One of the most frequent questions families ask on our blog is whether their relatives will be eligible for NHS Continuing Healthcare funding.
And yet it’s a question no one can answer – at least, not until the person needing care has actually been assessed for NHS Continuing Healthcare.
It is possible to hazard a guess about whether they should be eligible, but the only way to actually know is to be assessed.
What’s more, a Continuing Healthcare assessment is the first thing that should happen when a person needs care; means testing and being told to pay for care is strictly secondary to this.
If you’re asking yourself whether your relative is eligible for NHS Continuing Healthcare, answer these 5 questions first:
1. Does your relative have some health needs AND do they need care?
If the answer to this is yes, don’t pay a penny in care fees until they’ve been assessed for NHS Continuing Healthcare funding. This process starts with a ‘Checklist’ assessment. Here’s how to get the assessment process started.
2. Has anyone told you your relative ‘won’t qualify’ – before the Continuing Healthcare assessment process has even begun?
If so, ignore them. As we mention above, no one can tell you this until after your relative has actually been assessed. The person telling you that your relative won’t qualify may have a vested interest in trying to put you off.
3. Do people keep talking to you about ‘doing an assessment’, and yet you’re not sure what they actually mean?
They may be talking about a social care assessment – or perhaps a straight forward health assessment or some other kind of assessment. Not all ‘assessments’ relate directly to Continuing Healthcare. Read more here about different assessments and which one is relevant when.
4. Have you read the eligibility criteria for NHS Continuing Healthcare?
This is really important. You can find the links to the criteria in the main assessment forms here. You’ll see that there are two main stages to the Continuing Healthcare assessment process: an initial Checklist assessment and then a full multidisciplinary team (MDT) assessment.
You’ll also notice that there is a scoring system in both cases, i.e. a person will be given a score for the severity of their needs in relation to different aspects of their health and care.
However, the scores are not the only things that should guide an NHS Continuing Healthcare assessor in making a funding recommendation. Assessors must also:
- look at the whole picture of need and use competent professional judgement too, taking into account the nature of the care needs and how complex, intense and unpredictable they might be. (Note: A person does NOT have to have highly complex care needs to qualify for NHS Continuing Healthcare funding.)
- abide by the law and the principles established in the Coughlan case. The courts and the statutes made by Parliament about care funding and care fees always override any ‘guidance’ published about Continuing Healthcare. Examples include the ‘Standing Rules’ and the Care Act – and you’ll find links to those here.
Most importantly, however, the local authority has a vital role to play in the Continuing Healthcare process. The local authority must decide whether or not a person’s care needs falls within the local authority’s own legal remit for providing care.
If the person’s care needs fall within the local authority’s legal remit, the person will be means tested (this is actually voluntary), and if the person has sufficient means they will have to pay.
If the person’s care needs are beyond the local authority’s legal remit, the person should receive NHS Continuing Healthcare funding to cover ALL their assessed care needs.
Make sure you also read the national guidelines for Continuing Healthcare funding. These are called the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
5. Are you finding the divide between health care and social care needs confusing?
Although there is no definitive list of which care needs are social care and which are healthcare needs, the National Framework goes some way to defining each in broad terms. Read more here about the difference between a social care need and a healthcare need. Each person’s case should be looked at individually, and all care needs should be taken into account to determine whether a person is or isn’t eligible for NHS Continuing Healthcare funding.