If your relative has already been assessed for NHS Continuing Healthcare Funding, but has been found ineligible, don’t give up! They may still be eligible for NHS-funded Nursing Care instead. Read on…
What is NHS Continuing Healthcare Funding? (otherwise known as ‘CHC’)
NHS Continuing Healthcare is a “package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need…Such care is provided to an individual aged 18 or over, to meet the health and associated social care needs that have arisen as a result of disability, accident or illness….. Eligibility for NHS Continuing Healthcare is not determined by the setting in which the package of support can be offered or by the type of service delivery.”
This means that the free package of funded care provided by the NHS, can take place whether your relative lives in their own home, or in a care or nursing home.
CHC is not means-tested. It is simply a matter of health, not wealth.
The meaning of ‘primary health need’ and the assessment process for NHS Continuing Healthcare are both dealt with extensively in many of our other blogs which we encourage you to read, and can be found on our website www.caretobedifferent.co.uk.
If your relative has been successful in their application for NHS Continuing Healthcare, then all their clinically assessed health needs, including accommodation, will be met by the NHS in full.
But what happens if my relative doesn’t qualify for CHC?
If, however, the application for CHC is unsuccessful, then all is not necessarily lost!
An assessment of your relative’s daily nursing and care needs should then automatically be carried out by the Clinical Commissioning Group’s Healthcare Team, to see if they are entitled to NHS-funded Nursing Care (FNC).
Common mistake: Don’t get pushed into an assessment for NHS-funded Nursing Care before your relative has been assessed for NHS Continuing Healthcare. Otherwise, you may be paying care fees unnecessarily!
What is NHS-funded Nursing Care (FNC)?
If your relative has been rejected for NHS Continuing Healthcare Funding, but still needs nursing care, then they may be entitled to receive FNC.
FNC applies to individuals living in a care home who need some element of nursing care from a registered nurse.
FNC is not assessed, or means-tested and is tax free.
FNC is a weekly sum paid by the Clinical Commissioning Group directly to the care home, as a contribution towards the cost of your relative’s nursing care needs that are provided by a registered nurse, employed by the care home.
Nursing care includes, not only providing direct nursing care to your relative, but also tasks such as planning, supervising and monitoring their nursing needs.
Note: You cannot get FNC if your relative is either in their own home, in hospital, or a resident in a care home without nursing.
The current national FNC rate for England 2018/19 are £158.16 a week.
For self-funded residents (private paying):
If the care home is receiving a weekly FNC payment from the NHS as a contribution towards the nursing element of your relative’s care home fees, then that FNC payment should, in theory, reduce the weekly fees that your relative is liable to pay to the care home from their private funds. Simply put: if FNC increases, your relative’s contribution to their care home fees should reduce accordingly.
Any shortfall in the cost of nursing will be paid by your relative, unless there are any other contractual arrangements in place to cover the cost, such as contribution from or joint package of care with the Local Authority.
We always recommend that you check the contract to see what it says about FNC and whether the care home fees charged are inclusive or exclusive of FNC.
Once my relative has FNC, can it be withdrawn?
FNC can be withdrawn if it is no longer appropriate. For example: (a) if your relative no longer lives in a care home; 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.
It is surprising to learn that so many people miss out on FNC if their relative is found ineligible for NHS Continuing Healthcare Funding.
Remember: The key point is that your relative should first be formally assessed for NHS Continuing Healthcare Funding, and only if that assessment fails, should they then automatically be considered for FNC. It should never be the other way round.
So, if your relative has first undergone an assessment for NHS Continuing Healthcare and been found ineligible for this free funding, then, as a default position, ensure that the NHS Continuing Healthcare Team undertakes an FNC assessment. Any NHS contribution will undoubtedly help defray the care home costs payable.
For further reading on the subject: