In a nutshell, NHS Continuing Healthcare Funding is funding which is provided by the NHS to pay in full for the long-term care costs of those individuals who meet the criteria for it. It is dependent upon having complex and high level medical and or nursing care needs.
Eligibility is determined by reference to a document called the National Framework. This is an NHS document brought into being in 2012 to standardise the assessment process for determining eligibility. It is a long but well-constructed document and is used throughout England.
The Assessment Process
The assessment process is normally carried out by a multi-disciplinary team of health and social care professionals. The family would usually be invited to attend.
The assessment process can be requested at any time if it is identified as being required. In any event, it should always be completed upon a patient’s discharge from hospital into long term care. The assessment is usually led by a clinical assessor from the Continuing Healthcare department of the local Clinical Commissioning Group (CCG).
The assessment will go through 12 Care Domains covering all aspects of physical, emotional and mental health needs and apply a score for each domain. It is necessary to have an overall high score equating to a totality of need. This should be over and above what a local authority can reasonably be expected to provide.
It is not however, just about the scores, but also about the interaction of the 4 key indicators/determinants required to manage the needs of that individual:
- The nature of care
- The intensity of care
- The complexity of care
- And the unpredictability of care
The family will be consulted, and their views sought, and the nurse assessor will conclude with making a recommendation in terms of eligibility before the meeting concludes. The matter will then have to be referred to the CCG for ratification. The decision can sometimes be reversed by the CCG panel, or further clarification sought, before a final decision is made.
Eligibility For Funding
Eligibility for this funding is not determined by reference to the patient’s finances, but purely on health needs alone. Therefore, it is still possible to qualify for it even if the patient could afford to pay for the care themselves.
If you qualify, then the CCG will provide fully funded care, usually without any top-up from the family or the patient. This will be payable by them until the next scheduled review, which will initially be 3 months form the date of the first assessment and annually thereafter.
If funding is denied, this does not necessarily mean that this is the correct decision. We can assist with the determination of eligibility. This can be either prior to the original assessment being carried out, or on prospects of success on appeal after funding has been denied.
We have combined clinical and legal expertise to guide, support and advise you through the process.