**NEW COLOUR CODED INDEX … FOLLOW THE COLOUR !!!
IN ORDER :
PREAMBLE / INTRODUCTION / CHARTS / HOSPITAL DISCHARGES
NHS CONTINUING HEALTHCARE DECISION SUPPORT TOOL TIPS
CHC : WHAT IS IT / QUALIFICATION / ASSESSMENTS / VIDEO ( PROFESSOR LUKE CLEMENTS )
FAST TRACK NHS CONTINUING HEALTHCARE ( NOT JUST FOR END OF LIFE ! )
DEMENTIA ?
CHC : APPLIED FOR BUT REFUSED ?
REFUSED : ONE CASE STUDY … CONSEQUENCES
COUGHLAN CASE
GROGAN CASE
POINTON CASE : CARE AT HOME
COUGHLAN & GROGAN CASES : HOW TO USE THEM
NO CHC ? : NHS CONTINUING HEALTHCARE AS AN ALTERNATIVE ( FULL SP )
TOP UP FEES ? : CHC / NHS CONTINUING HEALTHCARE ( NO SUCH THING !!! )
WHAT COSTS ARE COVERED BY CHC … SOCIAL CARE COSTS ???
RETROSPECTIVE FEES ? FEES INCURRED BEFORE CHC APPROVAL ?
CHC / NHS CONTINUING HEALTHCARE : PROBLEMS ? ( LINKS TO EXTERNAL SITES )
NHS NURSING FUNDED CARE : AN ALTERNATIVE TO BOTH CHC / NHS CONTINUING HEALTHCARE**
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**CHC * COUGHLAN , POINTON & GROGAN JUDGEMENTS * NHS CONTINUING HEALTHCARE * HOSPITAL DISCHARGE PROCEDURES * NHS NURSING FUNDED CARE
FULL SP ON ALL FIVE**
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**GOLDEN RULES … NEVER BELIEVE ANYTHING ANY ACADEMIC AND / OR SUIT TELLS YOU ABOUT EITHER !!!
CHECK , AND CHECK AGAIN , WHAT YOU ARE BEING TOLD AGAINST THE INFORMATION AND GUIDANCE PROVIDED IN THE VARIOUS TEXTS AND LINKS THAT FOLLOW !!!
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ANY HOSPITAL DISCHARGE PROCESS … ASK THE QUESTION … " IS CHC OR NHS CONTINUING HEALTHCARE ON THE MENU ? "
CUK ORIGINATED THREAD ON " UNSAFE " HOSPITAL DISCHARGES … OUR NAME FOR IT " THE DUMPSTER THREAD " … AS IN DUMPING UNFIT CAREES BACK ON US :
https://www.carersuk.org/forum/support-and-advice/new-to-the-forum/please-tell-us-about-your-experiences-of-hospital-discharge-31980?hilit=chc%20rstioning\
HOSPITAL DISCHARGES … THE BIBLE :
Being discharged from hospital - NHS
IN SHORT … BY THE BOOK OR NO DISCHARGE !!!**
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FIRST STEP : NHS Continuing Healthcare Decision Support Tool tips :
Give yourself time to read the guidelines properly – so you understand the process that should have been followed and the eligibility criteria.
Make sure you also read about the Coughlan case and the Grogan case.
Keep a note of everything you know has been done incorrectly right from the very start, including where people have asked you about your relative’s money and/or told you your relative will automatically have to pay for their own care.
Take time to pull together as much information as you can about your relative’s care needs and risks. Keeping a detailed diary can help a lot – even if it feels as though you’re writing down the most trivial things. It can all count.
Make sure the correct evidence is reviewed during assessments and appeals – and that members of the multidisciplinary team who carry out the full assessment using the NHS Continuing Healthcare Decision Support Tool include all of this evidence in reaching their funding recommendation.
Go through the NHS Continuing Healthcare Decision Support Tool yourself, so you know what the scores should be in each ‘domain’. Be ready to back up what you’re saying.
If you’re right at the start of the NHS Continuing Healthcare assessment process, familiarise yourself with the Checklist and the things that can go wrong at this stage.
