NHS fully-funded care for people with primary health needs – part 1
People with a ‘primary health need’ could be eligible for NHS Continuing Healthcare financial support but it’s not a service that’s widely advertised. Expert Roger D Burgess describes what he has learned from helping families to make their claims.
Editor’s note: This article was originally published in February 2016, and the Framework it discusses has since been updated. While much of this article is still relevant, there have been some changes. Despite the complications, Roger still believes it is important and worthwhile to make a claim.
NHS Continuing Healthcare (CHC) is funded by the NHS for people who have a primary health need.
CHC covers 100% of their care fees including accommodation and food where appropriate for people who require full-time care primarily for health reasons, and it is available in any setting whether they are in a care home, in their own home, in a hospice or anywhere else.
This is one of the NHS’ best kept secrets – it is sometimes referred to as the ‘secret fund’. The NHS has a duty to promote Continuing Healthcare at key locations. You would perhaps expect to see this information freely available in your surgery waiting rooms, hospitals, health centre, care and nursing homes, but you could be mistaken, because strangely enough the information is unlikely to be there
The one vexed question that the NHS wants to avoid is who pays when someone has a ‘primary health need’? It is of course the NHS but very few people are aware of the term CHC, let alone how to make an application. This article is designed to help that process.
Who can apply for NHS Continuing Healthcare (CHC) Funding?
Anyone can ask for a Continuing Healthcare assessment. CHC services are for people who, because of primary health needs, are eligible for NHS CHC funding.
Upon hospital discharge
In accordance with section 2 (2) of the Community Care Act (Delayed Discharges etc) the NHS must take reasonable steps to ensure that an assessment for NHS Continuing Healthcare is carried out in all cases where it appears that the patient may have need for such care. (See the National Framework for NHS Continuing Healthcare & NHS Funded Nursing Care page 24 para 62)
What is the function of the service?
NHS CHC ensures that people with complex health needs have their care and support funded by the NHS.
A “primary health need” is determined by:
- Nature – how the characteristics and type of the individual’s needs and the type of interventions required to manage those needs
- Intensity – the extent and severity of the individual’s needs and the support needed to meet those needs including sustained/ongoing care
- Complexity – how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care
- Unpredictability – how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including risk to the individual’s health if adequate and timely care is not provided.
Each of the above characteristics may in combination or alone demonstrate a “primary health need”.
How can we access the service?
To access the NHS CHC service individuals need to be screened. Anyone can ask their doctor, social worker or any NHS professional to start the process. They may try to discourage the application, but if you believe that someone does have a “primary health need” you should not be put off.
There is no means testing and it is free from all budgetary restraints. Financial issues should never be discussed or play any part in the application process to access the NHS CHC system, so applicants shouldn’t allow themselves to be drawn on this subject.
The next steps
There are now just three steps that need to be followed. We explain these, their outcomes and how to appeal the process in Part 2 of this article.
Guidance and checklists can be found in these downloads and having copies of these documents to hand will help understand the process:
- National Framework for NHS Continuing Healthcare & NHS Funded Nursing Care
- Decision Support Tool for NHS Continuing Healthcare November 2012 (Revised)
- Check List for NHS Continuing Healthcare November 2012 (Revised)
- NHS Continuing Healthcare Refreshed Redress Guidance (Gateway Ref: 03261)
- Equality Analysis (revised November 2012)
Read Part 2 of this article for further advice on the application process.