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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.

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T: 01273 609 991

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