(* Many people question whether the National Framework guidelines are in themselves lawful, as they could be considered a barrier to NHS healthcare/nursing care. We can certainly understand that point of view; at the same time, the National Framework and the NHS Continuing Healthcare Decision Support Tool and Checklist are the processes that people right now are being made to follow.)
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CHC … What is the nature of this beast ?
Video … Professor Luke Clements ( If you don’t like bland text , HIGHLY recommended ) :
https://www.youtube.com/watch?v=HrpFLLwGqhs
NHS continuing healthcare
Who qualifies for CHC ?
To be eligible for CHC you must :
be over 18.
be assessed as having a ‘primary health need’ – this means that your main need must relate to your health.
have substantial and ongoing care needs.
Seeing whether you’re eligible for CHC is a two stage process :
Preliminary assessment.
Full assessment.
What is the preliminary assessment ?First, you’ll have a preliminary assessment of your needs using a checklist. This might be carried out by a doctor or a nurse when you’re being discharged from hospital, or by your GP or by a social worker.
Preliminary assessment checklist
The checklist covers the following categories ( Also known as " Care domains " ) :
behaviour.
cognition (understanding).
communication.
psychological/emotional needs.
mobility (ability to move around).
nutrition (food and drink).
continence.
skin (including wounds and ulcers).
breathing.
symptom control through drug therapies and medication.
altered states of consciousness.
other significant needs.What is the full assessment ?
If the preliminary assessment shows that you may be eligible for CHC, then you’ll have a full assessment. This will be carried out by a multi-disciplinary team, consisting of either :
two healthcare professionals from different healthcare professions,
or
one healthcare professional and one specialist community care assessor.The multi-disciplinary team will use a checklist similar to the one used in the preliminary assessment checklist and score you on how serious your needs are in each of the categories in the checklist.
Because most of the categories considered in the assessment process don’t relate to mental health, and because of the way they are scored, people with only mental health problems are rarely considered eligible for CHC, as opposed to those with physical health problems.
What happens after the full assessment ?
The multi-disciplinary team will make a recommendation to your clinical commissioning group if you’re in England or local health board in Wales about whether you’re eligible for CHC. The clinical commissioning group or local health board will write to you to tell you whether you’re eligible and give reasons for their decision.
If you are eligible for CHC, the clinical commissioning group or local health board will discuss with you :
how your care and needs will be managed.
where it will be provided ( For example in your own home or a care home ).
which organisation will be responsible for meeting your needs.
Can I challenge the decision if I’m not eligible for CHC ?Yes – if you have not been found eligible for CHC, you can challenge the decision this way:
Follow the review procedure of the clinical commissioning group that made the decision. The clinical commissioning group must have its own review procedure which should be publicly available and must be sent to you if you request it.
Apply for an Independent Review Panel. If the local clinical commissioning group review doesn’t uphold your complaint, you can apply for an Independent Review Panel to review the decision. For more information, see the NHS Continuing Healthcare page.
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FAST TRACK NHS CONTINUING HEALTHCARE ?
Fast Track funding is not only for end of life :
Many families are wrongly told that NHS Continuing Healthcare funding is only available for people who are at the end of their life. Not only is this incorrect, it often means that elderly people with significant health needs are wrongly denied the free NHS care they are entitled to in law.
What is a ‘Fast Track’ Continuing Healthcare Assessment? – Continuing Healthcare
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DEMENTIA ?
IGNORE WHAT YOU ARE TOLD INITIALLY BY THOSE WHO SAY THAT DEMENTIA IS NOT COVERED !!!
Three IMPORTANT links for any reader contemplating applying for CHC / NHS Continuing Healthcare for their caree suffering from dementia :
https://www.alzheimers.org.uk/dementia-together-magazine/june-july-2017/making-sense-chc
https://www.alzheimers.org.uk/get-support/help-dementia-care/nhs-continuing-healthcare-top-tips
Continuing Healthcare And Dementia • Continuing Healthcare
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CHC … Applied for but refused ?
