What is CHC?
NHS Continuing Healthcare Funding
NHS Continuing Healthcare Funding, often simply abbreviated to ‘CHC’, is the name for a special type of funding provided by the NHS, which pays for an individual’s cost of care in full (including their accommodation), if they have a ‘Primary Health Need’.
Eligibility for CHC funding using the ‘primary health need’ test is assessed by the NHS according to the guidance set out in the National Framework For NHS Continuing Healthcare and NHS-funded Nursing Care. This Framework sets out the criteria and process by which assessments for NHS Continuing Healthcare Funding should be carried out.
What is a Primary Healthcare Need?
An individual has a Primary Healthcare Need when it can be said that the majority of the care interventions they require are aimed at addressing health rather than social care needs.
It’s important to note that not everyone needing 24-hour care has a primary healthcare need.
It may be that your healthcare needs are incidental to your social care needs. If that’s the case, you will be means-tested by the Local Authority and you may well have to pay for some or all of your care.
However, don’t let anyone (either in the NHS or in the Local Authority/Social Services), tell you that you do not have a primary healthcare need until you have been properly assessed for Continuing Healthcare, using the appropriate national tools.
In most instances, Farley Dwek assist family members in relation to care funding issues faced by their relatives but, occasionally, we also deal directly with the person needing care.
Your right to be assessed for CHC Funding
The NHS and Social Services are under an obligation to ensure that eligibility for CHC Funding is considered in all cases where it “appears that there may be a need for such care” – this is critical.
You have every right to an assessment for NHS Continuing Healthcare, if there is any indication that you may have a ‘Primary Health Need’. Proper consideration for CHC funding should always be done before the Local Authority takes responsibility for meeting your care needs.
This is the starting point for all cases we deal with, because either:
- the NHS failed to undertake a Continuing Healthcare assessment at the appropriate time – usually upon admission to care or when it became apparent care needs had increased; or
- the NHS assessment was flawed and incorrect.
We often hear that people are not told about the availability of NHS Continuing Healthcare Funding or advised of their right to an assessment. It is open to debate whether this is due to a lack of knowledge and awareness, or for more insidious reasons (self-funders usually pay higher care fees, for example).
The important point is that you must know and understand your rights – otherwise, your relative may end up paying many thousands of pounds a month for their care, quite unnecessarily.
Stages of CHC Funding
CHC funding can be a long and difficult process for many patients. Before you receive funding, you must complete a CHC Checklist Assessment to be eligible for a full CHC assessment, at which point you may be eligible for funding.
However, just because you are recommended for the full assessment, does not mean you will be granted funding. At this point, you may want to discuss MDT advice for your meeting or a CHC appeal if you have been turned down for funding. This appeals the decision of the CHC assessment against the ICB, who grant CHC funding to an individual.
For individuals who are already in care, or are eligible and receiving CHC funding, case reviews and retrospective claims identify whether you are owed money from previous care home fees you have paid, when you should have been receiving Continuing Healthcare funding.
You can find advice from Falrey Dwek for each stage of the CHC process, including:
We frequently hear from clients that staff within the NHS and Social Services often give misleading or false information when asked about Continuing Healthcare Funding. For example:
“People with dementia don’t qualify for CHC Funding”
“Your relative won’t meet the criteria”
“Your relative will have to pay for care”
“Your relative doesn’t appear to have any health needs”
Statements along these lines are incorrect. If there is any indication your relative may have a Primary Healthcare Need, they must be assessed using the standardised national tools.
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 simply incorrect.
Remember
You should be told in good time if an assessment is taking place and be invited to participate fully in the process.
Once an assessment has taken place, you should receive a formal letter informing you of the outcome, and enclosing a copy of the assessment. The letter should explain how to challenge the decision if you disagree.
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 questions about your relative’s financial circumstances straight away.
This is against the NHS National Framework guidance which specifically states that financial issues should not be considered when undertaking an assessment. They cannot ask your relative about funding until eligibility for CHC has been ruled out.
We can help & advise
We understand it can be overwhelming.
Speak to our friendly team today.
How to ensure you are properly assessed
You can, of course, deal with the NHS yourself. Make sure you familiarise yourself with the National Framework.
We have produced a Free Guide to CHC Funding to help you understand the basics which you can download below for free.
However, our clients often tell us that this is a difficult, emotional and complex process, which is why they decided to enlist our help. We can provide you with a unique combination of legal and clinical expertise, to support you through the assessment process and maximise your chances of success. We can help you at every stage – Checklist, Full Assessment, Review and Appeal.
FAQs
CHC is a package of care, commissioned and funded solely by the NHS, which meets all their assessed health and social care needs, including the cost of accommodation.
