Our recent blog 10 More Untruths About NHS Continuing Healthcare Funding has clearly resonated with our readers as we’ve come across so many more untruths recently – or fake news! – designed to put families off claiming NHS Continuing Healthcare funding (‘CHC’).
Some untruths are possibly stated out of sheer ignorance and a lack of fundamental understanding of the CHC assessment process set out in the National Framework for NHS Continuing Healthcare (revised July 2022); others are peddled by care homes and NHS assessors potentially as a means of financial-gatekeeping.
We thought it would be helpful to share some of these misleading statements below in case they apply to your care funding situation.
However, first let’s start with the basics:
What is CHC funding?
- CHC funding is free -funded care provided by the NHS for adults aged 18 and over with ‘primary healthcare needs’ i.e. needs related to the treatment, control, or prevention of a disease, illness or disability and the aftercare of an individual with these needs.
- CHC is free at the point of need.
- CHC is not means-tested and is available irrespective of an individual’s financial means (unlike social care funding provided by the local authority). So, wealth is never a consideration when assessing CHC.
- CHC is available regardless of the care setting (e.g. whether care is provided at home, in a care/nursing home or hospice).
In short, if your relative has complex, intense or unpredictable healthcare needs which meet the eligibility criteria for CHC funding then they are entitled to have all their care fees (plus accommodation and their social care needs) paid for in full by the NHS – free of charge.
CHC is often described as the’ NHS’s best kept secret’, as the NHS doesn’t openly tell you this care funding package is available and, even if you do happen to stumble across it, accessing CHC can be a complex, daunting, emotional and challenging process. In our experience, and confirmed by numerous contributors on our Facebook page, the odds of getting CHC funding are heavily stacked against you. Sadly, many families who embark upon the CHC assessment process struggle to make it to the other end successfully, without professional representation.
We are in daily contact with members of the public, and too often find that they have been given incorrect information about Continuing Health Care (CHC). Here are some examples of untruths we have recently encountered:
1) Don’t bother applying because nobody gets CHC funding!
We have had several calls recently where family members have been told not to bother applying for CHC funding as they will not get it, “because no one gets it!” That is clearly an inappropriate attempt to dissuade them for applying for CHC. Yes, only a small per centage of those applying for CHC funding are ultimately successful, but how can anyone make such a misleading comment without first assessing the individual to ascertain whether they are likely to meet the eligibility criteria for CHC?
The process usually starts with a Checklist assessment – a basic screening tool used by the NHS to determine whether an individual should proceed to a full assessment for CHC funding.
So, don’t be fobbed off by such comments. Get an assessment done if you think your relative may qualify for CHC. Here’s a selection of helpful blogs on the subject:
Beware of companies offering services to assist you obtain CHC funding on the basis of helping you through the Checklist assessment. We feel that most families can follow the Checklist assessment themselves – as it is only a screening assessment and not the assessment itself. So, unless the Checklist is undertaken in an incompetent manner, those who get screened out at this preliminary stage are likely to have little or no healthcare needs.
Remember, if your relative’s needs increase, you can always ask for another Checklist to be done.
2) If you pass the Checklist for CHC funding, you are a strong candidate for CHC funding!
Again, this is not necessarily correct.
The Checklist has a very low bar, deliberately designed to screen most people in for a full CHC assessment.
However, if your relative has a positive Checklist, they will go on to have a full CHC assessment completed by a Multi-Disciplinary Team (MDT). This is the first proper assessment. Don’t be fooled by such misleading comments such as, “you’re a strong candidate”, however good you think your relative’s case may be, as the bar to success is set very high. The NHS will not part with their budgeted funds so easily, so be prepared to fight your corner.
It is only once all your relative’s healthcare needs have been properly considered by an MDT – using the Decision Support Tool – can an informed determination be made as to whether or not they will qualify for CHC funding.
We measure healthcare needs against the full MDT assessment and not against the Checklist assessment, as it provides a more accurate indication of overall healthcare needs and whether CHC funding is likely to be awarded.
3) Your mother will not qualify for CHC with gangrene as it only effects the Skin domain!
An enquirer had been told by a social worker that it would not be worth applying for CHC as gangrene would only affect the Skin domain. This is not correct. Remember there are 12 care domains to be considered when assessing an individual for CHC funding (1.Breathing 2. Nutrition 3. Continence 4. Skin Integrity 5. Mobility 6. Communication 7. Psychological & Emotional needs 8. Cognition 9. Behaviour 10. Drug therapies and medication 11. Altered states of consciousness 12. Other significant care needs. Skin is only one of the domains.
A brief discussion revealed that there was significant pain with the gangrene, as well as difficulties with mobility. This would impact on other care domains, particularly, Medication and Mobility – as well as, obviously, Skin.
Remember: When considering the eligibility criteria for CHC you have to take a holistic view and look at the whole person and how their needs interact, and what level of skill and care is needed to manage all those needs.
So, to say that gangrene only affects Skin is fundamentally wrong without considering the wider impact.
Moreover, as the gangrenous condition was likely to deteriorate fast following a clinical decision to withhold treatment, it would need close monitoring due to the likelihood of the condition becoming unstable. In the circumstances, the individual may be more suited to Fast Track application for CHC.
Fast Track funding is for individuals with a rapidly deteriorating condition that may be entering a terminal phase. If successful, CHC Funding for your relative’s care needs should be put in place within 48 hours of assessment. For more information read these blogs:
4) You need SIX severe levels of Need to be eligible for CHC!
This is absurd and totally incorrect.
Recently, we had an enquirer who had been told by the care home manager, that it was not worth making an application for CHC funding for a relative as she ‘would not qualify’ (see 1 above). The manager said that the patient needed to score SIX ‘Severe’ levels of need on the Decision Support Tool in order to qualify for CHC funding.
The Decision Support Tool makes it clear that TWO or more ‘Severe’ levels of need will normally give rise to a recommendation for CHC, but funding can also be given with ONE or NO ‘Severe’ levels of need. As above, it’s all about the overall picture of need.
It appears that this misinformation was an attempt by the care home manager to put the family off from making an application. Unless borne by ignorance, the most likely reason is that care homes usually get far more money from self-funding individuals i.e. those paying for their own care, than they will receive from the NHS for a CHC funded patient. It is therefore not always in the care home’s financial interests to inform residents as to the availability of CHC funding or to help them with the assessment process.
5) Only one Carer can be paid for under CHC funding!
This is blatantly incorrect, too!
The NHS told an enquirer that they could not get CHC funding for more than one carer. That’s news to us and totally wrong! In this scenario, their relative was already in receipt of CHC funding, but it wasn’t enough to cope with their increasing healthcare needs. They needed a second carer. The NHS said they could only fund one carer through CHC funding and flatly refused to pay for a second carer.
This is a worrying state of affairs as the NHS assessors should of course know that CHC package of care should be sufficient pay for all the individual’s assessed healthcare needs – whether those needs are met by just one carer, two carers or even more! Put simply, there is no bar.
We would suggest that if you have been such lies by your care home manager, you give us a call.
Please let us know if you’ve had any of these things or similar said to you which has put you off pursuing your relative’s right for CHC funding.
Here are some other blogs where misleading information has been given to families:
Plus, don’t forget, there is plenty of free information and resources to help you on our Care To Be Different website.
If there is a particular topic you would like us to cover, we’d love to hear from you! Just send an email via our “Contact Us” page with the subject “blog request” and we’ll do our best to cover your suggested topic.