FAQs: NHS Continuing Healthcare

1. Who qualifies for NHS continuing care??
2. Does Alzheimer’s or Dementia qualify for NHS continuing care?
3. Is NHS Continuing Healthcare means tested?
4. Will NHS Care Home funding pay the full cost of the care home?
5. What is the NHS Continuing Healthcare Checklist?
6. Is it true that you can only get NHS CHC funding if you are in a Nursing Home?
7. Is your NHS Continuing Healthcare funding award for life?

Who qualifies for NHS continuing care?

You will qualify for NHS Continuing Healthcare funding if the NHS agree that you have a primary healthcare need. There is no simple definition of what is a primary healthcare need. NHS England publish quarterly statistics that show how few people qualify for NHS continuing care. The latest figures show that only 57,240 adults across England were eligible for NHS CHC. From this total, 35,474 people were eligible for standard NHS CHC. The other 18,766 people had Fast Track funding, sometimes called “NHS end of life care funding”.

Does Alzheimer’s or Dementia qualify for NHS continuing care?

Eligibility for NHS continuing care is not based on your diagnosis. It is based on an assessment of whether your needs are of a primary healthcare nature or a social care nature. Some people with Alzheimer’s or Dementia qualify for NHS continuing care but many hundreds of thousands of people do not. This situation is often called “The Dementia Tax”. Many people with long-term conditions have to use up all of their savings and the value of their home paying their social care costs.

Is NHS Continuing Healthcare means tested?

Unlike Social Services means tested care, NHS Continuing Healthcare is not means tested. If you qualify for continuing care, the NHS should usually cover the full cost of your care package at home or in a care home.

Will NHS Care Home funding pay the full cost of the care home?

Not necessarily. Like Social Services, the NHS places a limit on the amount that they will pay for your care. The amount of NHS Care Home funding is based on your assessed needs and not your preferences. The Social Services funding rules give you a legal right to choose a more expensive care home, so long as someone can pay the care home top-up fee. Under the NHS funding rules, you do not have a legal right to choose your care home. The NHS might say that you have to move to a cheaper care home.

What is the NHS Continuing Healthcare Checklist?

The Checklist is a screening tool, which determines whether you should have a full assessment for NHS CHC eligibility. The Checklist is used by Health or Social Services in a number of care settings, often but not always a hospital setting. If you get enough A or B scores in the Checklist then you will move on to the Decision Support Tool assessment stage. Passing the NHS CHC Checklist does not mean you will qualify for NHS care fee funding.

Is it true that you can only get NHS CHC funding if you are in a Nursing Home?

No: this is one of many NHS CHC fake facts. Eligibility for NHS Continuing Healthcare does not depend upon where you receive care. If you qualify for NHS CHC, your care package can be funded in your home, in a care home or in a nursing home.

Is your NHS Continuing Healthcare funding award for life?

No: the Clinical Commissioning Group (CCG) CCG will regularly review your eligibility for NHS CHC. The first review is usually held after three months and then you will have annual reviews. The CCGs might withdraw your NHS CHC funding award on the basis that your needs have become stable and routine, so they are social care needs, not healthcare needs. You should always consider appealing a negative NHS CHC decision.

If you need help challenging a decision by Health or Social Services about yours or a family member’s assessed needs, or you disagree with a funding decision made by Health or Social Services, then please contact our Community Care Law Team on 01273 609911, or email info@ms-solicitors.co.uk.