Many people miss out on FNC – Funded Nursing Care – and yet it’s a tax-free, non means-tested benefit that is provided by the NHS for people living in a care home (registered to provide nursing care) or nursing home. FNC is a contribution to the cost of their nursing care provided by a registered nurse employed by the care/nursing home. The range of services provided by a registered nurse are quite wide and can include planning, supervising and monitoring nursing and healthcare tasks, as well, of course, as direct nursing care.
The most common question people ask us is how FNC is assessed – and it often surprises them to hear that it’s not actually assessed.
Instead, it’s awarded to people who have been turned down for NHS Continuing Healthcare funding (full funding), but who still need some degree of nursing care.
In other words, there must be a proper assessment for NHS Continuing Healthcare Funding FIRST, and it’s only once the outcome of that assessment is known that a decision is made about FNC. For more information about assessments, read the blogs below.
So, we’re talking about two different types of funding here:
- NHS Continuing Healthcare (CHC) – is full funding and it covers 100% of the costs of receiving full-time care, whether at home or in a care home, hospice or other care facility. It covers 100% of care fees, including social care and the cost of accommodation – i.e. everything.
- Funded Nursing Care (FNC) – is a weekly benefit paid by the local NHS Clinical Commissioning Group for people who need some nursing care, but who are deemed ineligible for full CHC Funding.
Don’t make the common mistake. NHS Continuing Healthcare and FNC are not the same thing.
When is FNC paid?
The only way anyone can decide whether your relative should receive FNC is if they first have a free assessment for NHS Continuing Healthcare. Their nursing needs should be assessed as part of their eligibility assessment for CHC.
If, having been assessed, they are not found eligible for CHC (free funded care), but still require the services of a registered nurse, then they should automatically be considered for FNC for their nursing needs whilst resident in their care/nursing home.
Remember: Paragraph 250 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care states that you MUST be assessed for NHS Continuing Healthcare first. Only after that should your relative be assessed for FNC – not the other way round.
Therefore, CCGs should never routinely ‘assess’ for FNC first, as a matter of course, instead of assessing for full CHC Funding. The result? Families are left unaware that their relative may in fact be eligible for full NHS funding (which could typically amount to many thousands of pounds a month), but is instead only receiving a small weekly allowance specifically towards the cost of their nursing care needs.
Tip: Don’t make the mistake of being pushed into talking about FNC unless and until your relative has first had their CHC assessment and been turned down!
For further reading around the assessment process:
- Understanding the Checklist Assessment
- Getting through the Checklist assessment – avoid these common mistakes!
When isn’t FNC applicable?
FNC is not paid if your relative has to go into hospital. (They may still have to pay for their care home placement in the meantime, though.)
FNC is not available if the person needing care is in their own home or is in an ordinary care home; instead, they must be in a care/nursing home registered to provide nursing care.
How is FNC paid?
FNC is a weekly sum paid directly by the NHS Clinical Commissioning Group to the care/nursing home and is a contribution to ‘reimburse’ them for the cost of any nursing care provided by their employed registered nurse for your relative’s care needs.
Depending on how the care home contract is written, it may lower the overall care fees paid by the individual. So, if you’re paying for your own care, and your fees are calculated to include all nursing care, your care fees should reduce once the NHS starts paying FNC. However, many people see no difference at all, even though the care home is obliged to show how FNC reduces the care fees. Transparency is paramount. Yet, some nursing homes may see this as a ‘windfall’.
If the contract is silent, they may well pocket the FNC payment received from the NHS, and in addition, still charge your relative full rates! It’s always worth questioning this with the care home.
Unfortunately, many families are unaware that their relative is in receipt of FNC, or if they are, don’t really understand what it is, and so don’t challenge what happens to the payments.
Our Tips:
- Look at the contract and the monthly invoices to see whether FNC is mentioned.
- Check to see how they have accounted for FNC and whether credit has been given for this weekly payment to reduce the fees payable.
- If necessary, speak to the Continuing Healthcare Department at your local NHS Clinical Commissioning Group.
- Also consider paragraph 256 of the National Framework, set out below:
- The Care home provider should set an overall fee level for the provision of care and accommodation. This should include any registered nursing care provided by them. Where a CCG assesses that the resident’s needs require the input of a registered nurse they will pay the NHS-funded Nursing Care payment (at the nationally agreed rate) direct to the care home, unless there is an agreement in place for this to be paid via a third party (e.g. a local authority). The balance of the fee will then be paid by the individual, their representative or the local authority unless other contracting arrangements have been agreed.
Read our helpful blog: Funded Nursing Care refunds – should your care fees reduce?
FNC rates in England
Prior to October 2007 there were three bands – low, medium and high. If you qualified for FNC before 1 October 2007 and continue to qualify in 2020/21, you will receive the higher rate of £253.02 per week in England.
