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CHC Funding

NHS Continuing Healthcare & CHC funding

This article was updated on 1 June 2019 and was initially reviewed by Tim Davies, a Director at Compass Continuing Healthcare

I think you will agree that the cost of care can be very expensive.  However, the NHS may have a responsibility to pay for those costs.  But working out if they should and if they will is a nightmare for many.

That is why we have created this information guide to help you!

In this page we will also tell you:

  • WHAT IS NHS CONTINUING HEALTH CARE
  • HOW TO FIND OUR IF YOU ARE ELIGIBLE FOR FUNDING 
  • YOUR CARE CAN EASILY COST YOU OVER £100K.  FIND OUT IF YOU ARE ELIGIBLE FOR NHS FUNDING AND HOW TO APPLY
  • WHAT CARE PACKAGE COSTS ARE COVERED
  • HOW TO CHALLENGE A DECISION NOT TO PROVIDE FUNDING
  • DETAILS OF HOW TO CONTACT SPECIALISTS THAT CAN HELP YOU APPLY FOR FUNDING OR CHALLENGE A DECISION NOT TO GIVE YOU ANY FUNDING

People over the age of 18 who are living with significant ongoing care needs may be eligible for a package of funding called NHS continuing healthcare ( sometimes referred to as NHS continuing care or CHC funding).

NHS continuing care is free and is not means-tested, unlike social and community care services provided by local authorities.

Having to meet the costs yourself can easily exceed over £100,000 in the longer term.  This is why it’s really important to understand whether you are entitled to having your costs paid as it will save you and your family a significant amount of money.

What is NHS continued healthcare?

NHS continued healthcare is a care package that funds the full cost of a person’s assessed health and social care needs, including residential accommodation ( such as a care home) .

The funding is not restricted to a particular setting which means that is can be received in a nursing home, a residential care home, or even in your own home.

It is for individuals who are not in hospital, and who have been assessed and identified as having a ‘primary health need’.

What is CHC?

CHC is just another term used for Continued HealthCare funding.  You can read more about this below.

Here is a great video that explains more about what it is.

The National Framework for NHS Continuing Healthcare

On 1 March 2018, the Department of Health and Social Care published revisions to the National Framework for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care. From October 2018, all Clinical Commissioning Groups (CCGs) should have adopted the new rules.

In essence, the National Framework for NHS funding sets out the criteria and rules around who is entitled to health care paid for by the NHS.  However, whilst this was an attempt to make the rules clearer, there are still different interpretations applied by the Clinical Commissioning Groups.

The National Framework itself was updated to reflect the Care Act 2014.  As such, it makes clear that it doesn’t matter whether you are receiving are in a care home or care at home ( domiciliary care) , the eligibility criteria must be applied consistently to everyone.

The National Framework also makes clear what the Clinical Commissioning Groups (CCG) responsibilities are.  Over the past few years we have seen some CCGs cap the level of funding that was received by people who wanted continue living and receiving care in their home.   BY applying the cap, they were in effect, forcing people to move in to residential care.

The framework makes clear that an individual has the right to have their care and social needs assessed.  In addition, the CCG have to take on board the individual’s preferences and without restrictions being ut on where they receive their care.

How much is continuing healthcare funding?

There is no one set cost that everyone is entitled to receive and not everyone is eligible for NHS continuing funding.  The funding depends on the health and care needs of the individual.  Therefore there is no one continuing healthcare funding rate.

However, NHS continues health care covers basic social care needs such as washing and dressing in addition to more complex nursing care needs such as the administering of medication and wound care.

It also covers specialist therapies such as physiotherapy or speech and language therapy where you have an assessed need for such services.

The funding criteria depends on the individual and what their care needs are deemed to be at the time of assessment, or anticipated to be in the near future.

continuing healthcare funding rates

How to get the NHS to pay for care

NHS continuing healthcare pays for all assessed health and social care needs resulting from disability, accident or illness. However, if you want, or need, the NHS to pay for care then you first need to be assessed.

If you are eligible for NHS continuing healthcare, then the NHS should meet the full cost of your care whether you live at home, a care home or any other setting other than hospital.

Assessing whether you meet the CHC funding criteria?

Your local clinical commissioning group is responsible for putting together a multidisciplinary team of health and social care professionals that are involved in your care or treatment.

They come together to assess the totality of your care needs and decide whether, on balance, your care needs are primarily for health. If so, that means you meet the criteria.

The multidisciplinary team will make a recommendation to your clinical commissioning group which should be upheld in all but exceptional circumstances. You or your representative should be fully involved in the continuing healthcare assessment process so that you are able to contribute your views and preferences.

Want some help and guidance on whether you are entitled to FREE care have it paid for by the NHS?

Compass Continuing Healthcare are here to help you.  Just click the button below to have a look at their website

Alternatively, you can speak to a NHS Continuing Healthcare advisor right away. Just call 0121 227 8940 and they will be able to help you.

Do not ask your Local Authority first

Unfortunately, many people get directed too, or often go straight to their local authority seeking financial support. However, it is important that you are assessed for NHS continuing care first, as this needs to be undertaken to clarify who is actually responsible for paying for your care.

You should first ask a health or social care professional, such as your GP, care home manager, or social worker for a Checklist assessment, which is the first stage in the continuing healthcare assessment process for most people.

Details of people who can help you understand more about continues health care can be found in our independent directory of CHC funding and healthcare specialists.

nhs continuing care funding

Eligibility for Continues Health care from the NHS?

