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Too many people entering the care system have no idea that their care fees could be paid in full by the NHS – yes, every penny! However, accessing this funding isn’t straightforward and the NHS does not freely advertise its availability or volunteer to help you obtain it.
Due to the veil of secrecy surrounding its availability, Continuing Healthcare funding has often been described as the NHS’s “best kept secret”.
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CHC Funding may cover 100% of your care fees
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.
CHC is a package of care, commissioned and funded solely by the NHS, which meets the all their assessed health and social care needs, including the cost of accommodation.
No, the funding system and rules in Wales, Scotland and Northern Ireland are different and, unfortunately, we do not provide any services or advice to people living in these jurisdictions. We only deal with clients whose care is being funded and provided in England.
Farley Dwek offer professional help, expertise and support at every stage of the NHS Continuing Healthcare Funding process, from the initial Checklist all the way to Independent Review.
Choose from our wide range of services, depending on the stage of the funding process you are at.
Our charges will be communicated in an entirely transparent way and will, of course, depend on your needs and the work you require us to do. Some services are undertaken on a fixed fee basis and others may be offered on a ‘no win, no fee’ basis.
There are two stages to the assessment process.
The first stage is the Checklist which is usually completed by a Social Worker, care home manager or nurse. The Checklist is a preliminary screening tool which is aimed at eliminating those who clearly do not qualify for CHC funding. If the individual scores sufficiently highly on the Checklist, they will automatically progress to the second stage – a Full Assessment.
The Full Assessment – often referred to as “the MDT” – is carried out by a Multi-Disciplinary Team (MDT) of professionals from different backgrounds; usually, a registered nurse and a social worker but sometimes two nurses of different skillsets. The MDT will complete a Decision Support Tool and make a recommendation of eligibility to your local Integrated Care Board. It is the Integrated Care Board that makes the ultimate decision about whether to award CHC Funding.
If you think that your relative may be eligible for CHC, it is vitally important that you understand your rights and know how to proceed with an assessment.
For more detailed information about your eligibility for NHS Continuing Healthcare Funding, please contact a member of our team, or download our helpful Free Guide.
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.
If you’ve already been assessed and turned down for NHS Continuing Healthcare Funding, you should contact us to discuss a potential appeal. The NHS should have provided you with a copy of the Decision Support Tool, which we can review. Our Appeal Advice Service will help you decide whether to pursue an appeal and discuss ways we might be able to help.
If you have a date for a Checklist or Full Assessment, we may be able to provide advocacy at short notice via our Checklist Support or MDT Advocacy services to give you the best chance of achieving a successful outcome.
The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (“the National Framework”) sets out national guidance from the Department of Health, covering all aspects of the assessment and appeals process, and the eligibility criteria.
The latest National Framework (July 2022), has increased to a whopping 187 pages and is essential reading for anyone seeking CHC funding for themselves or their relative.
The National Framework is freely available to download online. However, understanding the copious rules and guidance, and applying them in practice, is a different matter!
Currently, if you have assets of more than £23,250, you will have to pay for the costs your care, whether that is care in your own home, or in a nursing or residential care home. The £23,250 threshold will not include the value of your property if your spouse or another dependant is living in your home. But, and this is the most important point to understand – if you think you have ‘primary health needs’, you should have your eligibility for NHS Continuing Healthcare Funding assessed first.
If you are eligible for NHS Continuing Healthcare Funding, you will not have to pay for your care, regardless of your financial circumstances – the NHS will pay.
For more detailed information about your eligibility for NHS Continuing Healthcare Funding, please contact a member of our team, or download our 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.
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.
A person has a Primary Health Need when it can be said the majority of the care they require is focused on managing or preventing health, both mental and physical.
The National Framework sets out the process for assessing CHC eligibility using national standardised assessment tools – including the Checklist, Decision Support Tool and Fast Track tool.
The full assessment involves completion of the Decision Support Tool (DST) by a Multidisciplinary Team (MDT). Once complete, the DST is used to assess the nature, intensity, complexity and unpredictability of the individual’s needs, and to determine whether they have a Primary Health Need.
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.
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.
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!
Many people have already paid for care before finding out about the availability of CHC Funding. If you or your relative have paid for care and were not assessed for CHC funding at the time, there is provision to reclaim these costs retrospectively, dating back to 1st April 2012. This process can be very laborious and time consuming but we can help.
You should also know that you can recover care fees paid after 31st March 2012, on behalf of a relative or friend who may have since passed away.
For more information about our Retrospective Reclaims Service please get in touch.
- Record-keeping is vital to success; particularly, risk assessments, body maps, wound charts and photographs
- All too often, hospitals, nursing homes and other care providers are under-staffed, meaning they do not keep thorough records. If you are worried this may be the case, it can be a good idea to keep your own diary.
- Check that a risk assessment has been carried out and is updated regularly.
- Look for Waterlow and Braden assessments. These prevention tools are used by care homes, hospitals and health professionals to assess the potential risk of pressure injury. The lack of a risk assessment tool could indicate negligence.
- Ask for body maps and photographs. Take your own photographs of the wound if you are concerned about accurate recording.
- Make sure that the size of the wound (length, width, depth) is recorded in the care notes – this should be monitored daily, at a minimum.
- If there has been involvement by a specialist, for example a Tissue Viability Nurse, their records will be very important.
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.
Whether the person being assessed attends the MDT usually depends on their ability to understand and participate in the process. For example, a person suffering from advanced dementia is unlikely to attend. In these cases, they will usually be represented by a friend or family member.
If you are the patient, or you are acting as a representative for someone who can’t participate in the assessment themselves, we always recommend that you attend. Being present allows you to:
- Offer additional information
- Clarify misunderstandings
- Challenge assumptions about needs
- Ensure your voice is heard
Even if the meeting is held virtually (online), you should be invited to participate and share your perspective. If you weren’t told about the meeting, this may amount to an abuse of process and could be grounds for appeal.
The MDT assessment is a crucial part of the CHC process. Securing CHC funding at this early stage can save you a lot of time, energy and expense. Having professional representation at the meeting can make a real difference to the outcome.
At Farley Dwek, our MDT Advocacy Service provides families with expert support from a qualified CHC Nurse Assessor who understands the CHC eligibility criteria and assessment process inside out.
We help ensure:
- The patient’s needs are explained clearly
- The right questions are asked
- The levels of need are assessed fairly
- The process is followed correctly
- You have an expert to support and advocate for you
Our MDT Advocacy Service is designed to give families peace of mind at a stressful time and maximise prospects of success.
After the MDT meeting, the recommendation is sent to the local Integrated Care Board (ICB) for ratification. While the ICB is responsible for making the final decision, it should, in all but exceptional circumstances, accept the recommendation of the MDT.
If CHC funding is awarded, the NHS will cover all care home fees or home care costs, including accommodation, nursing care and medical support.
If funding is denied, you’ll receive a formal outcome letter explaining the decision. You can appeal this outcome through the local resolution process and, if necessary, escalate it to an Independent Review Panel.
You should usually hear back within a few weeks of the MDT, although timelines can vary.
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.