Links to specialist , external , sites with guidance therein :
NHS Continuing Healthcare denied? Here’s what to do first...
https://www.alzheimers.org.uk/dementia-together-magazine/june-july-2017/making-sense-chc
How Do I Appeal An NHS Continuing Healthcare Funding Decision? • Continuing Healthcare
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REFUSED : ONE CASE STUDY … CONSEQUENCES
My late father spent the final period of his life in a nursing home having lapsed into extremely poor health. I applied for CHC funding for him but this was turned down despite his meeting the eligibility criteria cf. Coughlan and Grogan test cases. The CCG involved withheld vital information from the CHC assessment in order to make it appear that my father’s health needs were less severe than they in fact were, and staff shouted me down at the assessment. . Shortly afterwards, he went into a nursing home. Throughout his time in the home, he was denied CHC funding and as a family we were forced to pay several thousand pounds every month in nursing home fees. After he died, the CCG tried to close his CHC file but after a complaint from me to NHS England his case was reopened. At a Local Review Meeting, I was again shouted down by the CHC assessor and falsehoods about me were stated.
Following this debacle, I applied for and was granted a hearing before an IRP (Independent Review panel). In advance of this, I prepared a 700 page file which included nursing home notes, consultants’ and GP notes and documents from other specialists covering the period of his stay in the nursing home and the months prior to this. The documentation clearly indicated eligibility for CHC funding and the evidence clearly shows trhat the CCG has withheld important evidence. . I recorded the IRP hearing with a voice recording device in order to avoid the possibility of any dispute over what was said at the hearing, as the CCG minutes of previous meetings were highly inaccurate and biased. The IRP ignored all my evidence and supported the CCG despite my evidence clearly contradicting CCG claims. The chair of the IRP continually cut me short during the meeting and I was shouted down by a panel member who made clinically incorrect claims. The IRP ruled my father ineligible, despite all the evidence. Its members were CHC assessors from CCGs adjoining the one which denied my father CHC funding, which undermined the stated independence of an IRP. It was shockingly mismanaged.
I now wish to take the CCG to court to recover the monies wrongly paid out by my family in nursing home fees, but every solicitor I have approached wants several thousand pounds up front before they will even look at the case or read a single document. The whole case, following on from years of stress and worry over my father’s health, has been so stressful and frustrating that it has damaged my health; I have had a heart attack and attempted suicide as a result of the problems this has caused. I have spoken to several of the ‘specialist’ solicitors who advertise their services re. CHC funding, but all have demanded several thousand pounds up front. I have not got several thousand pounds to pay up front and so I have no access to justice. I am sure that CCGs calculate that few people have the resources to sue them over CHC fees and so they effectively rob families of their savings and people of their homes in order to evade paying for CHC funding.
I have not given up. Despite my poor health caused by this, I am ready to sue the CCG and more determined than ever to see justice done. The one obstacle is that I am being denied access to justice because I do not have several thousand pounds to spare to pay a firm of solicitors to represent my family. We have c. 6 months to present a case since the IRP decision reached me in April 2019.
There must be a solution to this. I am unwilling to let the CCG get away with what they have done.
https://www.carersuk.org/forum/support-and-advice/carer-disability-benefits/denied-access-to-justice-through-lack-of-funding-38850
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THE COUGHLAN CASE :
Short video on the case and an interview with Pam :
coughlan case law chc - Search Videos
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_Pamela Coughlan’s case clarified the law regarding NHS Continuing Healthcare
Outcome of the Coughlan case - Continuing Care**\
Challenging injustice can be hard. Challenging injustice when you’re severely disabled, like Pamela Coughlan, requires extraordinary courage and determination.
Pamela Coughlan’s legal victory in securing NHS Continuing Healthcare for herself has since helped thousands of families with elderly relatives to also find the courage to fight for what they’re entitled to – and force the NHS to provide free care.
Many families are still fighting that battle and still face many obstacles. However, thanks to Pamela Coughlan they can refer to the ‘Coughlan test’ in their legal argument for the entitlement to care fees.
For this and for everything she went through during her case and beyond, Pamela Coughlan deserves our gratitude.
Pamela Coughlan’s case
In the 1970s Pamela Coughlan was paralysed after a road accident and needed full-time care. She had severe physical disabilities including partial paralysis of her respiratory tract.
At the same time, however, she could still speak coherently and with mental clarity, use an electric wheelchair by herself, use a computer with voice technology, and eat and drink with some assistance.
