Clear and simple guidance to help older people find their way through the care maze
NHS Continuing Healthcare
NHS Continuing Healthcare (NHS CHC) is a package of care arranged and funded solely by the NHS in England to meet physical or mental health needs that have arisen because of disability, accident or illness. It can be delivered in any setting. If you are to receive care in your own home, the NHS funds an appropriate care package to meet your assessed health and personal care needs. If you live in a care home, the NHS contracts with the home and pays for accommodation, board and to meet your assessed health and personal care needs.
Eligibility decisions are based on your needs and whether your need for care is primarily due to your health needs. You could be assessed for NHS CHC in a hospital as part of the discharge process or you could be assessed in your care home. If a discharge to a nursing home is proposed, your eligibility for NHS CHC must be considered first before any decision is reached about the need for NHS-funded nursing care. If you live in a care home the local Clinical Commissioning Group (CCG) should have a process in place to make decisions about NHS CHC eligibility. If your health deteriorated and you believe you may be eligible your care home can arrange for the CCG continuing healthcare team to assess you. Alternatively, you or a member of your family can approach the GP or CCG.
When assessing your eligibility for NHS CHC, staff must follow the National Framework guidance, using one or more of three decision tools – more information can be found here
Appealing the decision
NHS care funding decisions can often appear arbitrary and some people do not receive NHS continuing healthcare even when they are eligible. If you feel this is the case you may want to appeal the decision. If you wish to challenge an eligibility decision, you must write to the CCG requesting a review, no later than 6 months from the date you receive written notification of the decision.
Because of the work involved some people will seek the services of a Specialist Adviser or Solicitor to help.
Requests for an assessment can be made after the period of care concerned – for instance, on behalf of someone who has since died. The rules around this are complex.
Specialist Continuing Health Care Advisers and Solicitors
Challenging a NHS care funding decision or making a retrospective appeal, may appear daunting and arduous and you may want to seek the services of a specialist solicitor or advisor, it is important is to check that they actually are a specialist in Continuing Healthcare and ask how much you will be charged for their service.
Ask them about their specialism, they should have an indepth knowledge about Continuing Healthcare.
Are they working regularly with Continuing Healthcare cases and therefore have the experience of dealing with Continuing Healthcare Assessors and processes.
Have they experienced the problems that arise during the assessment and appeals journey. Have they successfully overcome them?
Do they have a good understanding of the law with regard to NHS Contining Healthcare and funding care.
Perhaps the best place to look for a Specialist is online, check their website out, does it give you confidence they have the skills and knowledge you would expect?
You may find these websites useful:
Useful reference material
You may find more information on your LOCAL PAGE