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What costs are covered by NHS CHC funding?

Continuing Healthcare Funding, also known as CHC Funding, is free healthcare provided by the NHS and it can cover up to 100% of care costs.

The package of care is available to people who have significant long term healthcare needs, known as primary health needs and it covers all your care costs such as aiding with washing and dressing, medication provision, continence care, therapies and other complex health needs that would otherwise we carried out by a social worker of social care professional.

What does continuing health care cover: an overview
Care in your own home The NHS will pay for healthcare, i.e. services from a nurse or therapist, and personal care, for example help with washing, dressing and laundry
Care in a care or nursing home In addition to healthcare and personal care, the NHS will pay for your care home fees, including board and accommodation

Not only does the framework for NHS Continuing Healthcare pay 100% of the fees associated with an assessed and established primary healthcare need, but there is also no financial limit of any kind and the National Framework explicitly prohibits patients paying ‘top-up’ fees.

Continuing Healthcare Funding is not means tested; meaning that 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.

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 primary health needs or long term, they are entitled to NHS Continuing Healthcare Funding to meet the cost of their care in full, whatever their financial situation.

To be eligible for NHS Continuing Healthcare Funding, the individual’s need for care must be healthcare rather than a social care need. It must be established that the need for care is primarily health-related. Additionally, these needs must be assessed as being complex, intense and unpredictable in their nature or a combination of the same. It should be noted that a person’s health needs – not their diagnosis – determines whether they are eligible for funding so having a certain diagnosis, for example having been diagnosed with Dementia, Alzheimer’s Disease or Parkinson’s disease, is not in itself an automatic entitlement to free care.

There are several stages individuals must go through before being awarded, or denied, continuing healthcare and funding can be denied at each stage of the process.

A Continuing Healthcare checklist is the first stage in determining whether an individual is entitled to free care. To trigger a checklist, you can ask your social worker, GP or other health and social care professionals that is in the department of health– such as a care home manager – to organise one.

An assessment should be carried out before a patient is discharged from hospital to a nursing home. This is a crucial point.  If the patient is already in a nursing home or health services or remains in their own home, then the responsibility for conducting an assessment is with the NHS Clinical Commissioning Group for the area.

If the checklist identifies the need to carry out a full assessment, your Integrated Care Board (ICB) will be contacted. The full assessment is carried out by a multidisciplinary team comprising two or more health or social care professionals familiar with the patient’s needs. In some cases, the multidisciplinary team will contact the specialists involved with the care to build a better picture of the health needs the individual has.

The information taken from your full assessment will be used by the multidisciplinary team to complete a ‘Decision Support Tool’ (DST). The DST document was developed to ensure assessments are carried out as consistently as possible across the national NHS network.

The multidisciplinary team will allocate a level of need to each care domain to determine if the individual has a ‘primary health need’ and then make a recommendation to the ICB as to whether the individual should be eligible for NHS Continuing Healthcare.

Once your Continuing Healthcare 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.

Don’t forget, if you are denied NHS Continuing Healthcare Funding, there are appeal options open to you.

Should you, or a relative, have any concerns regarding NHS Continuing Healthcare Funding, our expert advisors can assist by explaining the ins and outs of what a perplexing and complicated process it can be. There is no time limit placed on this free, no obligation consultation. Should you wish to discuss matters further, do not hesitate to contact us directly on 0121 227 8940 for information and advice.

Author: Tim Davies LLB

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