If you have a relative with complex healthcare needs, who is either being cared for at home, in a care home, or about to be discharged from hospital into a care home or hospice, and you’ve never heard of NHS Continuing Healthcare Funding (or ‘CHC’), then you must read this article! It could save your relative from selling their home or paying thousands of pounds a month for their care fees.
If you’re new to CHC, there’s plenty of free information on our Care To Be Different website – packed with free information and resources to help you at every stage of your CHC journey. But, if you’ve never heard of CHC, here’s some basic information to get you started.
What is CHC Funding in a nutshell?
It’s a package of ongoing care that is arranged and funded solely by the NHS for adults over 18, who have a ‘primary health need’ i.e. the main reason for care is health needs, not social needs, and such healthcare needs arise out of a disability, accident or illness.
What does CHC funding cover?
If you meet the eligibility criteria for CHC, then you should be entitled to CHC Funding to cover ALL your assessed healthcare and associated social care needs – and that includes the cost of accommodation at a care/nursing home. It won’t cover your extras, like chiropody and hairdressing, as you’ll have to pay for those services if you want them. But the significant weekly cost of care will be paid for by the NHS.
That sounds too good to be true!
Being awarded CHC Funding can potentially save families many thousands of pounds a month in care fees. That’s why the bar to getting CHC is set deliberately high by the NHS. It’s not a case of making an application and waiting for funding to kick in quickly. The assessment process is complex and applying the eligibility criteria is entirely subjective. You’ll have to work extremely hard to persuade the NHS to award CHC Funding.
Do I have to pay for CHC?
No. The whole point of CHC, is that the care should be free at the point of need. So, if you are awarded CHC, there will be no cost to you. Yes, that’s right – all your care fees paid in full by the NHS!
But I’ve saved all my life and have funds available. Won’t they want to factor in my wealth?
No. CHC is NOT means-tested, therefore, you shouldn’t have to pay a penny for your care. Your wealth is immaterial to the assessment process. CHC is all about health, not wealth!
Be warned! Many care homes don’t let on about CHC if you’ve got means, because they can often charge you far more for the same bed than they’ll get from the NHS. So, it’s not generally in their interests to push you to apply for CHC.
If CHC is free, how come I’ve been asked to contribute to my care fees?
That depends on the circumstances. If you’ve been awarded CHC, it is unlawful for the care/nursing home to charge you a contribution or ‘top-up’ fee to make up any shortfall.
The whole essence of CHC is that it should pay for ALL your assessed healthcare needs. If the care home says that the NHS funding isn’t enough to cover the cost of the care it provides, then it should go back to the NHS on your behalf and seek an increased package of funding. If it is too slow or refuses to do so, then you should contact your local NHS Continuing Healthcare Department and tell them of the situation and request for the funding to increase. When CHC is in place, the care home is NOT entitled to charge you for the shortfall (a ‘top-up’) – unless it’s for ‘hotel-style’ luxuries or extras that you particularly want (eg hairdressing/social activities) that are not included in the CHC healthcare package.
Why are the NHS trying to say my dad has social care needs?
Social care is for services such as getting help with personal hygiene, washing, dressing, toileting needs, meal preparation and assistance with mobility. Social care is the responsibility of the Local Authority (social services) and IS means-tested. If your relative has assets, capital or savings under £23,500 (current limit as at 20/11/23), then the Local Authority will have to pay for their social care needs; above this sum, and your relative will end up paying for their own care out of private resources (or more commonly selling their home to fund their care).
Wealth is the key driver here. If you have means, you are likely to end up paying for your care, whereas CHC is all about healthcare needs.
Often, the dividing line between healthcare and social care needs can be minimal or even blurred. Depending on which side of the line you fall will determine who pays for your care. So, it’s vital you understand and can recognise the difference, otherwise there is always the risk that you may be caught between the two and pushed down the wrong avenue of funding; with the NHS trying to say your care needs are social care needs and palming you off to the Local Authority (which is subject to means-testing) to protect their own budgets.
