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Rejected CHC Funding Because Needs Are Stable And Predictable

Rejected CHC Funding.

My Relative Has Been Rejected For Funding Because Their Needs Are “Stable And Predictable”

Following on from the previous blog, the NHS may seek to evade responsibility for paying care fees by suggesting that the patient’s needs are stable and predictable. This rebuff by the NHS in rejecting an application for NHS Continuing Healthcare Funding can often deter families from pursuing the claim further.  Don’t take such a statement at face value, as you still have to look at the totality of the needs by reference to the various Care Domains which should be considered in conjunction with the four key indicators (or characteristics), namely the nature of the needs, intensity, complexity and unpredictability of those needs.  These four characteristics may, alone or in culmination, demonstrate a primary health need – and it is the totality of the overall needs and the effects of the interaction of the needs that need to be considered.

The National Framework for NHS Continuing Healthcare and NHS – Funded Nursing Care describes “unpredictability” as, “the degree to which needs fluctuate and thereby create challenges in managing them.  It also relates to the level of risk to the person’s health if adequate and timely care is not provided.  Someone with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition”.

Therefore, just because an individual’s needs may be said to be “stable and predictable” –  does not mean that there is no longer an underlying health need. After discounting routine care needs, you need to ask what would the position be if you were to withhold “adequate and timely care?”. Would your relative’s condition still be stable and predictable (more akin to a social need), if the care intervention was removed, or would it fluctuate and deteriorate, and thus inevitably “create challenges in managing them”? Each case will depend on its own facts and merits, but just because the NHS contend that your relative’s needs are stable and predictable doesn’t necessarily mean that they are not entitled to receive funded care.  It could just be that those needs are stable only because of adequate and timely care intervention. Remove the care package, and then consider… would those managed needs still be stable and predictable? In many cases the answer is likely to be “no”.

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