Should your care be fully funded by the NHS?
Have you heard of Continuing Healthcare or CHC funding? Whether it’s you, a relative, a local authority or the NHS, someone has to pay for your care fees or those of a loved-one. Sometimes a person has visits from carers at home, a live-in carer or lives in a nursing home and the cost of care can run into the thousands of pounds a week. If you don’t have a lot of savings or other capital (generally over £23,250 and can, in certain circumstances, include the value of your home if you don’t live in it) then you can get assistance to pay these fees ranging from nothing to the full amount, depending on how much capital you have. This assistance is from the local authority who complete your care assessments and reviews.
Did you know however, that there is a legal limit as to how much healthcare a local authority can pay for? Continuing Healthcare (CHC) funding is there to ensure that local authorities don’t fall foul of the law and provide too much healthcare services whilst ensuring that those who need assistance with their care receive the service they need. People sometimes think that it isn’t important who pays for care as long as someone does but there are some significant differences.
If the local authority currently pays for your care, you might pay a contribution towards the cost. Your contribution can range from nothing to the full cost of your care. If the NHS pay for your care through CHC funding then there is no contribution, your care fees are fully funded by the NHS. You may pay your own care fees and have never involved the local authority. However, if eligible, the NHS will pay the full costs of your care.
How Is CHC Eligibility Assessed?
To be eligible for CHC funding, you must have a Primary Health Need. This is assessed by a multi-disciplinary team (at least 2 professionals from different healthcare professions) who will look at different areas of need and use a tool to identify the level of need you have. The process should be transparent, and you should be informed who will be coordinating the process.
The multi-disciplinary team will consider a person’s needs under the following headings:
- nutrition (food and drink)
- skin (including wounds and ulcers)
- psychological and emotional needs
- cognition (understanding)
- drug therapies and medication
- altered states of consciousness
- other significant care needs
These needs are given a weighting; priority, severe, high, moderate, low or no needs. If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for CHC funding. You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability. In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
Now, I’m realistic and I don’t pretend for one moment that everyone who lives in a care home or receives care in their own home is entitled to have their care funded through CHC. It’s just not like that and there is an eligibility criteria to identify who does have a primary health need. However, I have worked with many people who pay their own care fees and should be funded through CHC funding. I have supported them to obtain CHC funding or helped them to successfully challenge a decision that they aren’t eligible for CHC funding.
I can be instructed to assist you through the CHC process and attend meetings with you. Like you, I’m not part of the MDT who make the final decision, but I can help provide you with information about the process or supporting evidence that may otherwise be missed. I can also help ensure that the correct process and application of the CHC guidance that should be followed by the MDT.
If you would like to find out more about CHC funding or would like to discuss how I might be able to assist you with a past, ongoing or future case, please don’t hesitate to contact me for a free, informal discussion either over the phone or email. If I can help, I will.