However, CHC should ALWAYS be assessed FIRST before any questions over social care are considered. Remember it’s ‘health before wealth’ – so, how you are going to pay for your care should not be on the agenda at this early stage.
Why is CHC such a well-kept secret?
Easy! Because the NHS don’t want you to know about it, as they’ll have to pay care fees which will drain their budget. Instead, it suits them to stay quiet, meaning many thousands of people end up paying for their own care unnecessarily (self-funders) when it could have been funded all along by the NHS – free of charge.
How do I find out if my relative is eligible for CHC?
Firstly, you need to start by reading the rule book and guidance set out in the 187-page National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (updated July 2022).
The National Framework is designed to help healthcare professionals and practitioners conduct CHC assessments and appeals. The National Framework repeatedly states that the individual being assessed is supposed to be at the heart of the process (‘person centric’). That’s all well and good in principle, but for most people, they’ll have no idea how to go about preparing for a CHC assessment or appeal, and will inevitably be turned down for funding as the application process is so complex. The guidance doesn’t go far enough. It tells you the rules and what is expected from NHS practitioners, and their responsibilities when carrying out CHC assessments – which is helpful to some extent and to spot any abuses – but there’s no practical guidance on how to ‘beat’ the NHS and secure vital CHC Funding. It’s not a level playing field, and many have battled alone against the NHS and have either been put off claiming CHC, or got bogged down in the whole process and given up in frustration, bamboozled by its complexities.
That’s how Care To Be Different came into existence, following the trials and tribulations of its founder, whilst seeking CHC Funding for her own parents and encountering the CHC’s shenanigans designed to defeat her attempts to get much needed funding at every corner.
Where do I start?
Unless you have a rapidly deteriorating condition which may be entering a terminal phase (think of it as end-of-life) and can get Fast Track Funding, to start the process you need to have a screening test carried out using the Checklist assessment.
Read these helpful articles on when, where and how the Checklist is done:
What happens after the Checklist?
If it’s negative, your relative doesn’t qualify for CHC Funding. That’s not necessarily the end of the line. If their needs change or become more challenging, then you can always request for another Checklist to be done. You can use the previous negative Checklist as a benchmark to identify any changes in needs.
If it’s a positive Checklist outcome, then your relative will progress to a full assessment carried out by a Multi-Disciplinary Team (MDT).
For more information about MDT’s read these blogs:
Can I recover care (home) fees already paid?
Yes, as well as getting CHC Funding from the NHS to pay for ongoing care fees from now on, you can also reclaim care fees, retrospectively, for past periods of care, going back to April 2012, that weren’t assessed (Previously Unassessed Periods of Care or ‘PUPoCs’).
Alternatively, if your relative has already had an assessment, but was wrongly turned down for CHC, you can appeal. If successful, and are retrospectively awarded CHC Funding, you recoup those fees paid -PLUS you are automatically entitled to interest for the NHS’s ‘maladministration’ (whether abuse of process or incompetence in wrongly assessing your relative in the first place). Beware though! There are strict timescales for appealing negative decisions.
Getting to grips with the CHC process is not easy, and even the NHS assessors themselves don’t always appear to understand the process and what is required – hence the large number of cases we fight that go on to appeal and are successful! Unbelievably, many healthcare professionals don’t know what CHC is or how their patients can access it. If your local GP hasn’t heard of NHS Continuing Healthcare and they’re in the NHS business, what chance do the rest of us have?
Care To Be Different is a renowned resource website, helping families in the CHC arena, and excels in filling in the gaps and gives you practical guidance and tips on how to get CHC Funding, where applicable.
Read our blogs or call our Nurse Advice Helpline, or buy our book “How To Get The NHS To Pay For Care” or simply email us your enquiry or join our Facebook community and get help from others with similar experiences.