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.
- 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:
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.
For further reading about FNC, look at paragraphs 246 – 262 of the National Framework
Also take a look at these blogs: