Continuing Healthcare

What is CHC Funding?

There is a great deal of confusion and controversy surrounding Continued Healthcare funding also known as CHC funding. Some of this confusion we will try and clear up here; but first of all we will explain specifically CHC funding actually is.

NHS Continued Health Care is a means by which the NHS provides a care package that funds the full cost of a person’s assessed health and social care needs. If they are living in a residential or nursing home it will also cover the cost of the associated accommodation. However, if they are living at home it will not cover accommodation costs.

Recipients are people that have successfully been assessed as having a primary health need. Additionally, this need must be assessed as complex, substantial and ongoing. This wording ‘primary health need’ is very important because if your primary need is social care with some additional health needs you would not qualify. However, if your primary need is assessed as health with additional social care needs you will qualify. For the absence of confusion I will reiterate the point if you are assessed as qualifying for CHC support it will cover all of your needs including Health and Social needs.

Put simply, an individual has a primary health need if, having taken into account all their health and social care needs, it can be said that the main aspects or majority of the care they require is focused on addressing or preventing health needs (National framework for NHS continuing healthcare and NHS funded nursing).

Where can I receive CHC funding?

The location of the care that is delivered is not a factor in assessing needs, which means funding is not restricted to a particular setting. It can therefore be received in a nursing home, a residential care home, a hospice or even in your own home. The assessed health need is the key factor not the location.

Even though location is not an important element of CHC funding, you should bear in mind that in most cases in order to demonstrate a primary health need the type of care an individual will need may not be deliverable outside of a registered nursing home. It is not that the NHS is refusing to pay the cost of a residential care home, it is just a fact that in many cases they do not have staff qualified to deliver the required care and support of an individual that qualifies.

Having said that, there are many examples of residential care homes receiving CHC funding for residents and providing exemplary care to the individual that fully meets their needs. However, this is probably the exception rather than the rule. In all cases the Home Manager of any home will be able to fully explain whether they can support you or your loved one.

How much is CHC funding?

Unlike many examples of Social Care Funding, the NHS does not maintain a one size fits all policy for setting CHC funding rates. Once a decision has been made that an individual qualifies for it, a further assessment is made to identify specifically what care is needed. They will endeavour to find the most cost effective means of delivering that care, but, they will ensure that all the various elements are identified, commissioned and delivered.

Each qualifying individual gets a personalised and individual care package which may include, if appropriate, basic nursing care such as wound care, administration of medication, management of Peg Feed* (see PEG definition at the bottom of this Blog) and/or a range of other support. It also includes basic social care needs such as washing, dressing or support with eating and in some cases it will include specialist therapies such as speech and language therapy and physiotherapy.

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

Do I have too much money to qualify?

The NHS Continuing Healthcare Funding is non-means tested, this means that nobody looks into your financial situation prior to a decision on whether to award or not. It does not matter how much or how little money you have as this does not form part of the decision process.

You can own your own home, have a thriving highly profitable business or you could be retired living only on a state pension and it would have no bearing. The Assessor would base their decision solely on the criteria as to whether you have a primary health need.

Will I qualify for CHC funding?

There are numerous articles, blogs and news stories that talk about post code lotteries and inconsistencies in the assessment process and this article is not going to add to those. What it will do is provide an overall explanation into process is and what to expect. Further articles specifically deal with the individual elements of the CHC assessment process.

The NHS states the following on their website:

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.