Funding withdrawn
Her care was financed by the NHS until, in the 1990s, the East Devon Health Authority) transferred responsibility for her care to Social Services. By reclassifying her needs as ‘social’ care rather than ‘health’ care, this meant she would now be means-tested and have to pay for her own long-term care.
She pursued a case against the NHS to secure NHS Continuing Healthcare, fighting it in the High Court. It took two years and, in 1999 after an unsuccessful appeal by the then Labour government, she finally won a landmark case in the Court of Appeal (The judgment applies to England and Wales.)
Unlawful NHS decisions
The Court agreed that the actions of the local authority had been unfair and that the NHS had not followed its own guidance. It stated that the NHS had reneged on its promise to provide long-term care, used inconsistent eligibility criteria and had consequently made unlawful decisions.
Nursing care responsibility
The key question was whether nursing care for a chronically ill patient can lawfully be provided by the local authority as ‘social’ care (means-tested) or whether it must be provided free of charge in law by the NHS.
In court the judge ruled that both general and specialist nursing care were the sole responsibility of the NHS. However, the Court of Appeal subsequently found that the local authority can provide some nursing care, but only when…
“…the nursing services are merely (i) incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide and (ii) of a nature which it can be expected that an authority whose primary responsibility is to provide social services can be expected to provide.”
In Pamela Coughlan’s case, however, the Court of Appeal ruled that her nursing care was the responsibility of the NHS, not the local authority.
The Court also raised the issue of people with needs that are chronic yet stable – as opposed to people with acute conditions. The NHS should address chronic yet stable needs as part of a Continuing Healthcare assessment process. The NHS should also not assume that just because a need is ‘stable’ it is automatically the responsibility of the local authority.
The " Coughlan test "
Pamela Coughlan’s needs were greater that those for which the local authority could be expected to provide care. As a result she was eligible for NHS Continuing Healthcare. The ruling also indicated that it would therefore be logical that anyone with needs the same as or greater than Pamela Coughlan should also be eligible for NHS Continuing Healthcare. This became known as the ‘Coughlan Test’.
The case clarified the law regarding fully-funded NHS Continuing Healthcare. The Court of Appeal stated that…
“…where the primary need is a health need, then the responsibility is that of the NHS, even when the individual has been placed in a home by a local authority.”
Continuing Care assessors will often say that the Coughlan case is ‘old’ and therefore doesn’t count anymore. They also often say that the rulings in this case are no longer relevant. Both statements are incorrect. Assessors must still decide whether or not a person’s care needs fall above or below the legal limit for local authority care. If they fall above that line, the NHS must fund care through NHS Continuing Healthcare – and no means testing should take place.
Primary Health Need Approach
The judgment also concluded that the ‘vast majority’ of people in nursing homes should have their care fees NHS funded, and that only if someone’s health care needs are ‘incidental’ to their overall care needs should the responsibility be passed to Social Services.
This is now known as the ‘Primary Health Need Approach’ and it is applied in all assessments for NHS Continuing Healthcare. It came about in 2007 as a direct result of the Coughlan case. However, there is no definition in law of a Primary Health Need. It means that a culture has developed where NHS funding assessors seem to apply their own subjective interpretation of the guidelines onto funding decisions. The result is that many tens of thousands of people are still illegally charged for healthcare and nursing care in the UK.
National Framework for Continuing Healthcare
The guidelines in question are known as The National Framework for NHS Continuing Healthcare. Introduced in 2007 and revised in 2012, they were supposed to streamline the Continuing Healthcare eligibility criteria nationally.
However, there is a legal argument that suggests if Pamela Coughlan’s needs were measured against this National Framework, she would be found ineligible for NHS funding. This indicates that the National Framework itself could well be illegal.
The law, however, is clear: Pamela Coughlan does qualify for NHS Continuing Healthcare.
Find out how our step-by-step guide through the Continuing care assessment process can help you.
Does the National Framework replace the Coughlan case in NHS Continuing Healthcare?
Read about the Grogan case.
The Coughlan case and the Grogan case: Your 9-point checklist for NHS Continuing Care_**
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The Grogan Case
In 2005 Maureen Grogan challenged the NHS in the High Court for care funding…
Maureen Grogan’s family challenged her local Primary Care Trust’s (PCT) decision to deny her Funded Nursing Care.
