NHS Continuing Healthcare Funding: When do my care fees get paid?

Year Published: 2019

Recent publicity following the BBC drama “Care” has brought NHS Continuing Healthcare funding into the spotlight.

NHS England reports that 77,741 people were found eligible for Continuing Healthcare funding (CHC) during the nine month period to 31st December 2018. These patients are eligible for all of their care fees to be paid by the NHS, including their accommodation and meals if they live in a care home. The patients do not need to contribute towards their care costs (as they would need to if funded by the Local Authority) and so their pensions or other income can build up in their accounts whilst they qualify for CHC.

Genevieve Powrie, Elderly, Care & Mental Capacity Soliciotr at SAS Daniels

Genevieve Powrie, Associate Solicitor

With care fees often charged at £800 per week or more, CHC funding can make a tremendous difference to the financial circumstances of a patient receiving care, and consequently, to their children or other beneficiaries in their Will.

How can you start a claim for NHS Continuing Healthcare Funding?

The starting point is always to ask for an assessment of the patient’s care needs by a CHC nurse. The nurse would complete an initial checklist to decide whether there is a possibility of funding in this case. The checklist is quite easy to pass, and if there is even a small possibility that this patient would qualify for funding, it will trigger the next stage in the process. This would be a multi-disciplinary team meeting at which the nurse, carers, social services and family discuss the assessment and any other medical and care records available, and complete a form called the “Decision Support Tool”. This form categorises a patient’s care needs into different levels of severity, giving the patient a score for each type of care need. A very high score automatically qualifies the patient for funding (but also means that the patient is very ill indeed), whereas a low score will lead to the claim being unsuccessful.

Can you challenge a decision if you’ve been found not eligible?

Yes, although it’s important to have the right advice and a specialist on your side. We often find that help is needed when a patient receives a moderate score, where the NHS has discretion on whether to award the funding or not. The question then becomes whether the patient has needs which are so intense, unpredictable and complex as to be primarily medical in nature, not personal. Personal care can be provided by a carer, and includes feeding, washing and mobilising a patient. Medical care is usually provided by registered nurses and doctors, and includes complex drug therapy, skin treatments, breathing interventions, and management of unpredictable behaviour and infections, to name a few. There is often also an interaction between various symptoms which further complicates care. A specialist solicitor at this point can help by meeting with the patient’s family (as the patient is usually too ill to participate) and helping them to gather all the evidence required to assist with their claim. The solicitor would then advise the family on the prospects of success and conduct the claim for them if they wish to proceed.

If you would like further advice on NHS Continuing Healthcare Funding claims, please contact Genevieve Powrie, specialist Associate Solicitor in our Elderly, Care and Mental Capacity team on 01625 442146.

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