We often hear radio chat shows where callers are invited to talk about the cost of care in a care home, how expensive it is and their experiences of placing a relative into care. There is usually plenty of discussion about social care funding and means-testing, but hardly anyone ever mentions NHS Continuing Healthcare Funding – free funded care provided by the NHS!
Unfortunately, some callers who raise the topic are often unable to articulate exactly what CHC is, how you apply for it and what the eligibility criteria are for funding.
Equally, it is quite clear and maddingly frustrating to hear how many radio presenters who have broached the subject haven’t even heard of NHS Continuing Healthcare Funding either! The conversation usually proceeds with callers (and the show presenter) blissfully unaware that individuals can get their care fees paid in full (100%) – free of charge by the NHS – if they meet the eligibility criteria. The conversation needs to change and callers (and presenters) need to be educated on people’s rights to NHS Continuing Healthcare Funding.
Here’s a quick run through for those new to the subject (and any radio presenters reading this article):
1) What is NHS Continuing Healthcare Funding (‘CHC’)?
CHC is a package of ongoing care arranged and funded by the NHS for anyone over the age of 18 who has a ‘primary health need’ ie the overriding reason for their care is due to health needs – usually arising as a result of disability, accident or illness.
CHC is NOT means-tested and is paid irrespective of wealth. An individual’s wealth is never a consideration. You should never be asked if you can afford to self-fund your own care until you have had an assessment for CHC Funding first.
Quite simply, if you meet the eligibility criteria (and make no mistake, the bar is set high), you are entitled to CHC Funded care ie 100% of your care fees (including accommodation in a care facility) paid in full by the NHS – not the Local Authority.
Don’t make the mistake of confusing CHC with social care needs! There is a dividing line between care that the NHS must pay for and care that is the responsibility of a Local Authority. Local Authority funding is for social care needs and covers things like help with washing, dressing, eating, drinking, moving around safely and toileting etc.
Social care IS means-tested, and if, you have saving or assets over the threshold (currently £23,250) you will have to pay for your own care.
2) How do I apply for CHC?
If your relative is being discharged from hospital into a care home setting and requires funding and support for a new or additional package of care, the hospital discharge team co-ordinator should arrange an assessment for CHC. Otherwise, simply ask your GP, social worker, other care professional or the care home manager to arrange it. Or just approach the NHS Continuing Care Team manager at your local Clinical Commissioning Group (CCG), directly.
Read our blog: Why 31st March 2021 Is A Date To Look Out For…
3) Do I have to pay for an assessment?
The simple answer is ‘No’. The assessment (and appeal) process is free to use and you should not be charged by the CCG at any stage.
4) What does CHC pay for?
CHC Funding covers the full cost of an individual’s healthcare needs, including their social care needs AND the cost of their accommodation. So, if your relative is a resident in a care/nursing home, hospice or other care facility – ALL their healthcare needs should be paid for in FULL by the NHS and they should not be asked to contribute in any way.
But beware! Some care homes charge families unlawful top-up fees to meet to shortfall in the cost of care arranged by the CCG.
Read our blog: Have you been coerced into paying unlawful care home top-up fees?
5) Does CHC apply regardless of where I live?
Yes. CHC is assessed locally to where you live and funding is available throughout England and Wales.
However, some CCGs are known to award CHC more willingly than others, much depending on where you live – often referred to as the ‘postcode lottery’.
6) Do I have to be in a care home to get CHC?
No! CHC has no relevance to the setting where the care is provided. Therefore, if your relative is eligible for CHC Funded care, they can get it at their own home, a care home or wherever they are living.
7) How long does CHC last for?
For people being discharged from hospital into a care home, emergency COVID discharge funding (not CHC!) is automatically awarded for the first 6 weeks of care; it continues thereafter until an assessment for CHC has taken place and the outcome decision notified to you.
An individual’s healthcare needs can fluctuate over time and proactive CCGs recognise that it is useful to take stock periodically and make sure that the package of care in place is still sufficient to meet the individual’s needs.
