If you have a relative or friend going into care or already in care, then this article about Continuing Healthcare is for you!
Too many people entering the care system have no idea that their significant care needs could be paid free of charge by the NHS – yes, every penny! However, as you guessed, accessing paid care from the NHS isn’t straightforward and nor do the NHS advertise the availability of this free care or readily volunteer to help you get it.
The free care is called ‘NHS Continuing Healthcare’ (or ‘CHC’) and, due to the veil of secrecy surrounding its availability, has often been described as the NHS’s best kept secret.
What is CHC?
CHC is a package of ongoing care that is arranged and funded solely by the NHS – to meet the cost of an individual’s assessed health care needs – and includes the cost of accommodation (if part of the overall need) and associated social care needs.
How do I get free care?
Well, there is helpful guidance on the matter which is set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (the National Framework).
First, some background:
Originally, each local Strategic Health Authority had responsibility for assessing and awarding CHC funding – applying its own assessment criteria. That led to huge disparities across the country as to who got CHC funding and who was refused – largely depending on where you lived – and how the SHA applied its own assessment criteria. So, an individual with the same healthcare needs might be granted CHC funding in one area but denied it in another. This became known as the ‘postcode lottery’.
To standardise the assessment process and criteria nationwide, in 2007 the NHS created a standard, streamlined, cohesive set of rules and guidance which became embodied in the National Framework. The National Framework has undergone several revisions and enhancements and was since updated in July 2009, November 2012, October 2018 and recently culminating in the July 2022 edition.
With each update, the guidance has become clearer even though the assessment process remains still entirely subjective and therefore potentially open to misinterpretation or misapplication by NHS assessors. However, at least there is a standardised nationwide set of rules and assessment tools, which can only be a good thing, even if the whole process is still far from perfect and open to abuse.
The latest National Framework (July 2022), has increased to a whopping 187 pages and is essential reading for anyone seeking CHC funding for their relative.
The National Framework sets out the principles of CHC funding and how to access it. Of course, getting to understand the complex rules and copious guidance in this 187 tome, and then applying them in practice, is a completely different matter!
The National Framework repeatedly states that the assessment process is intended to be ‘person-centred’ i.e. putting the individual at the heart of the process. The principle is applauded in theory, but from our experience, the NHS process remains unwieldy and far too complex for most people to understand and achieve success.
The process favours the NHS assessors, as they are supposed to have been trained on the National Framework and its daily application; whereas families applying for CHC funding are often at a distinct disadvantage, as this is unfamiliar and complex territory, and they are entering into battle against the NHS professionals to try and secure much needed CHC funding for their relative.
Unfortunately, it is not an even playing field and the odds are heavily stacked against the family and in favour of the NHS.
Although the National Framework is intended to be read and understood by NHS professionals and the lay person alike, many families (and even appointed NHS assessors!) struggle to get to grips with its concepts and apply the assessment criteria correctly when determining whether CHC should be awarded.
Many families are put off from seeking CHC funding for their relative because the assessment (and then appeal process) can be daunting, overwhelming and protracted, causing them to give up and throw the towel in. Others are given misinformation and told untruths to divert them away from this pot of NHS funding. The result is that they could miss out on free funded CHC care and instead, end up selling their relative’s home to pay for their care, quite unnecessarily.
Who is eligible for CHC funding?
In short, any adult aged 18 or over who has a ‘Primary Health Need’ and requires care as a result of a disability, accident or illness, may be eligible for CHC.
What is a Primary Health Need’?
A Primary Health Need essentially means that the individual has significant physical and/or mental health needs and the majority of the care they require is focussed on managing these needs and preventing further health needs from developing.
Who provides CHC funding?
The NHS are responsible for providing CHC if the main (i.e. ‘primary’) reason for care is due to health needs which are (1) more than incidental or ancillary to the provision of accommodation which the Local Authority Social Services are expected to provide; or (2) are of a nature beyond which a Local Authority could lawfully be expected to provide.
How is the Primary Health Need test applied?
The Checklist is a basic screening tool to allow those who may be eligible for CHC funding to pass on to a formal assessment by a Multi-Disciplinary Team (MDT) using the DST. Those who are unlikely to be eligible are screened out at this preliminary stage.
The MDT assessment process looks at the nature intensity, complexity and unpredictability of the individual’s needs to determine whether they have a Primary Health Need. A positive DST outcome should result in the MDT’s recommendation for CHC funding. Search our website for numerous articles on the MDT process.
Why is establishing a Primary Health Need so important?
If your relative’s assessed healthcare needs meet the eligibility criteria for CHC funding, then all their assessed care needs (including accommodation in a care facility) should be paid in full by the NHS – 100% free of charge! That can, of course, create enormous savings at an average of over £65,000 per annum if your relative is paying substantial monthly care fees.
Is CHC funding means-tested?
Absolutely not! Money and your relative’s financial wealth should never be a consideration.
If your relative is eligible for CHC, the NHS should pick up the whole cost of the assessed care package. Sometimes, the package of care is jointly provided in conjunction with the Local Authority.
If, however, their needs are found not to be sufficiently high enough to meet the CHC eligibility criteria, then your relative should first be assessed for NHS-funded nursing care – a fixed weekly sum paid as a contribution to their nursing costs in a nursing home.
In addition, they may be passed over to their Local Authority to see what support can be provided to meet their social care needs. The Local Authority will carry out a means-test assessment before implementing a package of social care. Currently, if your relative’s savings or capital exceed £23,500 then they will most likely have to pay for their own care (i.e self-fund from private means). AS care can amount to many thousands of pounds a month, most self-funders sadly end up selling their home to pay for their own social care needs.
Don’t forget, that individual’s needs can fluctuate over time, and as such, any increase in needs can trigger a new Checklist assessment for CHC funding.
Do I have to have a recognised diagnosis to get CHC funding?
No, CHC funding is not linked to any particular condition, disease or diagnosis. So, for example, if your relative has dementia, Alzheimer’s or Parkinson’s, that does not automatically qualify them for CHC funding. CHC is about assessed needs and not any label ascribed to a specific condition.
CHC is about assessing an individual’s overall healthcare needs on a holistic basis and the quality and quantity of daily skill and intervention required to manage them.
Is CHC funding limited only to care homes?
No. The setting where the care takes place is irrelevant. CHC funding applies to any care setting. So, whether you require care in your own home, a care or nursing home, hospice or some other care facility – it doesn’t matter. It’s not about the setting, so don’t be told otherwise!
If your relative is going into care for the first time or is already in receipt of care, consider whether they may have a Primary Health Need and be entitled to have all their healthcare needs paid for in full by the NHS. Read the National Framework and seek an assessment.
If you want help with this or with any aspect of the CHC assessment process call us on 0161 979 0430 or email us at email@example.com.
Alternatively, send us your query via our website.