(At the time it was a PCT, whereas now it would be a Clinical Commissioning Group – CCG.)
In January 2006 she won her case.
Like the Coughlan Case, the Grogan Case has given families who are pursuing NHS Continuing Healthcare further clout in their legal argument.
Challenging the NHS can be a hard fight, and it helps enormously to be able to refer to and take courage from people who have already succeeded.
As with Pamela Coughlan, Maureen Grogan and her family also deserve our immense gratitude.
Criteria “fatally flawed”
The judgment in the Grogan Case in the High Court for England and Wales showed that the criteria used by the NHS in their care funding decision had been “fatally flawed” and that Maureen Grogan’s should not have had to pay for her own care.
Clear primary health need
At the time Maureen Grogan, 65, was chronically ill with multiple sclerosis and additional health needs, including dependent oedema and the associated risk of ulcers. She had nil mobility, was totally dependent and also experienced cognitive impairment. She was in a Nursing Home and she had already had to sell her house to pay for care.
Incorrect decisions
The NHS had care assessed her three times as ‘ineligible’ for NHS Continuing Healthcare – even though the care assessments showed she had substantial health needs. She was receiving the (then) top band of Funded Nursing care (FNC) – also known as Registered Nursing Care Contribution (RNCC).
High Court judgment
The Grogan Case came after the landmark Coughlan case and relied heavily on the legal argument that came out of that case. The final judgment in the Grogan Case found that Maureen Grogan’s local NHS Trust (Bexley) had moved the goalposts in terms of defining her level of need – with the result that Maureen Grogan had repeatedly been found ‘ineligible’ for NHS care. The judge ruled that the NHS should pay for her care.
The PCT had not followed the Coughlan Test in it’s decision-making process.
Since the Grogan case, new national guidelines about NHS Continuing Healthcare funding have been drawn up in an attempt to make things clearer. However, despite this, tens of thousands of elderly people with health care needs as their primary need are still being forced to pay for their own care.
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Ruling Arising out of the Pointon Case - Care At Home :
**_The Department of Health has stated repeatedly that eligibility for continuing care is not based on diagnosis but on need, and the Minister explained this in detail to us:
People with dementia are as entitled to NHS continuing care as anybody else. However, the judgment has to be whether they need, in order to maintain their condition or to improve their condition, the regular involvement of healthcare professionals. If somebody with dementia does not need that regular involvement of healthcare professionals, then they will fall outside the criteria for NHS continuing care. If they do require the involvement of healthcare professionals, they will come inside the criteria and they will get their NHS continuing care, as was the case with Mrs Pointon. She did get for her husband NHS continuing care.[60]
The Pointon case is a helpful example, but not, as the Minister implied, of the continuing care criteria working effectively to take account of the needs of those with dementia, but rather of the reverse. Barbara Pointon only succeeded in securing continuing care funding for her husband, who suffers from Alzheimer’s, after a lengthy battle which culminated in her taking her case to the Ombudsman.
Mrs Pointon described her experiences to us:
What has got to me is the notion that one size fits all. Malcolm’s assessments took very little account of important features of dementia such as panic attacks, hallucinations, inability to communicate or understand, and the psychological effects of the illness. Unless you ask the right questions, you will not get the right answers in the assessments.[61]
- Upholding Mrs Pointon’s complaint, the Ombudsman concluded:
The local eligibility criteria reflected the guidance from the Department of Health, but … the ambiguities within the criteria, particularly those referring to dementia and sensory and/or physical disabilities, caused staff to produce inappropriate assessments that concentrated solely on Mr Pointon’s physical needs.[62]_** >
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Coughlan and Grogan cases … how to use them :
Many people who are battling to obtain NHS Continuing Healthcare funding for an elderly relative in full-time care will find useful ammunition by exploring two of the well-known test cases – the Coughlan case and the Grogan case. We’ve pulled out some key arguments for you to make it easier.
The Coughlan case
The landmark Coughlan case was brought by Pamela Coughlan, who had been seriously disabled in a road accident. When her care funding was taken away, she brought a legal challenge against North & East Devon Health Authority. In 1999 she took her case all the way to the Court of Appeal – and succeeded in having her Continuing Care funding reinstated.
