Why does the NHS not tell you about your right to claim NHS Continuing Healthcare Funding?
NHS Continuing Healthcare Funding (otherwise known as CHC) has been described as the NHS’s best kept secret.
If your relative is going into a care home for the first time, or is already in a care home, then they ought to be assessed for CHC – free funded care – if they have a ‘primary health need’*. To determine eligibility for CHC, there should be a full assessment process, starting with an initial Checklist.
If the Checklist scores ‘positive’, your relative should proceed to a full assessment, carried out by a Multi-Disciplinary Team.
So why don’t most people know about this important area of free NHS-funded care, which could potentially save families a fortune?
The answer is because the NHS doesn’t volunteer it or advertise its availability openly! The reason being – it’s not in its interest to do so, so why would they?
CHC Funding requires the NHS to pay vast amounts of weekly sums, across the country, for individuals’ care needs (including care home fees for accommodation) out of ring-fenced budgeted funds. So, in order to protect funds (‘financial gatekeeping’) the NHS tends to keep this level of available funding out of the public domain. Care To Be Different’s number 1 priority is to raise awareness about CHC, and help families with free information and resources to challenge the NHS and obtain CHC Funding.
Note: If fully funded CHC is not available, then your relative should automatically be assessed for NHS-funded Nursing Care (FNC) which is paid as a weekly rate, currently £151.86. Although FNC still costs the NHS, it is far cheaper than paying around £750/£850 per week, for CHC, which can of course increase depending on where the care home is located within the country. In London, and the south of England there will inevitably be a higher rate, with some care homes charging up to £1,500 per week for care and accommodation – a cost which the NHS should meet in full if the individual meets the eligibility criteria for CHC.
With these level of care home fees, it’s no wonder that the NHS doesn’t readily volunteer CHC funding, and wants to keep it under wraps. The issue was clearly conveyed in the BBC drama, “Care”. Read our blog: BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare
Even if you happen to know about CHC Funding, many families feel that the whole assessment process is not always done fairly or robustly, and it is an uphill battle to try and get CHC Funded care for their relative. Certainly, the earlier stages of the assessments process are all done by the NHS appointed assessors. And although the assessment process is supposed to be impartial and fully compliant with the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, some of the assessments are woefully inadequate, almost as if a decision has been reached before it has even taken place! It appears that some NHS assessors effectively know who is ‘holding the purse strings’ – and that might account for some of the blatantly perverse outcomes where CHC funding is refused at the preliminary stages. This experience chimes with many families we hear from going through the assessment process.
For further essential reading, see our blogs:
So, why don’t Care Homes push families to get CHC Funding?
Some do, but not necessarily as the first option for funding. Care homes may be able to obtain far higher fees from privately paying residents than the standard CCG rate for that area. Frequently the subject of CHC Funding is further down their line of questioning – often at the point when the care home manager realises that the family have insufficient funds to pay for their relative’s care. Of course, that is the wrong way round. CHC funded care should be explored first on every occasion, even before discussing any other methods of financing care needs and care home fees. Remember, the first question asked by the CCG or care home should be about your relative’s health (ie consideration for CHC), not their wealth! The BBC drama “Care” was ‘spot on’ in its portrayal of the care home manager only mentioning CHC Funding as a last resort, when he had exhausted all other methods of funding the care home’s fees. For further reading take a look at our website and these blogs:
Isn’t it all about the money and who pays the care home fees?
Clinical Commissioning Groups have budgets allocated to pay for NHS Continuing Healthcare Funding. So, if the NHS reject an application for CHC Funding, it is up to the family either to seek help from their Local Authority (through Social Services) or, alternatively, pay for care from private means.
However, if you feel the CCG’s decision to reject funding is fundamentally wrong – then appeal, even if it means exhausting the local appeal process at a Local Resolution Meeting and taking the matter to the highest level – NHS England. Yes, it is time consuming and emotionally draining, but if you feel passionately that your relative should qualify for CHC, then keep going and don’t give up! NHS England is an independent body, where you stand the best chance of overturning earlier decisions by the CCG to refuse funding.
