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10 Myths About NHS Continuing Healthcare Funding

Chloe Smith

Chloe Smith

Being given incorrect or misleading information about NHS Continuing Healthcare funding for yourself, a friend, or a relative, can be upsetting and lead to unnecessary financial decisions and consequences that often cannot be undone.

We have listed 10 of the most common misconceptions below, so if you are confused about conflicting information you may have heard, then read on.

1. There’s no point in applying – you only get funding if you are terminally ill.

Incorrect. The Department of Health has provided the NHS with national eligibility criteria, the ‘National Framework’ and a standard assessment process in order to determine whether somebody has a primary healthcare need. You do not have to be terminally ill to qualify for funding.

2. I have paid my taxes all my working life/I have served my country so the NHS has a duty to pay for my care in my old age.

This is not true. The NHS are under a duty to provide fully funded care only to those people who have what is called a “primary healthcare need”. This may be arising from physical or mental health needs or a combination of both, and which may have arisen out of disability, accident or illness. The eligibility criteria are not based upon an individual’s personal history and are not means-tested, so paying taxes etc. does not lead to entitlement to NHS funding.

3. You can’t get funding unless you are in a Nursing Home.

Not true – the setting in which the individual receives care is irrelevant. It can be in a care or nursing home, or in their own home.

4. A diagnosis of dementia will always result in NHS Continuing Healthcare funding.

Not always. The individual with dementia may have needs that result in NHS funding but this is entirely dependent upon the nature, intensity, complexity and unpredictability of the individual’s needs, and the impact of those needs upon other care domains. An NHS Continuing Healthcare assessment or Social Services assessment will often conclude that a person who has dementia has routine and non-complex “social care” type needs and strong evidence will be required to show that the individual’s needs are more extensive than those that can be ordinarily met by Social Services care provision.

5. Healthcare costs must be met by the patient if they can afford to pay through savings, insurance or the sale of assets.

Cate Searle with a clientThis is a common misconception and unfortunately one that has led to needless upset, for example when a family home is sold to pay for a resident’s care unnecessarily. If an individual can qualify for NHS funding, then their savings and assets are irrelevant. If NHS funding is not available, then a resident’s capital assets might have to be used to pay for care, but this is not always the case. Life assurance policies should never be ‘cashed in’ to pay for care fees and a Deferred Payment Agreement may be available to loan fund care and avoid the sale of the family home. You can speak to our Community Care Team for advice if you have been told by Social Services or the NHS that you have to cash in an asset or sell property to pay for care fees.

6. You/your relative will not get funding because the carers are managing your/her/his needs well.

Incorrect. There are many skilled carers, including friends and relatives, who provide much needed support and help to those in need and often do this successfully. Just because a person’s needs are currently being ‘well managed’ by skilled carers – qualified or otherwise – does not rule out NHS CHC funding.

7. The NHS will pay for any care linked to a severe medical condition.

A ‘severe medical condition’ is a very broad term. For example, angina, high blood pressure and diabetes are all severe medical conditions but the National Framework requires the NHS to look at the individual’s combined needs and not just one or more medical conditions in order to determine eligibility for NHS Continuing Healthcare funding.

8. If the patient’s healthcare need is equal to or greater than that of Pamela Coughlan, then under the law they qualify for continuing healthcare funding.

This is not true – there is no “Coughlan” or strict definition of what constitutes a ‘primary healthcare need’. The Coughlan case set out many important principles, but not – as people think – a binding test applicable for all other people based upon Ms Coughlan’s individual level of need. Eligibility for Continuing Healthcare funding is based on a case-by-case analysis by relevant professionals. If a person has needs that are primarily healthcare related, then the NHS has a duty to provide for the need and fully fund the whole package of care.

9. We can’t involve you in the assessment process or allow you to appeal because you do not have a Lasting Power of Attorney.