The Grogan case
In 2006 Maureen Grogan successfully challenged Bexley NHS Trust in the High Court about their decision not to provide her with fully-funded NHS care (Continuing Care). Mrs Grogan was severely disabled by multiple sclerosis and was chronically ill. The High Court ruled that the NHS’s decision not to provide care was “fatally flawed” and that the NHS had wrongly moved the goalposts in defining her needs.
Remember that every Continuing Care assessment should be ‘Coughlan compliant’. This means that the assessment must be lawful and adhere to the principles in the Coughlan case. Pamela Coughlan received full-funded NHS Continuing Healthcare funding for her needs. It is therefore logical (as the judge states) that anyone whose needs are the same as or greater than Pamela Coughlan’s will also meet the criteria for full Continuing Care funding.
If you hear NHS assessors making comments that your relative is unlikely to be successful, ask them if the assessment has been properly carried out in the light of the Coughlan case. Some assessors state that they have never heard of the Coughlan case – and this is a good point at which to explain it to them. If they have already heard of it – AND they realise you have too – you are in a better position, although many families report that assessors do not necessarily follow its principles.
Similarly, if the assessors or the Decision Making Panel say that your relative has social care needs, not health care needs, and that you will need to pay for care, remind them of the mistakes made originally in both test cases where care needs were improperly defined.
Say that you will have no hesitation in taking your case as far as possible through the courts. Whether you ultimately do that or not is your choice. But your statement will let the NHS know how seriously you take the assessment process and that you will not accept anything less than a fully legal approach to Continuing Care funding.
If you feel that an assessment is not being conducted properly, or you disagree with the verbal recommendations being made, ask the assessors how familiar they are with actual healthcare law (not the Dept of Health guidelines, but the law). Very often they won’t be familiar with case law – the legal framework in which they themselves actually operate. At this point you can remind them of the Coughlan and Grogan cases, and state that your position would be upheld in a court of law.
If the assessors say that they are following the Continuing Care guidelines and that’s what counts, remind them that the guidelines do not override the law.
If the assessors seem particularly obstructive, they could be in breach of the Theft Act 1968.
If you’re told that your relative is ‘stable’ and that their needs are ‘predictable’, and for that reason they are ineligible for fully funded NHS care, remind the assessors of the judgment in the Coughlan case; the case stated that the needs of people with ‘stable yet chronic conditions’ (not just acute conditions) should be reviewed in a Continuing Care assessment, and that the NHS may have a duty to fund care for those needs.
If your relative is in a nursing home – or in a residential home and receiving what is effectively nursing care – and yet you are struggling to get funding, remind the assessors of their duty to apply a ‘primary health need approach’. This came from the judgment in the Coughlan case – and the judge commented that the ‘vast majority’ of people in nursing homes should have their care fees funded by the NHS, and that only if someone’s health care needs are just ‘incidental’ to their overall care needs should the responsibility be passed to Social Services for means testing.
So take courage from Pamela Coughlan and Maureen Grogan, who fought before – and won.
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CHC not on the cards BUT … NHS Continuing Healthcare as an alternative ?
NHS continuing healthcare
Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.Where can NHS continuing healthcare be provided ?
NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
Am I eligible for NHS continuing healthcare ?
NHS continuing healthcare is for adults. Children and young people may receive a “continuing care package” if they have needs arising from disability, accident or illness that can’t be met by existing universal or specialist services alone. Find out more about the children and young people’s continuing care national framework.
To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:
what help you need.
how complex your needs are.
how intense your needs can be.
how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time.
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.
A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
If you aren’t eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.
If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
Information and advice
The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS continuing healthcare.
Visit the Beacon website or call the free helpline on 0345 548 0300.
NHS continuing healthcare assessments
Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.
For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently – for example, if you’re terminally ill – your assessment may be fast-tracked.
Initial assessment for NHS continuing healthcare
The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed, and be asked for your consent.
Depending on the outcome of the checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.
Being referred for a full assessment doesn’t necessarily mean you’ll be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.
You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK.
Full assessment for NHS continuing healthcareFull assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care.
