Many families are wrongly told that NHS Continuing Healthcare funding is only available for people who are at the end of their life. Not only is this incorrect, it often means that elderly people with significant health needs are wrongly denied the free NHS care they are entitled to in law.
Continuing Care funding for care fees depends on the extent of your relative’s health needs, not what stage of your life they’re at. Assessments are supposed to be carried out swiftly, no matter what your relative’s degree of health needs. There is, however, a special assessment that should be used in emergency situations or when a person is in a period of rapid deterioration or when a person is in ‘terminal decline’ at the end of their life.
National Framework guidelines, page 32, paragraph 97:
“Individuals with a rapidly deteriorating condition that may be entering a terminal phase, may require ‘fast tracking’ for immediate provision of NHS continuing healthcare.”
Nursing care is provided by the NHS, and NHS care is free – in law. The Continuing Healthcare eligibility criteria are based purely on care needs and NOT on a person’s money, and by looking at the criteria – and at the local authority legal limit for means tested care – it will be clear whether or not a person should receive full NHS funding for their care.
If your relative is in terminal decline at the end of their life or in a period of rapid deterioration, you can insist on them having an urgent Continuing Healthcare assessment. This is done using the NHS Continuing Healthcare Fast Track process (‘Fast Track Pathway Tool for NHS Continuing Healthcare’). Essentially, it’s a fast assessment to get NHS funding in place as quickly as possible.
Here are some of the key points to keep in mind about this NHS Continuing Healthcare Fast Track process:
- It is used if your relative has urgent health needs and/or nursing needs and is rapidly deteriorating and/or in a terminal phase of life. It is also used if your relative’s health is likely to deteriorate rapidly before the next routine Continuing Healthcare review. It is not only for people at end of life.
- It allows a quick decision to be made about Continuing Healthcare funding. As part of this, it allows appropriate end of life support to be put in place quickly by the NHS – free of charge – and it means your relative can have care provided in their preferred location, including at home.
- The Fast Track assessment should be carried out by a registered medical practitioner (the ‘assessor’), such as a GP, consultant, registered nurse, hospice clinician, etc – but this person must have detailed knowledge of your relative’s needs. Unfortunately, families report that GPs and other medics often have little (if any) knowledge of the Continuing Healthcare assessment process, and it can fall to the family to ‘educate’ them in this respect. This can be immensely frustrating for the family at a time when urgent action is required.
- In the Fast Track assessment the assessor makes the decision that person is in a rapidly deteriorating state and/or in a terminal phase and with an increasing level of dependency. This decision should be accepted and acted upon immediately by the NHS.
- There should be no delay in providing free NHS Continuing Healthcare funding just because NHS or local authority staff are arguing or debating how the Fast Track should be used.
- Your relative should be moved to his/her preferred place of care and have funding immediately put in place without having to go through the long-drawn-out ‘full’ multidisciplinary team Continuing Healthcare assessment process. The NHS is responsible for this. If your relative is already in a care home, and no longer owns their own home, it may be that the care home will be the best place in which to remain.
- Once Fast Track Continuing Healthcare funding is in place, it should never removed without the NHS going through the proper review process, i.e. a full assessment process carried out by a multi-disciplinary team (MDT). This ‘full’ assessment process uses a form called the ‘Decision Support Tool’ (DST). Only once the Fast Track assessment is complete and funding is put in place should an MDT review process ever be started – and only if this MDT assessment is really necessary. This full MDT assessment process should never delay urgent Fast Track end-of-life funding and care.
- If parts of the Fast Track form have not been completed, or if the assessor does not know how to complete it, or the patient cannot assist in completing it, this should never delay a decision about funding or delay NHS care being put in place.
Essentially, the Fast Track allows for a decision to be made quickly that your relative has a ‘primary health need’, that they have a rapidly deteriorating condition or are in the terminal phase of life, that their needs are more than ancillary to the provisions of accommodation by a local authority, i.e. the care they need is beyond the legal remit of Social Services.
Remember, ask for a Fast Track assessment if you feel your relative should have one. If this is declined, and yet it’s clear that your relative is declining rapidly, put your concerns in writing to the Chief Executive of your relative’s local NHS (Clinical Commissioning Group) and copy it to the Continuing Healthcare Team, the GP, all appropriate consultants, nurses, medics, clinicians, carers and the care home manager (if relevant).
If necessary write to your MP.
If it’s obvious that your relative needs urgent nursing care, you could also refuse to pay (or continue to pay) care fees at this point.
This does, of course, raise a further question: If a rapid decision can be made using the Fast Track process, why can’t all NHS Continuing Healthcare assessments be as quick?