In any assessment for NHS Continuing Healthcare comparisons between patients are irrelevant.
An NHS Continuing Healthcare assessment should be carried out for each individual person. In addition, the result of any NHS Continuing Healthcare funding assessment is based on that individual’s care needs – and that person’s needs only.
However, some families report being told by assessors that an NHS Continuing Healthcare assessment involves making comparisons between patients.
In NHS Continuing Healthcare, comparisons between patients should not be made
For example, let’s take the example of two people in the same care home: Reg and Alice:
Reg has had a catastrophic stroke and now needs round the clock care.
Alice has advanced Parkinson’s and is now totally dependent for all her care needs.
Alice has had an NHS Continuing Healthcare assessment, but has been found not eligible for funding. (Whether that’s the correct outcome is of course debatable, but that was the NHS’s decision after the initial assessment process.)
Reg’s family, when requesting a Continuing Healthcare assessment, are told that he has no chance of getting the funding because ‘Alice in room 24’ has not been successful in getting it, and ‘Alice’s care needs are greater’.
This is wholly flawed – but sadly families may not be any the wiser and they may simply accept that this is the case.
Some people are never assessed for NHS Continuing Healthcar – purely on account of being given this kind of false information.
Alice’s care needs are entirely irrelevant to Reg’s assessment process – just as Reg’s care needs are irrelevant when it comes to Alice’s eligibility for NHS Continuing Healthcare.
Reg’s assessment process should look at Reg’s care needs only – and only in relation to the NHS’s legal requirement to provide fully funded Continuing Healthcare.
In addition, it could well be the case that the funding decision in Alice’s case was incorrect and that her family will subsequently win an appeal.
Here are some references to help you:
NHS Continuing Healthcare eligibility is all about the individual
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care makes this abundantly clear.
Page 7 paragraph 7
“Core values and principles…. The individual, the effect their needs have on them, and the ways in which they would prefer to be supported should be kept at the heart of the process.”
Page 10 paragraph 10
“Provider organisations should… ensure that individuals who may require a full assessment of eligibility are referred to the CCG…”
Page 21 paragraph 55
“Eligibility for NHS continuing healthcare is based on an individual’s assessed needs“.
There are so many references to the individual in the National Framework, we’re not going to list them all here. If you need further page and paragraph references to back up your case in as assessment regarding this topic, do a ‘search and find’ exercise with the National Framework document.
One additional point:
Eligibility for NHS Continuing Healthcare also has absolutely nothing to do with whether a care provider finds one person harder to care for than another. Just because a care provider might describe a person as ‘no problem to look after’ (or other such meaningless statements) does not mean the person’s care needs count for less than someone else’s needs. Other people’s needs are completely irrelevant.
For step-by-step guidance through the NHS Continuing Healthcare assessment process, our ebook How To Get The NHS To Pay For Care will help you.