Whilst the scoring system isn’t scientific by any means, generally speaking your relative should qualify for NHS Continuing Healthcare Funding if they score ‘Priority’ in any of the * domains, or a ‘Severe’ in two or more domains. However, they could still qualify if their scores aren’t as clear cut as this, as it is the totality of their healthcare needs that are being assessed. It is also worth noting that the NHS Guidelines state that if there is any uncertainty or disagreement within the MDT about what score to allocate, then the higher of the scores should be applied. This is important to understand when you are putting your case across.
Once the Full Assessment has been completed, the report is sent to the CCG in your area, who make the final decision on whether your relative qualifies for NHS Continuing Healthcare Funding or not. It is not the MDT who make the decision, although they will make a recommendation. In most cases, it is expected that the CCG will follow the MDT’s recommendations. The CCG will send you a written copy of their Decision with a copy of the DST (and process for appealing).
If you disagree with the CCG’s outcome or the rationale for their Decision to refuse NHS Continuing Healthcare, you have the right to Appeal, and must lodge your written appeal submissions within 6 months of receiving the Decision.
If your relative’s Full Assessment is successful, they will qualify for NHS Continuing Healthcare Funding, and it is then the responsibility of the NHS to pay for 100% of their care.
However, your relative should be aware that the NHS will undertake another Full Assessment after three months, and thereafter annually, at which point your relative’s funding may be withdrawn. Your relative will be advised when any further assessments are going to take place, and they (and their advocate) will have to prepare for this reassessment in exactly the same way.
If, following the Full Assessment, your relative agrees that their care needs are not primarily healthcare needs, then they will move from the care of the NHS into the care of the Local Authority/Social Services – which is means-tested.
How to ensure you are properly assessed
You can of course deal with the NHS yourself to ensure that a proper assessment of your relative’s entitlement to NHS Continuing Healthcare Funding is undertaken.
We have produced our Care Funding Guide to help you understand how the process works which you can download for FREE.
Clients often say that these Full Assessment meetings are daunting, intimidating, stressful and emotionally draining, and that the MDT often uses tactics to position what’s being said to their own advantage. Our nationwide team of specialist nurses have years of experience in dealing with MDT Assessments and can provide professional advocacy support – see our Supported Assessment Service. If you need help, get in touch below.