Indeed, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised October 2018) provides that CHC care packages should be initially reviewed at 3 months once awarded and thereafter at least every 12 months (although the National Framework states that “some individuals will require more frequent review in line with clinical judgement and changing needs”). Of course, in the current COVID pandemic, most CCGs were unable to undertake any reviews between 19th March and 31 August 2020. However, from 1st September 2020 the Government mandated that it was back to business as usual, and annual reviews should be re-activated. Most competent CCGs will have the reviews diarised, as there is no point using up their limited budgets for individuals who no longer qualify for CHC.
8) Can CHC be withdrawn and taken away?
Annual reviews can be a double-edged sword. That means that the care package in situ can remain at the same level or it can be increased as necessary, to meet the individual’s more challenging needs. However, if their needs no longer exist or have significantly reduced, then the matter can be referred back to the CCG to carry out a formal reassessment, and the risk that their CHC package will be withdrawn. For further information, read these helpful blogs:
9) Can I appeal if CHC is withdrawn?
Yes. If CHC Funding is withdrawn, you will be advised of the appeal process and have 6 months to lodge your appeal with the CCG. You must have substantive grounds for making your appeal. In the meantime, your relative may be required to pay for their own care out of private funds. That is why annual reviews can cause sleepless nights for families – especially if their relative’s needs are borderline CHC/social care.
10) What if I’ve already paid fees, can I get them back?
If your relative has already paid for care fees (wrongly) and believe that they should have been eligible for CHC Funding during that period of care, then they can make a retrospective claim against the CCG for reimbursement. If successful, the NHS Redress Guidance provides that the CCG are obliged to repay the care fees wrongly paid plus interest.
11) Where can I find out more about CHC?
The guidance for NHS Continuing Healthcare is set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised October 2018).
However, if you are reading this article, you’ve come to the right place! Our caretobedifferent website is a comprehensive information resource for NHS Continuing Healthcare, and most of it is free to browse. The information we publish tells you what actually happens in care funding assessments and the pitfalls to watch out for – it’s not just the theory. Not sure where to start? Here’s a good place.
You can also get our book “How To Get The NHS To Pay For Care” which could help save you thousands of pounds in care fees.
If talking through your own care situation on the phone helps you find a clearer way forward and gives you greater confidence, then contact our Nurse Advice Line for one-to-one advice about care fees and NHS Continuing Healthcare.
If you would like to speak to one of our experienced Case Managers about a CHC related issue regarding a forthcoming assessment for CHC or a potential appeal against a decision not to grant or to withdraw Funding, or have a complicated CHC procedural issue which you would like to discuss, contact our General Advice Line.
If you want professional support at any stage of your relative’s assessment, appeal or retrospective claim, you can access it here too.
Tell people the basics!
If your radio station goes on about social care needs without ever mentioning CHC, phone in and tell them that they should get educated about CHC first before their listeners part with a penny!
When a relative first needs care, there’s often little time to figure out how things are supposed to work. So, if you have friends or contacts with elderly relatives, tell them the basics – and tell people about NHS Continuing Healthcare! Be prepared for them not to believe that NHS care funding has nothing to do with a person’s own money. Like many of us, they may have been conditioned to believe they have to pay because they have savings and/or a house.
The more we can spread the word about NHS Continuing Healthcare, the more chance ‘mistakes’ will be avoided. Do what you can to dispel the myths about paying for care.
For more reading around the subject take a look at this small selection of blogs from our website.
- New to NHS Continuing Healthcare Funding? Here’s a guide to the basics you need to know…
- Who is entitled to CHC?
- 10 Common Issues Affecting Families seeking NHS Continuing Healthcare Funding
- Is your relative waiting for a review of their CHC care package?
- My Dad Has Dementia – So Will He Automatically Qualify For CHC Funding?
- Paying care home fees or paying for full-time care at home? You could be entitled to NHS Continuing Healthcare.
If there is a particular topic you would like us to cover, we’d love to hear from you! Just send an email via our Contact Us page with the subject “blog request” or mention in the comments below and we’ll do our best to cover your suggested topic.