Families often say how they have found the whole process of seeking NHS Continuing Healthcare Funding for their spouse or relative to have been a daunting and emotional process. Putting a relative into a Care Home is a life changing milestone for most families. If you are just starting out on this process, seeking eligibility or at a loss even where to start, here are 16 helpful tips:-
No.1 Download and read the latest version of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised October 2018) and familiarise yourself with its layout and contents.
The National Framework provides the guidance which Clinical Commissioning Groups are supposed to comply with when undertaking the assessment process. In order to give yourself the best chance of success, you need to be familiar with this guidance, the processes involved and your rights.
No.2 Download and read the initial Checklist, and Decision Support Tool (DST) both of which have been updated with effect from 1st October 2018.
These are the essential ‘tools’ for the assessment process.
Look closely at the various Care Domains and familiarise yourself with the description within each level of need. Consider whether your relative’s healthcare needs fit into any of the categories and what score that gives.
No.3 It’s a good idea to keep a diary of your relative’s daily health needs and any noticeable changes in the nature of those needs, the level of complexity, intensity or unpredictability of those needs – as this may become a useful record and aide memoire at the assessment process.
No.4 Consider involving your relative’s GP or other health professionals involved in your relative’ care, early in the process. Ask if they are willing to assist you with some clinical input into your relative’s healthcare and daily care needs to bolster your claim.
No.5 Ensure that any correspondence with the Clinical Commissioning Group (CCG) or care home is in writing, so you have a record of what has been said or agreed. It may become useful evidence if needing to point any delays in the CCG’s assessment process, or any abuse of process on appeal.
No.6 Press for an early Checklist assessment, if one has not already been done. Be persistent!
No.7 If your relative triggers for a full assessment at a Multi-Disciplinary Team meeting (MDT), chase the Clinical Commissioning Group to provide an early date for that assessment. The National Framework provides that the full assessment should be completed within 28 calendar days after the initial Checklist has been received until the date the eligibility decision is made. This timescale is often exceeded. Again, be persistent. Delays may mean your relative could be paying unnecessarily for their care.
No.8 Remember to diarise forward and chase the Clinical Commissioning Group regularly if you feel any delays are unreasonable. You can, of course, ask the care home in the meantime to get them to add pressure to the CCG to progress your request for the full assessment.
No.9 Don’t be bullied by the CCG’s assessors at the MDT full assessment. You have a right to speak and present your relative’s healthcare needs. You know your relative best, and can correct any misconceptions or misunderstandings the CCG assessors may have as to their medical condition or daily needs.
No.10 Ensure that you have been given plenty of notice of the full assessment, so you can attend and prepare for the meeting.
No.11 Be alert. The CCG’s assessors should not make any pre-determined assessment of your relative’s healthcare needs, without first undertaking a full assessment and also giving you the opportunity to attend. Nor should they make any pre-judgmental comments prior to the assessment, such as ‘you’re wasting your time because your relative simply won’t qualify for CHC Funding’. Make a note of any such abuses as they are grounds for appeal if the assessment goes against your relative.
No.12 Once the full MDT assessment has taken place, remember to diarise again and chase the CCG for the outcome decision. Be persistent, as delays in communicating the outcome decision are quite common.
No.13 If the MDT assessment is negative, then look at the decision letter and reasons for rejection carefully. Check whether you believe that the scores allocated by the MDT assessors to each of the 12 Care Domains, and the overall assessment of the 4 key indicators (nature, intensity, complexity, and unpredictability) fairly and accurately reflect your relative’s healthcare needs. Scoring is subjective, so don’t be surprised if certain needs are underscored!
No.14 If you believe the Clinical Commissioning Group’s outcome to refuse CHC Funding is wrong, then you must appeal. Be aware: you only have 6 months to appeal, so do not delay as you have a lot of work to do in the meantime, and your appeal submissions must be lodged in time. Gather all relevant care home, GP and hospital records and look for additional evidence which the CCG’s assessors have either overlooked, ignored or misunderstood. This could boost your relative’s overall score, and consequently their chances of getting free NHS Continuing Healthcare Funding.
No.15 Don’t let the Local Authority (Social Services) or the Clinical Commissioning Group’s assessors, side-track you by insisting your relative will have to undergo financial assessment or be required to self-fund before they have carried out their assessment. Remember above all – the assessment process is about health, not wealth!
No.16 Get professional assistance if you feel that you can’t cope on your own and take on the CCG. Visit our one-to-one page.
For further information, read these articles below to help you make a quick start:
Search on our website for areas of key interest and browse the wealth of free information and resources available at your fingertips to help you through the assessment process. Learn from others how they have handled similar situations you may be facing, and interact with them to learn more.
Download our e-book to view on your computer or mobile device “How to Get The NHS to Pay for Care” – which contains interactive features with links to other helpful articles and relevant documents you’ll need. Use the search facility to find key areas of interest quickly. Click on the sub-headings in the contents pages to take you directly to the pages you want to view and thereby save time.
Just launched – if you prefer to have a handy reference book, buy the paperback version “How to Get The NHS to Pay for Care” and carry it around with you. It fits easily into a bag and is an invaluable resource tool. You can mark the book and make notes at key areas of interest.