This would only be relevant if the individual lacks capacity. A person who lacks capacity may need assistance with making a particular decision or taking a particular action. A registered Lasting Power of Attorney (LPA) or an Enduring Power of Attorney (EPA) shows that you have the authority to deal with your friend or relatives affairs if they do require assistance. However, you may still be entitled to be involved in an appeal if you are a Deputy (appointed by the Court of Protection) or in some circumstances, next of kin. In the absence of formal authority, you may be able to advance a “Best Interest” argument that you should be able to represent your relative in the Appeal or Review.

10. NHS Continuing Healthcare funding is awarded for life.

This is not the case. Although it is called ‘continuing’, funding is only granted whilst the individual meets the eligibility criteria. The NHS is entitled to review cases at regular intervals (sometimes after the first three months and thereafter annually) and if a person’s needs no longer meet the eligibility criteria, funding will stop – although of course there should always be a right to request a Review or Appeal.

These are just a few of the complex issues that our Community Care Law team deal with on a daily basis. If you’re confused about NHS Continuing Healthcare Funding and need advice on how to secure funding for yourself or a loved one, our team can help. Contact us today to discuss your case.

About the author

Chloe Smith

chloe-smith

I work in the community care law team representing carers, family members, service users and Professional Deputies who require help and advice in various issues surrounding community care law.

  • By martin searle solicitors | 17/12/2014 at 15:56

    Hi Caroline
    Thank you for your comment and enquiry. I am sorry to hear of the difficulties you are having with regard to your husband’s NHS CHC funding and care. We would be able to assist you in dealing with the CHC team and their review of your husband’s eligibility for fully funded care. If you would like to appeal against the most recent assessment then we can provide you with advice and prepare the relevant appeal documents to put your husband’s case forward in the strongest possible terms. I have sent you an e-mail with further information but please do call our office on 01273 609911 if you would like to speak to someone from the community care law team today.
    Kind regards,
    Chloe

  • By Caroline | 12/12/2014 at 09:25

    Hi, my husband has early onset dementia. He is 54 years old. He had to leave his residential home and go into a nursing home as he has deteriorated so badly. He was awarded CHC in January. He was assessed two weeks ago, and the new nursing home he is in called me to say he had been reassessed and would not be getting CHC funding.They asked would I like him to go into a shared room so it would be cheaper for me.CHC should not have told the home that the funding was ceasing without following the correct procedures. I now have a meeting on the 15th with CHC and my new social worker who I have little faith in. My other social worker has sadly retired. I contacted a solicitor

  • Dear Fiona

    Thank you for your enquiry. The funding issues you are having both with Social Services and your local Clinical Commissioning Group are unfortunately becoming more commonplace. Adult Social Care budget cuts and various CCG Continuing Healthcare policies that have been introduced over the last 12 months have had a huge impact on people entitled to either or both types of funding. From what you have told me, I was wondering if you might be eligible for legal aid as it is available for matters such as yours. Our firm does not have a legal aid contract, but I could refer you to a legal aid firm if you want to find out if you are eligible. If not we would be happy to assist you and advise you on the most appropriate course of action.

    Kind regards

    Chloe

  • Hi, I used to get Direct Payments and ILF funding but I lost my entitlement to ILF as I was in hospital for 7 months. I was assessed for the Personalised budget but i do not agree with the indicative funding levels they came up with using the RAS. I tried to argue that it should be seen as just a starting point and that it is not accurate for everyone and although they increased the amount, it wasn’t by much.

    I was also assessed for Continuing Healthcare and I met their criteria. I thought this would help me with funding but it hasn’t because now Social Services are saying the overall amount of money will not change as instead of just having a Personalised budget I will be funded 50% Social Services, 50% Continuing Healthcare. When I questioned how they could do this they said it was at their discretion. So one person might get all their continuing Healthcare Funding in addition to their Personalised budget but another person may be no better off as Social Services can use it to halve their own input. This seems very unfair especially as the remit of the 2 sources of funding is so different. Please can you advise me as to whether what they are doing is correct and whether or not I can fight their decision to do this?

    Many thanks, Fi

  • Thank you for your enquiry. With regard to your daughter’s funding being withdrawn, she certainly should have been assessed before any decision to remove her funding was made and you should have been involved in this process (or at the very least made aware of it). However, as your daughter is a minor she may be entitled to legal aid in order to receive free legal help and unfortunately we do not have a legal aid contract. I will e-mail you the details of some community care firms that could provide you with advice under a legal aid contract.