But since 1st October 2007 there’s just one flat rate contribution now which has increased slowly, but steadily, over the years. Here are the recent annual FNC rates for England:
- 1st April 2018/19: £158.16 a week
- 1st April 2019/20: £180.31 (previously £165.56) a week
- 1st April 2020/21: £92 per week
Scotland: £81* (2020/21): free personal care payment of £180 per week
Wales: £179.97 (2019/20) per week
Northern Ireland: £100 (2018/19) per week
How Long Does FNC last?
According to paragraph 253 of the National Framework, individuals who are in receipt of NHS-funded Nursing Care are entitled to continue to receive it whilst they are alive until it is no longer appropriate. For example:
(a) if your relative no longer lives in a care home (or one that provides registered nursing care); or
(b) lives in a care home but does not now need any level of nursing care from a registered nurse; or
(c) your relative’s healthcare needs have changed, and they have become entitled to fully funded free NHS Continuing Healthcare instead.
Tax and benefits
FNC is a tax-free benefit and is not means-tested. As above, it can also be withdrawn if the NHS decides you no longer need it.
FNC does not affect your entitlement to Attendance Allowance, however it’s always best to double check your payments as it has been known for government employees to confuse FNC with NHS Continuing Healthcare and, as a result, stop paying Attendance Allowance.
For more information, read our blog:
Is your relative claiming their full entitlement to benefits?
What should you do?
If your relative has nursing needs but is not receiving either of the above two types of funding:
- Make sure they are assessed for NHS Continuing Healthcare funding (full funding).
- If they’ve already been assessed for full funding, but turned down, ask the NHS Continuing Care Team why FNC has not been awarded.
- Ask the care home to give you a breakdown of the nursing element of care in your relative’s care plan to support your enquiry.
Remember: You should be assessed for NHS Continuing Healthcare first. Only after that should a decision be made about FNC – not the other way round.
And of course, if you believe the outcome of the NHS Continuing Healthcare assessment was wrong, you must appeal.
Read our blog: Know your rights – Appealing the CCG’s refusal to grant CHC funding.
For further reading about FNC, look at paragraphs 246 – 262 of the National Framework
Also take a look at these blogs:
What’s the difference between a care home and a nursing home?
Things You Need To Check Before Your Relative Is Discharged From Hospital
Funding your relative’s care – who pays?
New to NHS Continuing Healthcare Funding? Here’s a guide to the basics you need to know…
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My husband has advanced Parkinson’s
And had a nursing assessment for permanent i home nursing care.
He’s completely dependent on others for every need. I’m struggling to do the basics for him like feeding meds ect
As I have severe heart failure plus other health issues.
We are in wales under the SS in Wrexham
If he qualifies for FNC, why do we need means testing? He already failed for CHC
Unless we paid all his money out, and left me with nothing.
Surely this is totally fightable
Does any one know how to go about it ?
My sanity is at an end, after ten years of caring
I have nothing left to give.
Hi Rosemary,
I feel your frustration and exhaustion. I believe that CHC guidelines and regs are the same as in England.
Without understanding your exact circumstances, it’s hard to offer any help, but my immediate reaction was
1. Did you appeal the CHC ineligibility decision? This decision would have been reached following a full assessment with a multi displinary team present…… including yourself!
2. Social Services shouldn’t be completing any financial assessment until the appeal process has been exhausted.
3. Are you caring for your husband or is he in a home? FNC (Funded nursing care) is only awarded to individuals who are in a setting with a registered nurse present 24/7
Perhaps, you can get a friend or relative to help you appeal the process?
Good Luck.
I’m told my husband has had a DST assessment, I was not present, as it was a telephone meeting with his nurse SS and his OT
Today he’s had his Covid test before he’s admitted to 24 nursing care facility within the next few days,
When I questioned his nurse as I need to understand how the funding for his care turned out,BTW it is now in the hands of CHC committee for approval,
I also know it’s not means tested, but the figure quoted to me by his SS worker that it will be 50% paid by DST and 50% by myself, which is £1640-50 per month..
It’s seems totally unfair that figure, as I’m no longer able to care for his needs myself, as I’m in heart failure, and have arthritis in most of my body..
Just how do they come up with a figure like that, as if I’m to
Pay it, I shall have to move out of this extra care apartment we moved into
A year ago, I have no idea where I will live as I cannot pay both the rent here £1300 pm
Plus the care home charges,
We have no property of our own, as we’ve always rented privately since we came. Ack to the U.K. in 2009
Any help appreciated
Thanks
Rosemary Lawrence
The 50:50 split doesn’t make any sense and appears to be made up on the hoof. I would get them (NHS and Local Authority) to put this in writing and to also explain the legal basis for the decision. This should include an explanation of how they have construed regulation 21(7) of the Standing Rules ,(the CHC eligibility test) in reaching its decision.
Hi Rosemary,
I’m sorry to read about your situation. Can I suggest you get some advice to help you understand the process.
It’s difficult to understand your situation without knowing the full facts, but if your husband has been assessed through CHC (Continuing Healthcare) the DST (Decision Support Tool) is a document used to determine if your husband is either eligible or not for FULL funding.
