…You’ve been through the NHS Continuing Healthcare assessment process.
…You’ve battled every step of the way.
…And now you’ve finally succeeded in securing the funding.
But what should Continuing Healthcare funding cover?
Here are 3 things you may be wrongly told at this point:
1. The local authority will still have to means test you for your social care needs.
2. Continuing Healthcare will only pay up to a certain amount for your healthcare needs.
3. Your family will have to pay the difference fees between what the NHS will pay and what the care provider charges.
If you’ve been told any of these things, challenge them right away. Here’s why…
Let’s look at the NHS Continuing Healthcare guidelines – the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care:
Page 14, paragraph 33:
“Where a person has been assessed to have a ‘primary health need’, they are eligible for NHS continuing healthcare. Deciding whether this is the case involves looking at the totality of the relevant needs. Where an individual has a primary health need and is therefore eligible for NHS continuing healthcare, the NHS is responsible for providing ALL of that individual’s assessed health AND social care needs – including accommodation, if that is part of the overall need.”
So, if you qualify for NHS Continuing Healthcare, the NHS must cover ALL your needs, whether they are social care needs or healthcare needs. It’s the whole package.
Let’s look further at the National Framework:
Page 46, paragraph 167:
“Where a person qualifies for NHS continuing healthcare, the package to be provided is that which the CCG assesses is appropriate to meet ALL of the individual’s assessed health AND associated social care needs.”
In other words, ALL the needs that have been discussed and assessed to get you to the point of qualifying for NHS Continuing Healthcare should be covered by the funding.
So be alert for anyone trying to tell you that Continuing Healthcare is capped, or that you still have to pay some of the fees. Indeed, if you qualify for NHS Continuing Healthcare funding, the responsibility for your care is squarely on the shoulders of the NHS.
What’s more, the local authority will be in an illegal position if it then tries to means test you. This is also reinforced in the new Care Act and in case law, for example the well known Coughlan case.
Remember also that ‘top up’ fees apply to local authority care ONLY, not NHS Continuing Healthcare.
What’s your experience?