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NHS Continuing Healthcare Funding

NHS Continuing Healthcare Funding is the technical term for the funding service provided by the NHS, where the NHS pays for the cost of care, in full, for an individual who is determined to be eligible for the funding by virtue of the fact that they have “primary healthcare needs” which require the provision of care.

Eligibility for NHS Continuing Healthcare Funding is assessed by the NHS using rules and guidelines set out in what’s known as The NHS Framework. This Framework sets out criteria by which assessments to an entitlement to NHS Continuing Healthcare Funding should be carried out.

It’s important to note that not everyone requiring care has primary healthcare needs.

It may be that your healthcare needs are incidental to your social care needs. If that’s the case, then your care need will be assessed and means tested by the Local Authority and you may well have to pay for some or all of your care.

However, first and foremost you must NOT make any assumptions that you do not have primary healthcare needs, or allow anyone (either in the NHS or in the Local Authority/Social Services) to tell you that this is the case, without the NHS having first conducted a Continuing Healthcare Assessment.

In most instances, we at Farley Dwek deal with family members in relation to Care Funding issues faced by their relatives, however in some instances we do deal directly with the person in care.

Your “right” to NHS Continuing Healthcare Funding

(You or) Your relative has a “right” to an assessment for NHS Continuing Healthcare Funding, where you or they reasonably believe that they have a Primary Healthcare need and this must be done before they are passed to the Local Authority to deal with their care needs.

We feel that this is a “right”, however the NHS is not under a legal obligation in the strictest sense to undertake an assessment. However, it is under an obligation to undertake an assessment in all cases where it “appears that there may be a need for such care” – this is the key.

This is where all the cases we deal with start, either a) a failure by the NHS to undertake a Continuing Healthcare Assessment, either before your relative was placed into care, or at a point in their care, when it was clear that their medical condition had deteriorated to a point where their primary healthcare needs had over taken their social care needs, or b) in cases where the NHS has conducted an incorrect assessment.

Very often, staff within the NHS will not advise (you or) your relative of their “right” to an NHS Continuing Healthcare Assessment. Whether this is due to a lack of understanding and training on their part, or part of a wider strategy to avoid the costs of NHS Continuing Healthcare Funding is open to debate. The important point is that you and your relative must understand your “rights”.

In many circumstances, we hear from clients, that staff within the NHS often give misleading or false statements when asked about NHS Continuing Healthcare Funding, for example:

  • People with Dementia don’t qualify for Funding
  • Your relative won’t qualify
  • Your relative has to pay for care
  • Your relative doesn’t appear to have any health needs etc

Statements along these lines are not true. If you or your relative consider that you may have Primary Healthcare Needs then you are entitled to an Assessment and one should be done.

In other circumstances, we hear that people are told that an Assessment has already been done, or for example:

  • Your relative has been continually assessed whilst they’ve been in hospital, so we don’t need to do any more checks
  • Your relative has already been assessed and they don’t qualify
  • Your relative will have to pay for an Assessment
  • An Assessment will take too long, your relative will have to pay for care until we can arrange one

Again, statements along these lines are not true. If an Assessment has taken place, your relative should have been told it was taking place, if they weren’t, they can ask for another one to be done. If an Assessment has already taken place they should have received a written copy of the Assessment. If they haven’t been given one, another one needs to be done.

Under no circumstances should you or your relative sign anything before an Assessment has taken place. That includes any form of agreement with Social Services in relation to a Care Agreement or Financial Terms.

Social Services will often start to ask your relative questions about their financial circumstances and whether they are self funding straight away. This is against the NHS Framework advice, which specifically states that financial issues should not be considered when undertaking an assessment. They cannot ask your relative about funding until the initial Checklist Assessment for NHS Continuing Healthcare Funding has taken place.

How to ensure you are properly assessed

You can of course deal with the NHS yourself to ensure that a proper assessment for your or your relative’s entitlement to NHS Continuing Healthcare Funding is undertaken.

We have produced a Care Funding Guide to help you understand how the process works which you can download for FREE here.

However, our clients often tell us that this is a difficult and daunting process, which is why we have developed our Advisory Service to provide you with legal and clinical expertise to support you through the assessment process.

Have at look at our Advisory Service page for more information about how we can help, or do not hesitate to call us today on 0800 011 4136 or 0161 272 5222 or Contact Us online and we will call you back. Or you can download our Questionnaire, which you can complete and return to us for a FREE ASSESSMENT.

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