It is important to make sure your loved ones get the care and support they are entitled to, and that includes getting the right funding.
What is continuing healthcare?
Continuing healthcare (also known as CHC funding) is a package of care funding provided by the NHS. It provides free care to individuals whose needs meet the eligibility criteria laid down in the national framework. Individuals that qualify for continuing healthcare funding are not required to contribute to the costs of their care, regardless of their financial means.
Am I eligible for CHC funding?
As of 1 July 2022, eligibility for NHS continuing healthcare funding is determined by local Integrated Care Boards (ICBs). The process begins with a screening checklist. If the checklist is positive, a more detailed assessment is undertaken by a Multi-Disciplinary Team (MDT) using a ‘Decision Support Tool’ (DST).
Both the checklist and the DST focus on 12 areas of need for the individual, as follows:
• Altered States of Consciousness (ASC)
• Behaviour
• Breathing
• Cognition
• Communication
• Continence
• Drug therapies and medication
• Mobility
• Nutrition
• Psychological/emotional needs
• Skin integrity
• Any other needs
The scores in these care domains help to inform the ICB about how the individual’s needs may (or may not) meet the ‘primary health needs’ test for eligibility. The test is intended to identify those individuals who have a ‘primary health need’ which should be met by the NHS instead of social services.
Eligibility is not determined by a person’s diagnosis or the place where care is provided to them. Instead, the primary health needs test considers the nature of an individual’s needs, the intensity of those needs, the complexity of how those needs interact and how unpredictable those needs are to manage. These four pillars make up the primary health needs test for CHC funding.
Sometimes, individuals who fall short of full continuing healthcare funding may be determined by the ICB to be eligible for Funded Nursing Care (FNC) instead. This provides a fixed contribution towards the individual’s nursing care needs, from the NHS.
How can we help?
Assessments for NHS funding do not always go to plan. If you are unhappy with the outcome of a continuing healthcare assessment, it is essential that you seek early advice to consider your options and the prospects of mounting an appeal or challenge to the assessment.
Our legal experts can support you through this complex area of care funding, both at the DST assessment and beyond. We can also answer any questions you may have about care options for an individual who finds themselves eligible for CHC funding.
