FAQ: NHS Continuing Healthcare Funding

Are you paying care home fees or paying for care at home? You could be entitled to NHS Continuing Healthcare funding which is free.

It is a popular misconception that if you have savings above a certain level, or own a property, you will not be eligible for care funding and will have to pay for care.

As professional advocates, we are aware of many cases in which individuals have been wrongly charged for care, leading to a reduction in hard-earned savings and sometimes family homes being sold to meet care fees.

NHS CHC funding is an entitlement irrespective of capital or income and is based on an individual’s care needs. If your primary need for care is a health need, rather than a social care need, then you should qualify for NHS CHC funding at no cost.

Care Necessities has recovered thousands of pounds on behalf of individuals that should not have been paying for their care. This is sometimes because they had been incorrectly assessed as not having a primary health need, or sometimes because an incorrect procedure had been followed.

Below are some of the common questions which we have received regarding eligibility for NHS CHC funding:

What is the difference between a social care need and a primary health need?

Social care needs are needs related to daily living activities requiring routine care, such as help with mobility, feeding, washing and toileting. Primary healthcare needs are needs requiring frequent monitoring and input intervention and review by skilled professionals (for example nurses or care workers) over and above routine care. It is not always easy to distinguish the difference without the help of an experienced professional.

The health condition itself is not the sole criteria for funding, and it is the interaction between the nature, intensity, complexity, and unpredictability of those health needs that determines eligibility.

If I have savings above the £23,250 threshold. Does that mean that I will have to pay for care?

Our clients often believe that they must pay for their care, without any assessment for NHS Continuing Healthcare funding having been carried out. If you have health needs, then you should be assessed with regard to the eligibility for NHS CHC funding. If you qualify for funding then you will not be required to pay for your care, regardless of your financial means.

Health rather than wealth determines whether an individual is eligible for funding.

I have been told that I won’t qualify for NHS CHC funding and there is no point in carrying out an assessment.

The criteria to establish eligibility for funding are extremely subjective and it is essential that a proper assessment of needs is carried out. Care Necessities advocates regularly attend assessments or assist with the assessment procedure, to ensure that all relevant factors are fully considered.

Often applications for NHS CHC funding are rejected. It is however possible to appeal decisions.

Anyone going into care with health needs is entitled to and should be assessed for funding. Eligibility cannot be established until a full and detailed assessment is carried out.

I have been told after the event that my relative has already been assessed and does not qualify for NHS CHC funding.

Family representatives have a right to attend the assessment and to be heard. You should be given sufficient notice of the proposed date and time of the assessment meeting. You are also entitled to take a qualified advocate to speak on behalf of your relative. Care Necessities regularly attend assessments to ensure that all relevant factors are considered, and the correct procedures are followed.

The nurse assessor didn’t allow us to put our views forward at the assessment meeting. Is this allowed?

Under the terms of the National Framework (a document which sets out the procedures relating to NHS Continuing Healthcare Funding), families should be involved in the assessment process and their input should be considered. Families are also entitled to have an advocate to speak on their behalf.

The care home manager has told me that I won’t get funding as there are people in the home with needs worse than mine and they don’t get funding.

Funding is based on the individual’s needs and each case should be considered upon its merits. It is impossible to determine eligibility for funding without a detailed investigation of the particular needs of an individual. No two cases are the same.

We have been told that we will have to move our relative to another care home if they succeed in securing NHS CHC funding, is this correct?

This is not true. If an individual meets the criteria for funding, then NHS CHC funding should be available to provide the care in that care home and there should be no need to move.

The nurse assessor maintained that my relative’s needs are well managed and that he does not, therefore, qualify for funding. Is this correct?

This is not correct. The decision-making process should not be influenced because a need is well managed. A well-managed need is still a need. A well-managed need will only have a bearing on NHS CHC funding eligibility if the successful management of a healthcare need has permanently removed an ongoing need, such that the active management of this need is no longer required..

My relative has been turned down for funding. What can I do?

If funding has been refused following a multidisciplinary assessment, then you can appeal to the CCG within 6 months of the outcome letter from the CCG notifying you of the decision. The appeal can be based upon a number of factors and professional help is desirable.

Many of our clients tell us that they find the whole procedure stressful and complex. We help families and guide them through the process.

This is what a few of our clients have to say about us: