The term continuing healthcare can be a confusing and scary one, in this blog we uncover the history behind this style of funding.
NHS Continuing Healthcare is a phrase that occurs frequently within the care and health sector and is often a topic many people don’t understand or feel slightly confused about, but where did it all start and what is the history of continuing healthcare?
What is Continuing Healthcare?
Continuing healthcare is a name that is given to a network of support and care that is paid for and arranged by the NHS for those looking to enter care. Designed to analyse a person’s needs and distinguish the necessity for the cover of costs that may otherwise be paid for by the individual or the council. NHS continuing care is opened up to those living in their own home or within a care facility.
Someone’s eligibility isn’t solely based on their illness or age, the NHS requires a person to have complex medical needs that are intense, complex or unpredictable in their nature. If someone passes the criteria for funding, the costs of their care in full that would usually be covered by the patient or the council will be covered within the funding.
Marie Curie describes in further detail what would make a person eligible for CHC: “Having a terminal diagnosis isn’t enough on its own to make a person eligible for NHS Continuing Healthcare. They have to be very ill to get it. The NHS says the person must have ‘a complex medical condition with substantial, ongoing care needs’. To get it, people are assessed. If they meet the criteria, they are said to have a ‘primary health need’. That means the NHS now has responsibility for their care costs.”
The history of Continuing Healthcare
Before the NHS framework, the entitlement for someone looking to be granted NHS healthcare funding was seen as somewhat unfair and at the time was not means tested to give a just and accurate conclusion that the patients who were applying deserved.
After many complaints arose and the outcomes of the decisions lead to challenges in the courts the NHS continuing healthcare package was imposed in October 2007. Since the launch of the framework, it was established that where a persons need falls within the primary healthcare bracket that the whole cost should be covered by the health service and not the patient or direct family.
But Continuing Healthcare was in the pipeline long before 2007. In 1995, some local areas formed a continuing healthcare framework template which was launched until the NHS and the local authorities expressed concerns about the potential of the funding since complaints about long-term decisions that were made were deemed incorrect. The local policies that were drawn up were discarded as not deemed fit for national exposure.
In 1999, a conversation was had which determined that the local authorities should be the ones paying for the care of chronically ill patients, which was soon lowered and a decision was made that if the person’s healthcare need is a primary one, the costs should be covered by the NHS.
2003 saw another bump in the road, suggesting that the new guidance had not been solving the problem of local variation and the restrictive and somewhat confusing criteria could be the issue. This lead to the 2007 report being launched where the decision was made that the funding should fall solely with the NHS if the persons need is solely a primary one.
Who is eligible for Continuing Healthcare Funding?
As we have already discussed, not everyone with a severe illness will qualify for NHS Continuing Healthcare. The NHS website depicts the outline for who is eligible for NHS funding: “Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.”
You should be fully involved in the assessment process, kept informed, and have your views regarding your needs and support taken into account. Carers and family members should also be consulted where appropriate.
“A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.”
The guidance for eligibility is strict and often misleading. It is sometimes best to consult a team of experts, like us here at Compass CHC who can guide you through the process and answer any questions you may have. The assessed needs should fall into the criteria of the NHS funding assessment and need to be confirmed as a primary healthcare need that requires full-time care from a team of professional experts, only then will the costs of the care be completely covered by the NHS.
“The National Framework for continuing healthcare funding confirms that ‘where an individual has a primary health need and is therefore eligible for NHS continuing healthcare, the NHS is responsible for providing all of that individual’s assessed needs – including accommodation if that is part of the overall need’. One individual’s interpretation of a primary health care need may differ to another, and sometimes it can take an outside party like ourselves to offer perspective on a situation and help quantify if someone truly has a primary health care need.
There are four characteristics that are tested to establish whether someone has a primary health care need. The four characteristics are:
- Nature: “This characteristic looks at the individual’s needs, and the care interventions required to meet those needs. The National Framework for continuing healthcare funding provides a number of questions that can be useful in determining whether an individual’s needs constitute the required nature characteristic to be considered primary health needs”
- Intensity: “The characteristic of intensity looks at the quantity, severity and continuity of needs.”
- Complexity: “This characteristic looks at the level of skill and knowledge required to meet the individual’s needs as well as the interaction between two or more domains.”
- Unpredictability: “This characteristic considers the degree at which needs fluctuate and create challenges in managing the needs.”
If someone you know is looking to seek funding for their care, get in contact with our team of experts who will be able to guide you through the process of the NHS continuing care assessment. Give us a call on 0121 437 6655 for more details.
Author: Tim Davies LLB