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NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS. It is not means-tested and is based on an adult’s nursing care needs. Such funding is intended to cover the entire cost of the care, including all medical care, nursing care, personal care, living costs and accommodation. Unlike Local Authority care funding, it cannot be topped up.

Who can get NHS Continuing Healthcare funding?

NHS Continuing Healthcare is provided to an adult that has been assessed to have a “primary healthcare need” as a result of disability, accident or illness. Children and young people may be entitled to a similar package of care funding called a “continuing care package” if they have multiple, complex and enduring health care needs arising from disability, accident or illness.

When should we get a NHS Continuing Healthcare assessment?

NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care or nursing home. NHS Continuing Healthcare can be applied for at any time through the hospital or nursing home or directly to the body in charge of the fund – the CCG (Clinical Commissioning Group). Situations when a person should particularly consider having an assessment are:

  • when being discharged from hospital (and their long-term needs are clear);
  • if their care needs have deteriorated significantly and their current level of care seems inadequate
  • if they have a rapidly deteriorating condition and may be approaching the end of their life

How do we apply for NHS Continuing Healthcare funding?

The application process for NHS Continuing Healthcare is not easy to understand or to go through. It is made up of several stages with different professionals, who will need to meet with the person being assessed and/or their representative.

Firstly, a healthcare professional or social worker will carry out an initial Checklist assessment. This is a screening process to determine if a full assessment should be carried out. The Checklist contains ‘domains’ of care needs sub-divided into broad levels of needs, identified by the letters A-C.

If the person being assessed passes the Checklist, they will have a full comprehensive assessment by a multidisciplinary team of healthcare professionals. The team will consider the person’s physical, mental, psychological and emotional needs to determine if they have a “primary healthcare need”. This assessment is carried out by reference to a Decision Support Tool (DST).

What is a “primary healthcare need”?

A “primary healthcare need” is not based on person’s diagnosis (i.e. dementia), the setting of the care (i.e. nursing home) or the need for ‘specialist staff’ to provided care. A person’s health needs are considered within 12 domains of care, each weighted so the greater the intensity, unpredictability and/or complexity of their needs, the more likely the person will have a primary healthcare need.

If the person is assessed as eligible for NHS Continuing Healthcare, the CCG should make arrangements for the person’s care. Their funding should be backdated to the 29th day after the CCG received the completed Checklist. It is important to remember that a decision of eligibility is not a permanent one; there will be regular reviews and the person may stop qualifying for funding in the future.

What if we’re turned down? Can I appeal a NHS Continuing Healthcare assessment?

If the person is assessed as ineligible for NHS Continuing Healthcare you (or they) can appeal the decision. However, you have a 6 month time limit starting from the date of the letter notifying of the decision. The person can also reapply for NHS Continuing Healthcare, if their condition deteriorates and/or their needs change.

Where a person has a rapidly deteriorating condition that may be entering a terminal phase, such individuals will require fast tracking for immediate provision of NHS Continuing Healthcare funding. Eligibility under the fast-track pathway will be reviewed usually after 3 months.

What other funding is available apart from NHS Continuing Healthcare funding?

There are other potential care funding options that a person may be able to receive if they are not entitled to NHS Continuing Healthcare, such as:

  • NHS Funded Nursing Care – is a fixed weekly payment made directly to the nursing home to cover the nursing element of a person’s home fees, if their health needs are such that they need some nursing care;
  • Section 117 (of the Mental Health Act 1987) Aftercare – are free services that someone may be entitled to if they have been compulsorily detained for treatment in a psychiatric hospital under Section 3 of the Mental Health Act 1987; and/or
  • Local Authority Care Funding & Support – the Local Authority may provide some service or equipment for free and may provide means-tested care funding for eligible care needs they have a duty to meet.

This article has been written by Francesca Tubb at Ashtons Legal

Francesca specialises in advising and acting for vulnerable and elderly clients and aspects of mental capacity. Francesca prepares and advises on Deputyship and other Court of Protection applications (including Statutory Wills and Gift applications) and provides guidance for deputies and attorneys in carrying out their roles.

Francesca is an associate member of Solicitors for the Elderly (SFE) having completed both the SFE OCCP and OCLP award. She is a Dementia Friend and has also completed several professional development courses in probate and estate administration, mental capacity and wills. Francesca is a member of the STEP Special Interest Group for Mental Capacity and Cross-Border Estates.

Ashtons legal serve clients nationwide and are based in Bury St Edmunds.

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