Do I stand a better chance of getting CHC Funding depending on where I live?
Unfortunately, the answer is – YES!
Farley Dwek Solicitors commissioned a national survey on this subject. The survey conducted by Survation, found that a staggering 87% of people they interviewed had never heard about NHS Continuing Healthcare Funding! The results were published in the Times on 25th March 2018. You can read the results of their national survey and summary report here:
Where you live does make a difference to your chances of getting CHC Funding – often referred to as the ‘postcode lottery’. Again, Farley Dwek Solicitors have helpfully reproduced a map of areas most and least likely to grant funding. See the link below:
An excellent article in the Daily Telegraph on 3rd March 2019, featured a story relating to Rear Admiral Philip Mathias’s (retired) long fight to get CHC Funding for his mother. The stark north-south divide is quite apparent, and the statistics clearly show the areas where CHC is most / least likely to be awarded. For example: in the South, in areas such as Luton, Berkshire West, Tower Hamlets, Wiltshire or Croydon, on average only 20.76 per 50,000 achieved CHC; whereas, further north, in Salford, Bury, Heywood Middleton & Rochdale, and Wigan, the average is 149.1 per 50,000 people. That is a huge discrepancy!
So why is there such a discrepancy as to who is entitled to CHC funding?
In most cases, a fair and robust assessment at a Multi-Disciplinary Team meeting should achieve the correct decision as to whether an individual is eligible for CHC Funding or not. There should be no difference whether your relative is assessed in the Midlands, north or south of England, or Wales. The results should be consistent wherever the assessment takes place. However, sadly, that is not the case, as we know from the above research.
There are inconsistencies right across the country and outcomes / chances of success can therefore differ widely, depending on where you live. This is largely due to the fact that the National Framework for NHS Continuing Healthcare and NHS Funded Care is open to subjective interpretation. Invariably, NHS assessors may interpret an individual’s healthcare needs one way (ie negatively), whereas families and their advocate representatives may interpret the same needs positively.
Our conclusion is that either some CHC assessors are either not properly trained, are unfamiliar with the NHS National Framework, or just don’t apply the National Framework consistently when undertaking CHC assessments. The National Framework invites subjective interpretation of the Care Domains and 4 key indicators – and is, therefore, open to misinterpretation/misapplication of the eligibility criteria, errors, and more cynically abuse for financial gatekeeping purposes.
My father has Alzheimer’s so surely he automatically qualifies for CHC?
No, not necessarily at all!
When seeking CHC for a spouse or close relative, there is an additional element – the ‘emotional’ factor – which can cloud a family’s perception of their relative’s entitlement to CHC Funding. Many families are understandably caught up in the emotional side of the assessment process, and naturally want to do the best to secure CHC Funding for their relative. Unfortunately, that can lead to false expectations as to their relative’s realistic chances of success, especially if you have been misinformed that certain physical or mental health conditions, such as Alzheimer’s or other forms of dementia/cognitive impairment, automatically qualify your relative for CHC funding. Beware! That is not correct, and that is perhaps where there is a big misunderstanding.
Whilst your relative may well qualify for CHC, merely having a condition such as Alzheimer’s in itself, is not guaranteed to secure CHC. It is not about the ‘label’, medical condition or the diagnosis. It is about the totality of healthcare needs – taking into account the nature of those needs, and how complex, intense and unpredictable they are to manage (the 4 key indicators). It is not simply taking a medical condition, such as Alzheimer’s, and automatically assuming that alone is sufficient to get CHC Funding. It isn’t, and that is where a lot of families go wrong. For further reading on the subject, see our blogs:
Read as much as you can. Browse the many articles and comments on this website. Spread the word and tell others about CHC Funding.
Another article that will help you is, Tell people about NHS Continuing Healthcare