NHS continuing healthcare At a time when our loved ones are at their most vulnerable through illness or disability, the issue of who may be responsible for assisting with meeting the costs of any care, whether in a care home or a package of care being provided at home, is often not considered. As a consequence there may be thousands of elderly or incapacitated people both in care homes and in the community, who are meeting the costs of their care themselves unnecessarily.

Although this information is freely available on the Department of Health website, experience has shown that few patients, family members and carers are informed about NHS Continuing Healthcare funding by the health and social care professionals who are involved in their care planning.

In the UK, the NHS must currently provide and pay for appropriate care and accommodation for anyone over the age of 18 who has physical or mental health needs which have arisen as the result of disability, accident or illness.  Whether or not you pay for care does not depend on your wealth. It depends on your care needs only.

NHS Continuing Healthcare is a complete package of ongoing care arranged and funded solely by the NHS, for those assessed as eligible. Care need not be provided in a nursing or residential care home; it can be provided in any appropriate setting including the person’s own home.

An assessment can be requested at any time but at the very least, under the following circumstances:

  • when a loved one is residing in a care home or receiving a package of care at home;
  • is about to move into a home or
  • is about to be discharged from hospital into a care home or to their home with a package of care.

The duty to decide on a person’s eligibility for Continuing Healthcare currently rests with NHS Clinical Commissioning Groups (CCG’s). The process of assessing for Continuing Healthcare is laid down in the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care which was introduced in England on 1st October 2007. The National Framework sets out a clear process that must be followed by all CCGs and Local Authorities when considering eligibility for NHS Continuing Healthcare; it states very clearly that all health and social care staff must be familiar with the National Framework, legislation and relevant case law before they undertake an assessment of eligibility. Unfortunately however, the latest set of statistics indicate that nationally, the assessment and eligibility processes are not always being applied in a consistent, fair and equitable manner. They highlight the possibility that health and social care staff are not as familiar with the assessment processes as they should be and as a consequence, decisions on eligibility can be open to challenge and appeal.

It is regularly the case that the NHS attempt to apply a higher bar to satisfy the eligibility criteria than is set out in law and in the Department of Health literature pertaining to Continuing Healthcare. Many people who should be receiving in full to meet the cost of their care are not.  It is estimated there are 100,000 in the UK presently paying for care when these costs should be met by Continuing Healthcare.

Securing continuing healthcare can therefore be a long drawn out process, but it is often a process worth engaging in due to what is at stake.

You should also be aware that a retrospective claim can be made for those loved ones who have either been subsequently awarded Continuing Healthcare Funding following an assessment or where the person has since passed away and the Executors dealing with the administration of the Estate believe that the deceased may well have qualified for Continuing Healthcare funding, had they been assessed for eligibility when they were alive. In such cases as a claim can still be made as far back as April 2012. In exceptional circumstances a claim may be backdated further.

The assessment process can be an emotional and difficult time for all involved. At WBW, Advocacy services are provided with the best interests of the individuals at the forefront of concern.

If you or a loved one has been affected by the issue raised in this article, please contact us and we would be pleased to assist you.