NHS Continuing Healthcare Funding – am I eligible?

NHS Continuing Healthcare (CHC) is a funding stream whereby, if eligible, an individual will have all costs associated with their care paid for by the NHS.

As healthcare in the UK is free at the point of access, if you can show, via a testing system, that your needs are predominately healthcare based as opposed to social care based, then fees arising for the provision of this care will be covered.

What is the test?

The National Framework for NHS Continuing Healthcare and NHS-funded nursing care 2018 govern the application and assessment process for any eligibility determination. An individual must establish that they demonstrate a “primary health need” in that their care needs go above and beyond that of social care provision.

Needs are assessed by both individually and collectively in a 2-stage process. Individually, 12 care domains are considered including Behaviour, Cognition, Nutrition and Mobility and weighted between having No Needs to High or in some domains where it’s available, Severe or Priority needs.

Once those 12 domains have been assessed, the NHS will then consider these needs collectively to ascertain whether they go beyond social care’s remit. This looks at whether their needs demonstrate an Intensity, Complexity or Unpredictability of need or whether the overall Nature of the condition(s)/needs are predominantly healthcare based. This part of the test is clinically led, but will consider the frequency of interventions, the skills needed to meet need, how stable a condition is and the level of support an individual requires.

Should someone score either 1 Priority or 2 Severe needs during the first stage, the National Framework determines that this should be sufficient to demonstrate a primary health need.

Where can funding be provided

CHC funding is eligible for anyone who meets the criteria. It does not matter if they are in a care home, nursing home or living in their own home with a care package. The National Framework makes no distinction on where that care can be administered.

My loved one has dementia. I have been told that they will not be eligible, is this true?

No, this is not always true. Whilst dementia is sadly becoming more and more common, there are no medical conditions that automatically mean someone is not eligible for funding. Equally, there is not one condition that means someone will automatically be eligible for funding. The assessment purely looks at their needs and how they manifest and what support they require on a day to day basis.

For full details and information about CHC and dementia, listen to our recent podcast covering this subject.

How Moore Barlow can help

At Moore Barlow we specialise in CHC applications and appeals and offer a free preliminary assessment on eligibility. Please contact us our expert team for more information.