You should be informed who is co-ordinating the NHS continuing healthcare assessment.
The team’s assessment will consider your needs under the following headings :
breathing.
nutrition (food and drink).
continence.
skin (including wounds and ulcers).
mobility.
communication.
psychological and emotional needs.
cognition (understanding).
behaviour.
drug therapies and medication.
altered states of consciousness.
other significant care needs.These needs are given a weighting marked “priority”, “severe”, “high”, “moderate”, “low” or “no needs”.
If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare.
You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.
In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.
You can download a blank copy of the NHS continuing healthcare decision support tool.
Fast-track assessment for NHS continuing healthcareIf your health is deteriorating quickly and you’re nearing the end of your life, you should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
Care and support planning
If you’re eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget.
If it’s agreed that a care home is the best option for you, there could be more than one local care home that’s suitable.
Your CCG should work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.
NHS continuing healthcare reviewsIf you’re eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.
Refunds for delays in NHS continuing healthcare funding
CCGs will normally make a decision about eligibility for NHS continuing healthcare within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.
If the CCG decides you’re eligible, but takes longer than 28 days to decide this and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.
If you’re not eligible for NHS continuing healthcare
If you’re not eligible for NHS continuing healthcare, but you’re assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you’ll be eligible for NHS-funded nursing care.
This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees.
Read more information from NHS England about NHS continuing healthcare.
Frequently asked questions about NHS continuing healthcare
I have a local authority support package that works well. I’m now eligible for NHS continuing healthcare – will my support package change?
If you’re concerned about changes to your care package because of a move to NHS continuing healthcare, your CCG should talk to you about ways that it can give you as much choice and control as possible. This could include the use of a personal health budget, with one option being a “direct payment for healthcare”.
Can I refuse an assessment for NHS continuing healthcare? If I refuse, will I be able to get services from my local authority?
An assessment for NHS continuing healthcare can’t be carried out without your consent, so it’s possible to refuse. However, if you refuse, although you’ll still be entitled to an assessment by the local authority there’s no guarantee that you’ll be provided with services. There’s a legal limit on the types of services that a local authority can provide.
If you refuse to be assessed for NHS continuing healthcare, the CCG should explore your reasons for refusing, and try to address your concerns. If someone lacks the mental capacity to consent to or refuse an assessment, the principles of the Mental Capacity Act will apply and in most circumstances an assessment will be provided in the person’s best interest.
My relative is in a care home and has become eligible for NHS continuing healthcare. The CCG says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different care home. I think a move will have a negative effect on my relative. What can we do?
If there’s evidence that a move is likely to have a detrimental effect on your relative’s health or wellbeing, discuss this with the CCG. It will take your concerns into account when considering the most appropriate arrangements.
If the CCG decides to arrange an alternative placement, they should provide a reasonable choice of homes.
Is it possible to pay top-up fees for NHS continuing healthcare?
No, it isn’t possible to top up NHS continuing healthcare packages, like you can with local authority care packages.
The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you’re assessed as needing from the NHS. These private services should be provided by different staff and preferably in a different setting.
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Asked to pay " Top up " fees when receiving CHC or NHS Continuing Healthcare ?
In a word , DON’T !!!
Should You Be Asked To Pay an NHS Continuing Healthcare “Top-Up” ?
With a loved one living in a residential or nursing home will probably be familiar with the concept of top-up fees. These are third-party payments which bridge the gap between the cost of care home fees and the amount the local authority is willing to pay. They are so common that the charity Independent Age calls them a “secret subsidy” propping up the residential care system. So you may not be surprised if a social or healthcare professional asks you for an NHS Continuing Healthcare “top-up” to help meet the costs of care. But here are some things you should know before you agree.There is no such thing as an NHS Continuing Healthcare “top-up”
While the legislation governing local authority social care expressly provides for “topping up” care fees (though only in specific circumstances), the NHS are not permitted to ask for an NHS Continuing Healthcare “top-up” for assessed needs. The only way you can “top up” an NHS Continuing Healthcare package is if you choose to pay for additional private services. These are over and above services to meet your full needs as set out in your care plan. They should be provided by different staff and preferably in a different setting, though there should be liaison where necessary to ensure continuity of care.