Anyone classed as having ongoing and substantial care needs could be eligible for NHS funding. For example, Alzheimer’s patients with intense and unpredictable care needs, or someone who is recovering from a stroke in their own home following a period in hospital may be eligible.

However, the focus is on the individual’s care needs rather than their diagnosis.

The NHS are very specific regarding the criteria for funding eligibility, and sometimes very poorly patients may not be eligible because their day-to-day care needs are not particularly intense, complex or unpredictable, and can be managed by social care.

To quality for healthcare funding the individual must be assessed as having a ‘primary health need’. In simple terms, this means the majority of care required is related to addressing or preventing health care needs.

The only sure way to know if you’re eligible is to ask your GP, social worker or another care professional to arrange a continuing healthcare Checklist assessment.

What to do if you meet the CHC funding criteria

The first thing that you have to do is go through the continuing healthcare full assessment process. More information on this is below.

However, you shouldn’t just start the application process.  Like everything, you should approach the full assessment in a tactical manner with the aim of lessening the change that your claim is rejected.  To pursue it further will mean that you need to go through the appeals process, which can also be difficult.

What we strongly recommend is that you build your case as to why you or a loved one is entitled to continued care funding.

The reason for receiving or getting rejected for funding can be complex so its VERY important that your case is clear about why you should receive it.

This will involve many aspects, but in the main it will directly reference the criteria set out by the Department of Health for the NHS and the person’s medical records and history.

This approach of clearly building your case makes it harder for the case to be rejected.  A successful approach can easily save you over £100,000 in long term care costs!

chc criteria

The continuing healthcare assessment

Initially, eligibility for a funding assessment will need to be determined by a healthcare professional, such as a nurse, doctor or social worker.

They will use a specially devised system called the Checklist Tool, which will take into account your individual situation based on a number of important questions.

You will then be contacted by your CCG (Clinical Commissioning Group), and if you are deemed to be eligible you will be referred for a full continuing healthcare assessment.

During the full CHC assessment, a detailed evaluation will be made of your current state of health using a Decision Support Tool, which will be carried out by a team of two or more healthcare professionals.

It’s their job to make a recommendation to the CCG which ensures that you are provided with the exact level of care you require in the most appropriate capacity.

The continuing healthcare criteria – What happens during the Continuing care assessment process?

The NHS CHC assessment process is essentially made up of 2 steps.

Here is a short video that explains more about the process.

Step 1 of the CHC process– The initial screening care needs

Initially, you will have a screening to see if you’re eligible for funding. The screening is typically carried out in hospital or at home. The CHC screening is usually undertaken by a nurse, doctor, social worker or other recognised healthcare professional.

During the continued health care screening process, they will assess your general health and care needs with a simple checklist that will cover:

  • psychological and emotional needs
  • mobility
  • nutritional needs
  • behaviour
  • understanding of what’s going on around you
  • communication
  • continence
  • skin condition
  • breathing
  • symptom control through drug therapies and medication
  • other significant care needs

If your health, or the health of someone you care for, is getting worse rapidly, ask about a fast track assessment to bypass the initial screening.

Step 2 – The CHC assessment

The assessment process can be complex. However, we would strongly urge not to let that put you off, as ultimately it can be worth going this process both from a financial and emotional perspective.

If the initial screening shows that you may be able to get free NHS Continuing Care, you’ll need to have another assessment. This second assessment will be undertaken by a team of two or more health- and social-care professionals who are involved in your care.

The team will use the same checklist above but will go into a lot more detail. They will mark each of your care needs as:

  • priority
  • severe
  • high
  • moderate
  • low

If you have at least one priority need or two severe needs, you should qualify for funding.

If you have one severe need and a number of other high or moderate needs, you may also be eligible.

Here is a useful video on what is involved with the assessment for continued health care funding.

continuing healthcare assessment

How to apply for CHC funding

The CHC funding criteria can be applied for by speaking to your social worker or any person who is in charge of your care – as a friend, relative or carer may be able to apply on your behalf or assist you in submitting your application.

You can also speak directly to your GP or the person who is dealing with your care at hospital, such as your doctor or consultant about NHS continuing care funding.

The NHS care package – What costs will be covered

NHS continuing healthcare covers your assessed personal (social) care and healthcare costs, such as help with washing, dressing, medication, continence care, skin care, therapies and complex health needs.

It may also include accommodation if your care is provided in a care home, or support for carers if you’re being looked after at home.

If you do not meet the criteria and you receive care in a nursing home, you might be able to receive NHS-funded nursing care. This is a small contribution to the cost of care provided by a registered nurse, paid by the NHS. The level of funding is reviewed regularly.

Is the care package in place indefinitely?

Things can of course change – and if they do, you will need to inform your key worker, doctor, social worker or nurse if this hasn’t been discussed during one of your regular reviews. It may be that you need more than was previously agreed, or less depending on your circumstances.

What happens if you are declined for care funding

If you are declined, and you feel that this is an incorrect decision, you are able to challenge that decision.  The best advice would, at this stage, be to use the services of a specialist who understand the rules.

They can help you challenge the decision that was made.

You can access a range of Healthcare Funding specialists using our directory.

Expertise and authority of this article

This article was reviewed by Tim Davies, a Director at Compass Continuing Healthcare on 9 October 2018.

Tim is a qualified (non-practising) solicitor specialising in healthcare funding issues.

Tim has extensive experience of each and every aspect of the funding process and regularly acts as an advocate at assessments as well as appeal hearings where required. More information can be found via Tim’s biography video.

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Are you looking for some help to obtain NHS funding or challenge a decision not to provide it? If so, you can call 0121 227 8940 and speak to a specialist at Compass or visit their website.