What is CHC?
NHS Continuing Healthcare Funding
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.
What is a Primary Healthcare Need?
An individual has a Primary Healthcare Need when it can be said that the majority of the care interventions they require are aimed at addressing health rather than social care needs.
It’s important to note that not everyone needing 24-hour care has a primary healthcare need.
It may be that your healthcare needs are incidental to your social care needs. If that’s the case, you 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, don’t let anyone (either in the NHS or in the Local Authority/Social Services), tell you that you do not have a primary healthcare need until you have been properly assessed for Continuing Healthcare, using the appropriate national tools.
In most instances, Farley Dwek, assists 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
The NHS and Social Services are under an obligation to ensure that eligibility for CHC Funding is considered in all cases where it “appears that there may be a need for such care” – this is critical.
Your relative has every entitlement to an assessment for NHS Continuing Healthcare, if there is any indication that they may have a ‘Primary Health Need’. Proper consideration for CHC funding should always be done before the Local Authority takes responsibility for meeting their care needs.
This is the starting point for all cases we deal with, because either:
(a) the NHS failed to undertake a Continuing Healthcare assessment at the appropriate time – usually upon admission to care or when it became apparent care needs had increased; or
(b) the NHS assessment was flawed and incorrect.
We often hear that people are not told about the availability of NHS Continuing Healthcare Funding or advised of their right to an assessment. It is open to debate whether this is due to a lack of knowledge and awareness, or for more insidious reasons (self-funders usually pay higher care fees, for example).
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 and Social Services often give misleading or false information when asked about Continuing Healthcare Funding. For example:
“People with dementia don’t qualify for CHC Funding”
“Your relative won’t meet the criteria”
“Your relative will have to pay for care”
“Your relative doesn’t appear to have any health needs”
Statements along these lines are incorrect. If there is any indication your relative may have a Primary Healthcare Need, they must be assessed using the standardized national tools.
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.
Remember
You should be told in good time if an assessment is taking place and be invited to participate fully in the process.
Once an assessment has taken place, you should receive a formal letter informing you of the outcome, and enclosing a copy of the assessment. The letter should explain how to challenge the decision if you disagree.
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 questions about your relative’s financial circumstances 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 eligibility for CHC has been ruled out.
We can help & advise
We understand it can be overwhelming.
Speak to our friendly team today.
How to ensure you are properly assessed
You can, of course, deal with the NHS yourself. Make sure you familiarize yourself with the National Framework.
We have produced a Care Funding Guide to help you understand the basics which you can download below for free.
However, our clients often tell us that this is a difficult, emotional and complex process, which is why they decided to enlist our help. We can provide you with a unique combination of legal and clinical expertise, to support you through the assessment process and maximize your chances of success. We can help you at every stage – Checklist, Full Assessment, Review and Appeal.
