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What costs are covered by NHS continuing healthcare funding?

What costs are covered by NHS continuing healthcare 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.

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The package of care is available to people who have significant ongoing 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.

 

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 NHS continuing healthcare pay 100% of the fees associated with an assessed and established primary healthcare need, there is 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 primarily health needs 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 a 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 professional – 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 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 Clinical Commissioning Group (CCG) will be contacted. The full assessment is carried out by a multi-disciplinary team comprising two or more health or social care professionals familiar with the patient’s needs. In some cases, the multi- disciplinary 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 multi- disciplinary 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 multi-disciplinary 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 CCG as to whether the individual should be entitled to 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 Clinical Commissioning Group (CCG) responsible for funding in your area. The CCG 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 can be a perplexing and complicated process. 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.

Author: Fiona Gilbert BSc (Hons), MA


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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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