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Written on 14th July 2021 by

 

What is it?

NHS Continuing Healthcare is free care arranged and funded by the NHS.

NHS Continuing Healthcare is for individuals who have significant healthcare needs. An individual’s health needs is the key factor.

Who is eligible?

NHS Continuing Healthcare is for adults aged 18 or over.

Eligibility is not based on diagnosis.

Eligibility to receive NHS Continuing Healthcare is not means tested which means it is not impacted by an individual’s income or savings.

An assessment of the individual’s care needs will be required to determine eligibility. The assessment will look at what help an individual needs, how complex their needs are, how intense their needs can be and how unpredictable they are.

What is the assessment process?

To be entitled to NHS Continuing Healthcare funding, you must have primarily health needs, beyond social or personal care needs. This may be as a result of disability, accident or illness.

There is a two-step process. The first step is an initial checklist assessment and depending on the outcome of this, this will be followed by a full assessment.

The initial checklist has a number of care domains broken down into three levels; A, B and C. The outcome of the initial checklist assessment depends on the number of As, Bs and Cs scored.

The initial checklist threshold has intentionally been set low. Having a full assessment does not necessarily mean you will be eligible for NHS Continuing Healthcare.

The Decision Support Tool (“DST”) is used during the full assessment. Completing the DST should provide a comprehensive picture of an individual’s needs and in turn the care required to meet those needs.

What if an individual lacks capacity to consent to an assessment?

In this scenario, a decision can be made in the individual’s best interests as to whether to proceed with the assessment. For example, a Court appointed Deputy may be able to make this decision on behalf of the individual.

Are there are any restrictions on where care can be provided?

If an individual is eligible to receive funding then NHS Continuing Healthcare can be provided in various settings outside of a hospital including in your own home or in a care home.

What if an individual’s needs change?

Where an individual has been found eligible for NHS Continuing Healthcare, a review should be undertaken within three months of the eligibility decision and further reviews should be undertaken at least once a year.

If your care needs change then your eligibility to NHS Continuing Healthcare may change.

Can an individual appeal an NHS Continuing Healthcare decision?

Yes you can appeal a NHS Continuing Healthcare decision.

Are there any alternatives to NHS Continuing Healthcare?

If you are ineligible to receive NHS Continuing Healthcare then you may wish to consider contacting your local authority to explore whether or not you are eligible to receive social care and support from them. The healthcare body may also consider whether you are eligible for NHS-funded nursing care, depending on your needs and circumstances.

How can we help?

This is a brief overview of NHS Continuing Healthcare which is a complex area. If you have any queries or questions about NHS Continuing Healthcare or other statutory funding then please contact our specialist Court of Protection team by email on cop@boyesturner.com