In short, any adult aged 18 or over who has a ‘Primary Health Need’ and requires care as a result of a disability, accident or illness, may be eligible for CHC.
Recent statistics from the NHS indicate that 58,000 people currently qualify for NHS Continuing Healthcare Funding, but with 450,000 people currently in care, we think the number of people who should qualify for funding is much higher – perhaps as high as 150,000. People often miss out on funding in many circumstances, including:
- Being discharged from hospital straight into a care home.
- Those whose eligibility has been assessed and rejected, whose condition subsequently worsened.
- Those who received NHS- Funded Nursing Care (FNC) – which pays for the nursing, but not accommodation – who never had an proper assessment that would also have paid for their accommodation.
- More affluent patients who assumed no help would be available. NHS Continuing Healthcare Funding is not means-tested, so if you qualify for health reasons, you get it.
Don’t miss out! For more detailed information about your eligibility for NHS Continuing Healthcare Funding please contact a member of our team, or download one helpful Free Guide.
No, CHC funding is not linked to any particular condition, disease or diagnosis. So, for example, if your relative has dementia, Alzheimer’s or Parkinson’s, that does not automatically qualify them for CHC funding. CHC is about assessed needs and not any label ascribed to a specific condition.
Eligibility for CHC funding is determined by the quality and degree of the care interventions required to meet the assessed needs, regardless of why the care is needed, who it is delivered by or where it is provided.
Yes. You can undertake the whole process yourself and our Free Guide is designed to help you to understand how to work through the process. However, our clients tell us that the process is often difficult, stressful, complex and daunting, which is why we offer a range of specialist services and can act on your behalf at every stage.
As Martin Lewis previously said on his Money Saving Expert website:
“We don’t normally believe in using lawyers or claims handlers for things it’s easy to do yourself, such as PPI Reclaims, as they take a cut of your payout. Yet, even though we think it’s possible to reclaim care costs DIY, we’re not as militant in this case. If you’re struggling and need help, we strongly suggest using a solicitor rather than a claims handler. But never pay up front, and ensure it’s a ‘no-win no-fee deal’ …….While lawyers are regulated, care costs claims handlers are not (some other types of claims handlers are). If you weren’t happy with the claims firm, all you would be able to do is complain to Trading Standards.”
We understand the complexities of the CHC process and a combination of legal and clinical expertise to give our clients the best opportunity to secure funding, either at current assessment or appeal stage.
For more information about our Checklist Support, MDT Advocacy, Appeal or Retrospective Reclaims services, please get in touch.
No. The setting where the care takes place is irrelevant. CHC funding applies to any care setting. So, whether you require care in your own home, a care or nursing home, hospice or some other care facility – it doesn’t matter. It’s not about the setting, so don’t be told otherwise!
Absolutely not! Money and financial status should never be a consideration.
Once an individual is found eligible for CHC, the NHS must fund the full cost of meeting all their health and social care needs.
Yes, funding can be obtained without the CHC Checklist. However, this assessment gives you a good indicator if you will be eligible for CHC funding. Without the CHC checklist, you could be referred immediately for a full assessment, or you can obtain funding via the Fast Track Pathway Tool which deals with end of life care or short-term CHC funding.
Unfortunately, if you do not meet the criteria for NHS CHC Funding, you will be subject to means testing. Depending on your financial situation, you may have to fund your own care.
Currently, if you have assets over £23,250 (excluding your property if your spouse or other dependent is living in the property) then you will have to pay for your care.
If your assets are below the £23,250 threshold, then the Local Authority will pay for your care and is obliged to find you accommodation in one of their care homes. (You will still have to pay some costs if your assets are between £14,250 and £23,250 – see our Free Guide for more detail).
However, eligibility for CHC Funding can and does change over time: just because you don’t meet the criteria now, doesn’t mean you will never be eligible. You can be reassessed at any time, if your care needs change. We are always happy to provide further advice at a later date, if you believe your situation has changed.
If you have to pay for your own care, there are a number of options open to you in terms of the care or residential home you choose and you may benefit from specialist financial advice through Farley Dwek Financial Services* to help you plan for the costs of your care.
*- Farley Dwek Financial Planning is a trading style of Cheetham Jackson JV LLP, who are an appointed representative of Cheetham Jackson Ltd, authorised and regulated by the Financial Conduct Authority (FCA). Registered Address: 14-16 St Thomas’s Road, Chorley PR7 1HR. Registered in England & Wales number 7071622.
Get in touch if you require for more information.
To receive a CHC checklist, you can speak to a social worker, GP or District Nurse to request a Checklist to be completed. If this does not work, you can contact your local Integrated Care Board (ICB) for help.
CHC funding is paid by the Integrated Care Board (ICB), which is the local arm of the NHS. Each ICB has a CHC budget it uses to fund the care of eligible constituents.