We investigate the length of time it should take to receive a continuing healthcare funding decision

Once your continuing healthcare (CHC) assessment has taken place, the NHS health and social care professionals involved with your care will recommend whether you are eligible for funded care. This recommendation is forwarded to the Integrated Care Board (ICB) responsible for funding in your area. The ICB will decide whether to accept or decline your assessment results and, if upheld, the level of care and support package available to you.

The ‘National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care’ gives clear guidelines to all ICBs and local authorities on the timescales that should be followed. It makes clear that the time between the checklist being received by the ICB and a continuing healthcare funding decision being made should not exceed 28 days.

If the timeframe is longer than this then funding should be met by the NHS whilst a decision on eligibility is met.  At Compass CHC we have experienced examples of significant delays where individuals have been expected to pay for their care in full.  This is not correct or acceptable.  If you are in a similar situation do not hesitate to contact us today.

When the Need for Care is Urgent

If the need for care is more urgent, where someone is in very poor health and near the end of their life for example, their eligibility should be determined as quickly as possible using the National Framework fast track pathway tool. In these circumstances, a care package should be approved and put into place as quickly as possible.

During their investigations, the Continuing Healthcare Alliance (a group of 13 organisations who believe NHS continuing healthcare needs to improve) discovered that the clear guidelines relating to the length of time the review process should take place were being ignored with many people (42% of survey respondents) waiting for unacceptable time periods with little or no communication on the progress of their application.

The CHC Alliance also found that the decision on whether someone is eligible for NHS CHC funding often depends on the quality of evidence supplied and that “this varies greatly, with some assessments resulting in two lines of evidence, while others produce several pages” (page 9 ‘Continuing to Care Report).

Unfortunately, at Compass CHC, we experience all too often ICBs and CHC teams flouting the guidelines clearly laid out in the National Framework, particularly when it comes to time scale assessments.

Many of our clients report being told that there is a ‘backlog’ and their case decision would be delayed until the backlog has been dealt with. The CHC Alliance also raises concern that this ‘backlog’ was being blamed by ICBs for failing to meet the 28-day deadline. The Alliance discovered that in some cases the backlog could be as long as 18 months.  This delay can make the process so much more trying for families who simply do not have the time to constantly chase the NHS and ICB for information.

How can Compass CHC help?

We know the Framework back to front and we are aware when a continuing healthcare process has not been carried out correctly, or when a ICB directly contravene the guidelines. We can step in to ensure that your application for CHC funding is carried out as smoothly and efficiently as possible.

We are also able to help you access funding from day one. We specialise in helping to ensure healthcare funding is in place from the start meaning no fees are paid from the outset so if you have yet to have an assessment but think your health need meets the criteria, we can assist you from day one.

After speaking with you, if we think you have a strong case for CHC funding, we will obtain copies of your medical records and our team of continuing healthcare experts, comprising lawyers (non-practising) and clinicians (including nurses, tissue viability specialists and pharmacists), will review and consider the evidence from a clinical perspective before drafting reasoned arguments which identify where the threshold for entitlement to NHS Continuing Healthcare funding is met. We will then liaise with the NHS and ICB every step of the way to ensure a swift resolution of the case can be achieved.

The key to success is to ensure that you have sufficient expertise in your corner to support you through the process so the correct outcome is reached.  We will work tirelessly to secure the best result for you, in the swiftest timeframe, at minimal cost.

Do not delay, contact us today.  We specialise in securing funding from day one and assisting families with the process from the outset.  Don’t wait until a negative decision has been made and it is then necessary to appeal the outcome, this can take many months and all the while the patient will have to pay the cost of their care.

Complete our confidential free nursing assessment today and we can start the journey navigating you to free care.

Author: Tim Davies LLB