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THE PROCESS EXPLAINED

3 SIMPLE STEPS...

The continuing healthcare checklist for funding and free care.

The process surrounding continuing healthcare funding is set out by the government in a document called The National Framework for NHS continuing healthcare and NHS-funded nursing care. It is a Department of Health policy document first introduced in October 2007.

Stage 1

A continuing healthcare checklist is the first stage in determining whether an individual is entitled to free care.  A PDF of an example checklist is available here
 
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 remains in their own home then the responsibility for conducting an assessment is with the Clinical Commissioning Group for the area. 

A nurse assessor or social worker will consider the individual’s needs across a range of 12 domains or areas of need and score them on the basis of A (high), B (moderate) or C (low/none). 

The next stage and a full assessment is required if an individual is scored as having two or more A scorings, 5 or more B scorings or 1 A and 4 B scorings.

Time frames

Time between receipt of the completed Checklist and a funding decision being made following a full assessment and meeting of the Multi-Disciplinary Team 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.  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.

Fast Track assessment

If an individual is approaching the end of their life, then a “fast track” continuing healthcare funding assessment may be appropriate.  This enables the individual to receive prompt NHS funding to meet the cost of care at the end of life stage.  The only requirement for by-passing the normal NHS continuing healthcare assessment criteria and receiving the fast track pathway is that the individual must have:

  • a rapidly deteriorating condition; that may be entering a terminal phase.

A GP can complete the fast track tool.

It should be noted that strict time limits that base eligibility on some specified, expected length of life remaining should not be imposed.

Appeals

If you do not agree with the decision that has been reached by the panel then the decision can be appealed.  This has to be backed by evidence, e.g. the decision reached was flawed.  We can assist in this process.  With our expert knowledge and experience of this complex area, we are able to determine whether you have a basis for an appeal by reviewing the evidence, and assisting you with the full appeals process.  We have a strong success rate of securing funding after attending the panel hearings and arguing our client’s case.  Contact us today for further details.

Summary

This guide is only intended as a brief outline to provide a useful summary as an overview of the process.  The key to success is to ensure that you have sufficient expertise in your corner to support you through the process and ensure that the correct scorings are awarded according to the needs of the patient and 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 have 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.


Complete our user friendly online continuing healthcare assessment form

Do not delay, contact us today. We specialise in securing funding from day 1 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 have to appeal the outcome. This can take many months and all the while the patient will be having to pay the cost of their care.

Did you know?

If an individual is approaching the end of their life then a “fast track” Continuing healthcare funding assessment may be appropriate. This enables the individual to receive prompt NHS funding to meet the cost of care at the end of life stage.

What is Continuing Healthcare?

Click the video to see a detailed explanation.

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