NHS Continuing Healthcare Funding is the technical name for the free funding service 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’ ie main reason for care is health needs, not social care needs.
Eligibility for this funding and determination of the ‘primary health need’ approach is assessed by the NHS using rules and guidelines set out in the National Framework For NHS Continuing Healthcare and NHS-funded Nursing Care. This Framework sets out criteria and process by which assessments for 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 robust Continuing Healthcare Assessment.
In most instances, we at Farley Dwek deal with family members in relation to care funding issues faced by their relatives, but occasionally we also deal directly with the person in care.
Your ‘right’ to NHS Continuing Healthcare Funding
Your relative has every entitlement to an assessment for NHS Continuing Healthcare, if they reasonably believe that they have a ‘Primary Health Need’ and this should always be done before passing them to the Local Authority to deal with their care needs.
The NHS 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 critical.
This is the starting point for all cases we deal with, because either:
(a) the NHS failed to undertake a Continuing Healthcare assessment, either before your relative was placed into care, or at a stage in their care when it was clear that their medical condition had deteriorated to a point where their primary healthcare needs have overtaken their social care needs; or
(b) the NHS assessment was flawed and incorrect.
However, very often, staff within the NHS will not advise you or your relative of their right to an NHS Continuing Healthcare assessment. It is open to debate whether this is due to a lack of understanding and training on their part, or part of a deliberate wider strategy to avoid the costs of Continuing Healthcare Funding. 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.
We frequently hear from clients that staff within the NHS often give misleading or false statements when asked about 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 consider that your relative may have Primary Healthcare Needs then they 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 simply incorrect.
- Your relative should be told in good time if an assessment is taking place, and if they haven’t, you can ask for another one to be done.
- If an assessment has already taken place, your relative should have received a written copy of the Decision outcome. If they haven’t been given one, request a copy immediately.
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 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 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 you 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, emotional, complex and daunting process, which is why we have developed our various Care Funding Services and can provide you with a unique combination of robust legal and clinical expertise, to support you throughout the assessment process.