is not means tested and it will cover up to 100% of care costs.
You should not be asked any questions about your financial situation and Social Services should not complete any financial assessments until the NHS Continuing Healthcare funding assessment has been completed. If an individual’s needs are primarily health needs they are entitled to NHS continuing healthcare funding to meet the cost of their care in full, whatever their financial situation.
4. You shouldn’t have a long wait for a continuing healthcare funding decision
The ‘National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care’ gives clear guidelines to all CCGs and local authorities on the timescales that should be followed. It makes clear that the time between the checklist being received by the Clinical Commissioning Group (CCG) and a continuing healthcare funding decision being made should not exceed 28 days.
Unfortunately, this is one of the many procedures and processes that is often ignored by Clinical Commissioning Groups.
5. Your eligibility for Continuing Healthcare funding will undergo regular reviews
If you have been awarded NHS continuing healthcare funding, your needs and support package will be reviewed within three months of the initial assessment and at least annually thereafter. The review considers whether your existing care and support package still meets your assessed needs and – if your needs have changed – the review will consider whether you are still eligible for funding.
The CCG undertaking the reassessment must carry out a full DST assessment with a multi-disciplinary team and the client (and advocates if required) must be present during the process. The National Framework states that when reassessing someone’s eligibility, the multi-disciplinary team must reference the previously completed DST and prove that things have changed.
How can Compass CHC help?
The key to success when dealing with NHS continuing healthcare professionals is to ensure that you have sufficient expertise in your corner to support you through the process so the correct outcome is reached.
At Compass CHC, our advocates are all (non-practising) lawyers specialising exclusively in continuing healthcare funding matters. Compass CHC does not undertake work in any other area which means we have accumulated vast experience attending assessments and appeal hearings at local and NHS England level and we are not distracted by work of other natures.
Compass CHC has helped hundreds of individuals and their families understand and receive NHS continuing healthcare funding. Complete our free, confidential assessment today and an expert member of our team will contact you for a no obligation discussion to outline your options.
Author: Tim Davies LLB