What do the rules on NHS Continuing Healthcare say about covering the cost of care ?
The National Framework says the funding package should be sufficient to meet all needs in the care plan. The CCG should base this on its knowledge of the local costs of services for those needs. It is also important that the models of support and the provider used are appropriate to the individual’s needs. And they should have the confidence of the person receiving the services.So why is one in five recipients paying an NHS Continuing Healthcare top-up ?
Yes that’s right – one in five. According to Continuing to Care?, a major report released before Christmas by the Continuing Healthcare Alliance, almost 20% of those awarded NHS Continuing Healthcare said the funding did not cover the full costs of their care, resulting in them having to pay “top-up” fees. This fits in with what we are hearing from clients here at Just Caring Legal.
Could social workers be blurring the lines between local authority and NHS Continuing Healthcare “top-ups” ?
We are hearing of an increasing number of cases in which social workers are taking the main role in dealing with NHS Continuing Healthcare cases. Could this be blurring the lines between NHS and local authority funding? It can be difficult for those applying for NHS Continuing Healthcare to understand the different rules that apply to each, around areas such as top-up fees. It is right that social workers play a vital role in NHS Continuing Healthcare cases as part of a multi-disciplinary team of professionals assessing care needs. But once eligibility is established for NHS Continuing Healthcare, like all NHS care it is designed to be free at the point of use.
This is one of the founding principles of our NHS and its constitution: that it should provide a comprehensive service, available to all based on clinical need – not on the ability to pay.
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WHAT COSTS ARE COVERED BY CHC … SOCIAL CARE COSTS ???
What Costs Are Covered By NHS CHC Funding? • Continuing Healthcare
A snippet :
The package of care is available to people who have significant long term healthcare needs, known as primary health needs and it covers all your care costs such as aiding with washing and dressing, medication provision, continence care, therapies and other complex health needs that would otherwise we carried out by a social worker of social care professional.
WELL WORTH READING IF YOU ARE ASKED TO CONTRIBUTE !!!
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RETROSPECTIVE FEES ? FEES INCURRED BEFORE CHC APPROVAL ?
Over to the experts … CareToBeDifferent for a bullet type guide :
Retrospective claim for care fees rejected? - Care To Be Different
Not extensive but … one of the better outside links !
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PROBLEMS WITH CHC AND / OR NHS CONTINUING HEALTHCARE ?
Multitudes … just add those words into an Internet search … and sample the results !!!
It will save me listing 10 / 20 of the better answer sites !
Politically , existing thread on my take on both … conclusion ?
Rationing by design !
https://www.carersuk.org/forum/support-and-advice/all-about-caring/chc-rationed-high-time-to-ask-some-obvious-questions-33311?hilit=chc%20rstioning
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Allied topic … NHS Nursing Funded Care ( NFC ) :
NHS-funded nursing care
NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.Who is eligible for NHS-funded nursing care ?
You may be eligible for NHS-funded nursing care if :you’re not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse.
you live in a nursing home.
How will my needs be assessed ?You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care.
Most people don’t need a separate assessment for NHS-funded nursing care. However, if you do need an assessment or you haven’t already had one, your clinical commissioning group (CCG) can arrange an assessment for you. Find your local CCG.
Outcome of the assessment
If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided by registered nurses employed by the care home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.
If you’re not eligible for NHS-funded nursing care and you don’t agree with the decision about your eligibility, ask your CCG to review the decision.
The cost of NHS-funded nursing care
NHS-funded nursing care is paid at the same rate across England. In April 2018, the rate was set at £158.16 a week (standard rate).
Before October 1 2007, there were 3 different levels or bands of payment for NHS-funded nursing care – low, medium and high.
If you moved into a care home before October 1 2007, and you were on the low or medium bands, you would have been transferred to the standard rate from that date.
If you moved into a care home before October 1 2007, and you were on the high band, NHS-funded nursing care is paid at a higher rate. In April 2018, the higher rate was set at £217.59 a week. You’re entitled to continue on this rate unless:
you no longer have nursing needs.
you no longer live in a care home that provides nursing.
your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £158.16 a week, or
you become entitled to NHS continuing healthcare instead
