NHS Continuing Health Care

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What is it and how does it work?

Most people are aware of the high costs involved when a loved one is in need of additional care. The type of care required could result in specialist carers coming into the home, or could result in the difficult decision of placing your loved ones into a care home. What is less known is that if an individual’s needs are complex enough, and they meet the eligibility criteria they may be entitled to full funding from the NHS.

NHS Continuing Health Care (CHC) is the name given to a package of healthcare provided by the NHS. It is only available to adults and eligibility is based on the needs (not the diagnosis) of the individual. NHS CHC is not means tested, and therefore it is irrelevant if that individual is able to fund the cost of their care. If their needs are complex enough to meet the eligibility criteria the NHS will pay.

The initial assessment is carried out by way of a checklist. This can be done by a doctor, nurse, social worker or other healthcare professional. Once this assessment is completed you will be told either the individual concerned is not currently eligible for NHS CHC or they will be referred for the full assessment.

The main assessment is a more in-depth examination of how complex the individual’s needs are. It is usual to have a Multi-Disciplinary Team (MDT) which consists of at least two healthcare professionals (one of which is a Social Worker), and a NHS assessor. The individual concerned, if able, or their family members are encouraged to be present to provide their views.

Once the assessment has concluded the MDT will discuss in private all of the evidence presented. A recommendation will then be made and there are three possible outcomes:

  • Award for full funding NHS CHC;
  • Award for partial funding NHS funded nursing care; or
  • No funding.

A final decision should be made within 28 days of the checklist being carried out. If an individual’s health is in rapid decline or becomes terminal, the assessment can be fast tracked to ensure a decision is made urgently.

It is important to note that eligibility for NHS CHC is based on the individual’s needs. Therefore if after the assessment, no funding is awarded it does not mean that it will not be awarded in the future. Equally if NHC CHC is awarded it is not for life and can be withdrawn following a review. The key is to monitor the individual for any significant changes in their needs and to request a further assessment when required.

If you feel that a family member should be assessed for NHS CHC please contact a healthcare professional to arrange for a checklist to be carried out.

The guidelines that govern this area are complex and can sometimes be misinterpreted. It is therefore important to ensure that if an assessment is to be carried out it is done so correctly and promptly. All relevant issues should be considered to ensure the right decision is made as a wrong one can have a serious financial impact on those concerned.

It has been reported in the news that a number of families are challenging the NHS CHC assessment process because they feel the wrong decision has been made. If upon review a decision is reversed it is possible for funding to be backdated to the assessment date.

Our legal specialists can help assist you through the process should you need advice and support. We can assist if it is your first time with the initial assessment or help challenge a decision that has already been made. In addition, if you or a loved one requires advice in relation to estate and care planning please contact our Wills, Trusts and Probate Team on 01733 882800 or please email [email protected].

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