Securing continuing health care funding for those in need

There continues to remain much confusion around the CHC (Continuing Health Care) funding available to individuals and the difference between it and Social Care. This confusion often leaves families unable to fully assess their options, and usually during a time of crisis, when a loved one urgently requires care

 

Tom McInerney, Head of Private Client at Hedges Law  explains the definition of CHC (Continuing Health Care) Funding, to help families navigate through the minefield of government health care and determine whether their loved ones are eligible. This comes as  news reports suggest that over a million homes have been sold by desperate families forced to pay care bills for loved ones when, in many cases, the care should have been funded by the NHS.

What is NHS Continuing Health Care (CHC) funding?

CHC Funding is determined as a “a package of care for people who are assessed as having significant ongoing healthcare needs” while Social Care is a term that generally describes all forms of personal care and other practical assistance for children, young people and adults who need extra support from the local authority.

NHS CHC differs from local authority assistance, which is means tested and relates to support with daily living such as help with getting up in the morning, getting washed and dressed.

NHS CHC focuses on whether an individual has a ‘primary health need.’ This is not defined in any of the guidance; however, the nature of a person’s underlying condition is considered, rather than a particular condition they have been diagnosed with. It is about what the individual’s overall day-to-day care needs are when considered as a whole, which makes it very complex to determine.

If eligible for NHS CHC, the individual receives a package of care which is arranged and funded by the NHS (the local Clinical Commissioning Group (CCG)).

NHS CHC can be provided in in any setting, whether at home or in a nursing home. 

What is the process for claiming NHS CHC and what is the criteria to be considered eligible?

 The first stage is the completion of a checklist assessment (this is often completed by the individual’s GP). If the person scores highly enough in this stage, a more detailed assessment follows, which is the full NHS CHC assessment.

During the full assessment, a Decision Support Tool (DST) is completed to assess the evidence compiled from medical records and care records. A nurse assessor from the local CCG will be assigned to the claim to review the records.

12 domains of care needs are considered, such as the individual’s behaviour, cognition, mobility, nutrition and communication needs. These care domains are each awarded levels of need in order to build up an indication of eligibility for funding. The nature of a person’s underlying condition is assessed, rather than eligibility being based on whether they have been diagnosed with a particular condition.

Once the DST has been finalised, the information provides a guide to establish whether the person’s primary need is for health care.  The CCG will then make a recommendation.

If the individual is found ineligible, there is an appeal process, which begins at the CCG level.

Fast track funding

Where an individual has a rapidly deteriorating condition and may be entering a terminal phase, the individual should be eligible for NHS CHC funding through the mechanism of the Fast Track.

This process should identify individuals who need to access NHS CHC quickly, with minimum delay, and there is no requirement to complete a DST where this funding is identified as appropriate.

 Initial steps – checklist assessment

Your local Clinical Commissioning Group (CCG) deals with NHS CHC claims. The first stage in the process is to obtain a checklist assessment, which is essentially an indicator as to whether you have demonstrated enough health needs in order to warrant a full assessment.

Our tips regarding the initial checklist stage are as follows:

  1. You should not have to necessarily request a checklist assessment. It should be done as part of procedure, for example on hospital discharge. The checklist can be completed in any setting, and it is usually done by a doctor or care home manager.
  2. The individual, or their attorney or deputy, should be advised of the time and place of the assessment. The individual or their representative must be fully informed of the process.
  3. The Fast Track process should not be overlooked for those who are in a period of rapid deterioration or at end of life care. The checklist assessment can be bypassed in these situations.
  4. The checklist is an indicator of whether a person requires a full assessment. No decision has been made at the conclusion of the checklist about who is responsible for paying for care.

While there is a process for families to follow, it can often be a frustrating and daunting experience. Having professional assistance can help to navigate the process and complexities. However, if families decide to go it alone, it is advisable to fully document all meetings, and ensure that all relevant information is considered to stop the assessment becoming a tick box exercise.