If you or a family member need care because of health reasons, you could be eligible for NHS Continuing Healthcare (NHS CHC). Available to people with intense, complex or unpredictable healthcare needs, eligibility for CHC is not dependent on your finances like local authority care funding. It is solely dependent on an individual’s healthcare requirements.
Since mid-2017, the proportion of people found eligible for CHC funding through the NHS has dropped from 27% to 21%. A surprising statistic given the increase in our aging population.
So exactly who is eligible for NHS CHC, how difficult is it to get and are you one of the many families that could be missing out on thousands of pounds of healthcare fees?
What is NHS Continuing Healthcare?
Funded by the NHS, Continuing Healthcare is a free care package for people with significant ongoing health needs. Applicants are assessed based on their healthcare needs and if successful, receive fully funded care as required, be that at home, in hospital or a care home.
NHS CHC is different to local authority funding which is based on your financial situation. To qualify for fully funded care home fees from your local authority, your assets should be less than £14,250, or between £14,250 and £23,250 to receive partial support.
If your assets are greater than £23,250 (£50,000 in Wales), you will be required to pay for your care, which could be as much as £41,000 per annum for residential care or £56,056 a year for nursing home care.
Currently around 40% of Britain’s care home residents are self-funded, but should they be? Are some families unknowingly missing out on this crucial funding?
To receive NHS Continuing Healthcare, you need to pass a 2 part assessment consisting of an initial checklist, then depending on the outcome, a more detailed assessment to evaluate the severity of your health care requirements.
Who qualifies for CHC funding?
To qualify for Continuing Healthcare funding, you need to be over 18 and have significant ongoing healthcare needs. To understand if you are eligible for this fully funded support, a team of healthcare professionals will need to assess:
- The help you need
- How complex and intense your needs are
- How unpredictable your needs are and the risk posed to your health if care is not provided
The outcome will be dependent on your assessed needs, not a medical diagnosis or condition you may have.
If your application is refused, you may still be eligible for partial financial support from the NHS or you could look to your local authority for funding, but as mentioned, this will be dependent on your finances.
You could also appeal the decision either on your own or with the help of a specialist company.
How do I get continuing healthcare support?
The first step to receiving CHC funding is to complete the NHS Continuing Healthcare checklist with a multidisciplinary team (MDT). The MDT is a mix of at least 2 people from different disciplines such as a doctor, nurse, healthcare professional or social worker.
Yours needs will be assessed based on the following twelve areas:
- Breathing
- Nutrition
- Continence
- Skin (wounds and ulcers)
- Mobility
- Communication
- Understanding
- Behaviour
- Physical and emotional needs
- Drug therapies and medicine
- Altered states of consciousness
- Other significant care needs
If successful, you will either be put forward for a full assessment by an Integrated Care Board (ICB) or fast tracked if your requirement is urgent. For example, if you or the person you care for has a terminal illness.
If you are eligible, full funding should be awarded within 29 days of the ICB receiving the completed checklist.
Is Continuing Healthcare difficult to get?
Although CHC funding is in place to help individuals with significant care requirements, eligibility can prove problematic, with only 21% of standard assessments converting into successful funding approvals.
To start with there is a complete lack of awareness and understanding of the funding. Many families are not informed about CHC and are left struggling to pay for healthcare, often through the sale of assets and property.
The outcome of the assessment is also very subjective and a bit of a postcode lottery with a definite north south divide. According to the Nuffield Trust, between April 2023 and March 2024 36.9 people per 50,000 in Cornwall and the Isles of Scilly were assessed as eligible for CHC compared to 301 per 50,000 in Lincolnshire.
So, it is important to get robust evidence together before making a claim.
Where do I go for help?
Whether you’re looking for help with applying for CHC, or recovering fees you believe you have paid incorrectly, you can do this yourself or get the help of an expert who specialises in this area.
Applying for Continuing Healthcare
If you would like to apply for NHS continuing healthcare for yourself, a family member or someone you care for, you should speak to the medical professional or social worker responsible for care.
Alternatively, you could speak to a company like leading UK law firm Hugh James who can for a fee handle your application for you.
Recovering Continuing Healthcare fees
If you or a family member have already been paying for care, you may be eligible for future funding and entitled to full refund of the money you have paid to date.
The appeals process is complex and potentially very emotional, so you may wish to approach a specialist legal company that can take care of this for you. Some companies will work on a no-win no-fee basis, therefore, de-risking your exposure to potentially significant costs, others will charge a fixed fee.
Hugh James Solicitors – Nursing Care Fees Specialists
As experts in the field, the Hugh James nursing care team are experienced in making claims and recovering wrongly paid care home fees retrospectively. With over 15 years’ experience, their nursing team have successfully overseen 6,000 families secure free funding and recovered £287 million in wrongly paid care fees.
You can call them on 0800 500 8010 for a free assessment or visit their website for more information.
Visit Hugh James website
Should you speak to the Hugh James nursing care team and use their services, we receive a commission, however this will not affect the price you pay.