To give yourself the best chance of obtaining NHS Continuing Healthcare Funding, we recommend you follow our 14 top Tips and adopt them as your New Year’s resolution.
Tip No 1: Respond promptly to the CCGs deadlines
Clinical Commissioning Groups are becoming increasingly difficult, and are seeking to impose unilateral deadlines (often 28 days) to respond to their outcome decisions when rejecting claims for CHC Funding. This is insufficient time to consider formulating any substantive appeal arguments. The actual deadline is 6 months from the date you receive their decision letter, but CCGs are trying to catch people out by imposing this shortened timescale. If you miss it, they will refuse to deal with your claim. Although this 28 day deadline is not specified in the National Framework for NHS Continuing Healthcare, you must still respond in time, and indicate your intention to appeal, stating that further submissions will follow in due course once you have had an opportunity to consider their reasons for rejecting your claim in more detail. For more information on how to appeal, read our blogs:
Tip No 2: Don’t be pushed into paying for care fees unnecessarily
Ensure you are fully familiar with the criteria for seeking NHS Continuing Healthcare Funding – which is free at the point you need care; as opposed to Social Services Funding (provided by the Local Authority) which is means tested. If your relative has a ‘primary health need’ they may be entitled to free fully funded care for all their health needs (including accommodation). So, understanding the difference between NHS Continuing Healthcare and social care could potentially save your relative many thousands of pounds in unnecessarily paid care home fees.
For more information, read our blog: Apply for NHS Continuing Healthcare Funding if your relative has a ‘primary health need’…
Tip No 3: Get to grips with the National Framework for NHS Continuing Healthcare
The National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care is the NHS ‘bible’ in this arena. You must familiarise yourself with this guidance, as it contains the processes that the Clinical Commissioning Groups are supposed to be working to and adhere to. You must be equally familiar with the National Framework in order to give your relative the best chance of success. The NHS National Framework was recently updated in October 2018. If you missed the update, read our helpful blog: What’s new in the 2018 NHS National Framework for CHC? Are you getting an interim care package?
Read our blog, BBC Drama, “Care”, shines A Spotlight On NHS Continuing Healthcare. Even if you didn’t actually see the BBC Drama screened on Sunday 9th December 2018 and cannot get to watch it on iPlayer, then our blog takes you through it, as if it is a live case study, and comments around it.
Tip No 4: Remember NHS funding can apply wherever your relative lives, so don’t be fobbed off!
Don’t forget, the setting where your relative lives is irrelevant in seeking eligibility for fully funded NHS Continuing Healthcare. Such funding can apply, whether your relative resides in their own home, a care or nursing home. Above all, it is the health needs which are the important factor. It is not the place where the care is provided, but the nature of the care that matters.
Tip No 5: Get specialist advocacy help if you need it – don’t fight this battle alone!
Don’t worry if you find this whole funding process daunting. You are not alone. You are entitled to choose a family member, friend or other person to accompany you to any assessment or appeal. It can be useful to have a second pair of eyes and ears in the background listening in and taking notes for you.
Care To Be Different provides plenty of help and Resolutions on our website should you wish to attempt the advocacy yourself. However, given the high stakes if NHS Continuing Healthcare funding is not granted, it is quite common for families to engage the services of a professional advocate who is familiar with this arena, and how the ‘system’ works. You can access individual help with your case by visiting our one-to-one help page.
A good advocate can diffuse any emotional anxiety you may feel about the whole NHS CHC funding process, and the personal pressure you may feel to secure a successful outcome for your relative. Whilst success cannot be guaranteed, having the services of a specialist in this field can only improve your chances of success. So remember, help is available and you don’t have to do this alone.
For more information, read our blog: Can The MDT Panel Refuse To Proceed If I Have An Advocate?
Tip No 6: Get your house in order – keep good records
It’s essential to keep an accurate record of what happens at each stage of an assessment or appeal – including before and after. Although the procedures are set out in the National Framework for NHS Continuing Healthcare, sometimes the process does not go to plan and any abuse can give you grounds for an Appeal. Therefore, your records may become useful evidence in due course if the outcome decision goes against you.
Tip No 7: Quote Coughlan!
Familiarise yourself with the Coughlan test. The Court of Appeal stated in the Coughlan case that, “where the primary need is a health need, then the responsibility is that of the NHS, even when the individual has been placed in a home by a Local Authority.” Therefore, if your relative’s healthcare needs are over and above the scope provided by the Local Authority (Social Services), then they may be eligible for NHS Continuing Healthcare Funding – which is free! Read pages 151 to 153 of the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (Revised 2018) for more information on Coughlan. So, if your relative has a ‘primary healthcare need’ (see Resolution 2 above), the NHS should provide and pay for 100% of their care, including any residential home fees.