    If you find out that for any reason your daughter does not pass the legal aid eligibility criteria, please do get back in touch with me.

  • I have a 15 year old daughter we have been receiving continuing care since March 2013. My family support worker came on Friday 14th Feb 2014 and told me he had just received an email saying they have decided to stop the funding. How do we stand with this our child’s circumstances haven’t changed since last year if anything got worse. No one has come and done a proper assesement and they appear to be going on a report from her doctor who hasn’t seen her for over a year. Since the doctor has seen her she has been in and had spinal surgery (which she nearly died). So how can anyone go on her reports? What should we do?

  • Dear Alexandra

    Thank you for getting in touch – I am sorry to hear of the difficulties your father-in-law is having with Health and Social Services and his (now previous) care home. I am sure that it is very distressing for you and your family and I would be happy to advise you on your next steps. I will need a bit more information from you so I have e-mailed you directly with a few pointers and my contact details so that we can go through things at a convenient time for you. I look forward to speaking with you soon.

    Kind regards

    Chloe

  • By Alexandra Jenkins | 08/12/2013 at 08:35

    Dear Ms Smith

    Please help! My father in law has been in local authority care funded by himself for 3 years.

    I have constantly attempted to start the ball rolling and requested an assessment for chc. I’m sick of being told that he does not qualify without a full assessment being made.

    In short he is doubly incontinent, completely immobile, he has limited use of one side of his body following a stroke, he cannot dress himself or wash himself, needs assistance to eat and drink and generally cannot do anything for himself.

    Last month he started to become violent with staff in the care home and was taken to hospital as they could not care for him.YesYesterday we found out from the home that they had given the local authority 28 days notice that he could notrreturn and that we needed to collect his things. We have never been advised that the notice was given until it expired.

    He is now in an assessment unit and whilst he hasn’t been diagnosed with dementia he clearly is deteriorating.

    I’m stuck and not sure what to next. Please can you help.

    Many thanks

    Alexandra

  • By Chloe Smith | 14/06/2013 at 15:13

    Hi Sean. Thank you for your comment. The CHC review should still be completed despite your mother-in-law’s death so it would be advisable for her Executors to engage with the CHC team.

    It is difficult to get a fast track pathway tool completed retrospectively and unfortunately fast track pathway tools are sometimes not completed at the appropriate time, whether the person was in hospital or elsewhere.

    If you would like to book a telephone appointment with us for some initial advice on NHS Continuing Healthcare, we would also be happy to advise you on how to deal with your mother-in-law’s outstanding care fees and who will be held responsible for the nursing home bill.

  • By sean kearns | 13/06/2013 at 14:13

    Hello

    My mother in law died recently before the CHC review was complete, she will have little or no money after her funeral, who will be held reponsible for the nursing home bill?

    Also a written request for the fast track tool to be deployed during a hospital stay was never acted on, despite this bieng raised by us prior to her discharge? we were informed this could be dealt with in the community?

  • By Chloe Smith | 07/01/2013 at 14:19

    Dear Mrs Boyce: Thank you for your comment concerning your mother’s potential eligibility for NHS Continuing Healthcare. Unfortunately, the deadline has passed to request a review of any period of self-funded care prior to 1st April 2004.

    If you managed to request a review prior to the deadline of 30 November 2007 and the matter is ongoing, then we might be able to assist you with a retrospective review.

    If you did not, we may still be able to assist but this will depend on the individual circumstances of your mother’s case; it is very difficult to lodge a successful application after the cut off date has passed.

    Please call us on 01273 609911 and either myself or one of my colleagues would be happy to discuss this issue if you have any further questions.

    Chloe

  • By joyce boyce | 23/12/2012 at 21:46

    I understand that a request for refunds only go back to 2004, but my mother was paying from her admittance to her nursing home from 1999. Would it be possible to go back to 1999, if she were elidgeable for a refund?

    Regards, Mrs Joyce Boyce


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