NHS Continuing Healthcare Funding (CHC) is a free package of care provided by the NHS to individuals aged 18 or over, to meet their health and associated social care needs that have arisen as a result of disability, accident or illness. CHC is provided free at the point of need and is not means-tested. So, if you meet the eligibility criteria, the NHS will pay for all your assessed healthcare needs, free of charge. CHC Funding for care is provided by your local NHS Integrated Care Board (ICB).
However, whilst CHC should be accessible by all those who qualify, recent findings suggest that fewer people are being found eligible by their ICB for CHC Funding at a point in their lives when they need it most.
Assessments for CHC Funding are usually carried out by a Multi-Disciplinary Team (MDT). However, according to statistics compiled by NHS England in their Quarter 2, 2023-24 Care Report (published 09 November 2023), for the second quarter period, 1st July to 30 September 2023, the total number of people referred for a standard MDT assessment was 16,147. Of this number 3,618 were discounted before assessment, leaving 12,529 people who were assessed via the standard MDT route (the vast majority, 11,852, using the standard Decision Support Tool). What is interesting is that the results show out of those 12,529 people assessed, only 2,568 were found eligible and awarded CHC Funding i.e. approximately a 20% conversion rate. By contrast, that means that there were 9,961 people (i.e. approximately 80%) who were assessed and found ineligible for CHC Funding.
When you consider that we generally have an ageing population, and if you think about those who are already being cared for at home, or indeed, in any type of care home or care facility, this seems to be a staggeringly low number getting access to CHC across the whole of England and Wales.
With ICBs expected to deliver huge cuts and savings from their budgets, it’s easy to see why less people may become eligible for CHC. But what other factors might be influencing this downturn in available funding?
Here are a few ideas exploring why so many people may be missing out on CHC:
- In our experience, so few people have ever heard of CHC or know what it is. This is a major contributing factor as seen by the low numbers that were referred for assessment (16,147 in 3 months). For those who have come across CHC, most have no idea how to apply for an assessment to see if they are entitled to a fully-funded NHS package of free care. As we’ve said in previous blogs, the NHS don’t flaunt the availability of CHC and offer it. It has been described as the “NHS’s best kept secret”.
- Care funding is often a sensitive yet highly emotive topic of conversation on radio chat shows and in newspaper articles, with much mention of social care funding and families having to sell their parent’s home to pay for their care. But what is startling and equally frustrating and maddening, is that there is so little, if any, mention of CHC Funding! We estimate that many thousands of people are missing out on their entitlement to free NHS funded care.
- Equally, those we speak to in the medical profession, GPs and Consultants alike, are typically clueless as to what CHC Funding is, and so fail to recommend their patients seek an assessment. So, if those working in the medical profession, and particularly within the NHS, haven’t heard of, or don’t really know or understand what CHC is, how can their patients be expected to know? Indeed, our recommended lawyers, Farley Dwek Solicitors, recently acted for two GPs who were unaware how to access CHC Funding for their own relative! Again, we wonder just how many thousands of NHS and private patients have missed out on CHC Funding due to ignorance.
- Of course, care homes don’t often volunteer CHC to self-funding residents as a first port of call, because the fees they can charge a private-paying resident are usually far in excess of what they can get in CHC payments from the NHS for the same room.
- Many people are told untruths or given wrong or misleading information which effectively puts them off having an assessment at all, or simply abandoning it if they get a negative MDT outcome – without necessarily understanding if their assessment was actually carried out fairly and robustly.
- Any assessment as to eligibility for CHC Funding must first be done by the ICB before any discussion about funding takes place. However, that premise may not necessarily stop an ICB trying to divert a potentially eligible CHC candidate, by referring them to their Local Authority instead (where care will provided on a means-tested basis). For obvious budgeting reasons that might well suit the ICB because, if this tactic works, the NHS won’t have to fund the individual’s care. However, it could leave the individual frustrated if they are batted back and forth between their ICB and LA, until one body takes action and responsibility to provide and fund care.
- We sometimes wonder whether some ICB assessors move the goal posts at MDT assessments, or raise the already lofty bar to achieving CHC, even higher, to make less people eligible? The flaw in the assessment process is that the interpretation and application of the eligibility criteria is entirely subjective. So, that, in theory, gives flexibility and discretion to assessors to reach negative decisions refusing CHC, which may be flawed or considered unfair or not robust. Over the years, we have heard too many horror stories of unfair or incompetent assessments being carried out.
- On a similar theme, is the NHS National Framework – the rule book on CHC Funding – being interpreted and applied correctly by the appointed ICB’s assessors? What formal training and experience have they had to undertake these life-changing assessments? And why do a high percentage of negative decisions then go on to be successfully appealed further down the line? From the experiences of others shared on our website one can be forgiven for thinking that some NHS assessors are ‘asked’ to tow the party line and find people ineligible, simply to protect budgets, however shocking this may seem.
- With stretched staffing resources, do care home accurately record daily entries appertaining to a patient’s daily care needs? Inaccurate, incorrect, misleading or missing entries, can have a significantly adverse effect on your chances of getting CHC awarded. Whilst the NHS assessors can, and should speak to care home staff and family members as to the individual’s healthcare needs, often what’s written in black and white carries far more weight. Poor record keeping can produce incorrect outcomes.
- Whilst the CHC assessment process is intended to be user-friendly for the public to access, we often wonder how many people are having the wool pulled over their eyes. As we’ve already said, the public really have little actual knowledge of how the CHC process works or how to best present their case for Funding. Some have inflated ideas about their own knowledge of CHC or ability to present their case succinctly, but unfortunately, soon realise they are out of their depth against trained and hard-seasoned ICB assessors – often left coming away from their MDT with a feeling of mistrust or frustration. Others may have no idea that they have unwittingly been edged out of the assessment process. Good preparation and advocacy and support are critical.
Preparation, Preparation, Preparation! Never Take MDT Outcomes For Granted
- Even if the CHC assessors do recommend that an individual is eligible for CHC at MDT, the ICB is the ultimate decision-maker and, therefore, have the power to reject any positive recommendation for funding. Admittedly, the circumstances have to be exceptional, but anecdotally, it seems to be happening too often.
- Delays in getting assessed are an issue, too. According to the NHS Quarter 2 Care Report, as at August 2023, there were an estimated 249,589 people waiting for an assessment, of whom an estimated 84,788 had been waiting for over 6 months! If you are in need of an urgent CHC-funded care package for your relative, this is an inordinately long time to wait – the outcome of which could materially decide whether you need to sell an asset, such as your home, to pay for your own care (ie self-fund), or whether it will be provided free of charge by the NHS.
Of course, not every application for CHC will be successful. But there are too few people who know about CHC, and those who do try to access it, are often wrongly rejected. There needs to be so much more public awareness and training and that includes the medical profession, too!
Care To Be Different is a renowned resource website, helping families in the CHC arena, and excels in filling in the gaps, giving you practical guidance and tips on how to get CHC Funding, where applicable.
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