If he is found ineligible then there is NO funding through this stream. CHC eligibility is FULL Funding for all of your husbands care. No other payment (Top up) is necessary.
A full financial assessment is taken after an ineligible DST, to determine if your husband is able to pay.
If you do not own a property, then it is clear to me that YOU should not be paying for your husbands care, from your own assets.
The fees should be paid from your husbands assets. If you have joint
assets, then these should be halved before any financial assessment is made.
You shouldn’t be worrying and relying on a website such as this, to help you understand the process. I urge you to ask for help to understand what decisions the authorities are making/taking.
Good Luck.
My daughter got the social services to give my brother an assessment but he cancelled it because he thought they were going to make him sell his house he has Prostrate Cancer very bad and has to have. Catheter on which keeps coming off .A nurse has to go to the home and flush it out twice a week he has Arthritis in his legs and elbows and cannot walk as he keeps falling over . He has been paying Care fees now at full rate because the care home just kept giving him a bill of £2600 a month now £3000 a month and has now ran out of money My daughter has now got the social worker involved as she is going to try to get him an assessment but there is no visiting at he moment because of the virus How do we go about money wise has he has already paid £46000 and owes about another 18000 because he cannot get to the bank because of the virus and the social worker said he shouldn’t have paid a penny before he had an assessment and it’s the care homes fault for not informing the social worker he is 92 years old and the are all confined to their rooms .
This funding is a joke. My experience – As soon as it was awarded the care home put the fees up to cover their costs of ‘increased nursing’ which they said were now required. (Which were no different to the care given before the funding was awarded)
My husband is waiting for the MDT today for
24 hr nursing care, in a care home,?
He has advanced Parkinson’s, is unable to do anything for himself, and bed bound
Have I got this correct?
Any means testing should be done after
The outcome of the MDT meeting, as the amount of funding by NHS has yet to be established.
As a ball park figure I was. Told it could be 40% up to full NHS funding
But he has pensions
I’m not looking forward to a means test as all pensions are in his name !!!!
Hello Rosemary,
Good Luck with the MDT. I do hope that you attended to add your observations and questions? As a spouse I would expect you to be fully involved in the process & hope you have POA? You are correct in terms of the financial assessment. This is completed after an ineligible decision at MDT. Do not agree to “means testing” until you have exhausted the appeal process.
If your husband is found eligible for CHC the NHS will fund ALL of his care,
My father was granted FNC by the local CCG after his latest assessment for CHC was not approved. The decision in July awarded funding effective from Nov last year. The care home have confirmed that they will deduct the FNC payments from his care bill so we have been fortunate that they are not just absorbing FNC as an additional payment. It depends on the contract you sign at the start of residency and dad was down for full on support so they had technically already indicated he needed nursing care and hence why they are going to deduct the payments from his care bill going forward.
Please be aware though that even if you are approved for FNC it takes a long time to come through! Payment still not taken effect for dad although I’m hopeful that the latest payment run will include it so he will initially get a big lump sum to cover the period from Nov last year up until now.
In my mother’s case FNC was awarded some three weeks before her CHC Assessment. I pointed out to the CCG that this completely ignored all the NHS instructions that FNC can only be awarded following an unsuccessful application for CHC.
The CCG replied that they had implemented this locally agreed (reverse) procedure as a direct result of complaints about the length of time it was taking to set up FNC payments while waiting for the outcome of CHC assessments. I replied saying that this was directly incompatible with the legislation. I then asked the CCG to provide details of the approval sought between them and The National Framework which allowed them to ignore the legislation.
The astonishing CCG reply was that the National Framework was only guidance and therefore did not breach any legislation.
This is now part of an appeal about process to the Independent Review Panel.
If you require 24/7 care in a nursing home, how can you separate care from a registered nurse, when the care being given is being delegated and overseen by a nurse? Surely this is still classed as a nursing need, otherwise you could be in a residential home and just getting visits from the district nurse. This is a crafty way of making you pay for part of care as funded nursing care only happens in a nursing home.
Dear CTBD
Can a care home keep FNC to compensate increases in their fees as I believe this is what’s happening in my mums case resulting in her paying more than she should be if FNC is deducted from the fees charged at present
I have been in dispute with this for months going round in circles and being fobbed of being told at one point she wasn’t receiving the funding
Mum was receiving CHC funding until Feb then it was taken away but was told she would receive FNC
Dear CTBD readers,
Don’t be hoodwinked by this stream of funding! This paltry weekly amount is insignificant when most residents are paying in excess of a thousand pounds a week! I clearly remember my mum saying how kind the NHS were, in contributing to my late father’s fees! She didn’t understand CHC. My argument is that if your loved one has been specially placed in a nursing home by CHC/CCG, then there is an acknowledgement that their needs are significant and that they require nursing care 24/7, as did my father. For me, it was a case of proving through the K.I.s that my father’s needs were indeed, intense, complex and unpredictable. I believe, anyone who has been awarded this funding should appeal the process and strive for full funding.