The principles and processes to Continuing Healthcare funding are set out in The National Framework Guidelines, but we’ve broken down the 3 key stages:
1.The NHS Continuing Healthcare checklist
The NHS Continuing Healthcare checklist is the first stage of determining eligibility for funding. It’s a basic screening tool which is used to identify individuals who need a full assessment for Continuing Healthcare. The NHS Continuing Healthcare checklist comprises of 11 areas of need and scores are based on the answers given (A being a high need, B moderate and C low or no need). The outcome of this checklist indicates whether a full assessment should be carried out.
2. Full healthcare assessment
If the NHS Continuing Healthcare checklist determines that the individual’s condition and care needs warrant progressing to the next stage of the funding process then a full assessment will be carried out. A form called the ‘Decision Support Tool’ (DST)’ is completed by a Multidisciplinary Team (MDT) – this is often a GP, social worker or nurse assessor, who will score the individuals care needs categorising them as none, low, moderate high, severe or priority needs.
The team’s assessment will consider the individuals needs in relation to the following:
- cognition (understanding)
- psychological/emotional needs
- nutrition (food and drink)
- skin (including wounds and ulcers)
- symptom control through drug therapies and medication
- altered states of consciousness
- other significant needs
It’s important to note that if your or your relative’s health is rapidly deteriorating (or may be entering a terminal phase) you can ask for a Fast Track Assessment, which may result in urgent funding being granted, usually within 48 hours, so that appropriate care and support can be put in place as soon as possible.
3. Panel decision
Once the MDT have completed their healthcare assessment, a separate panel will consider the recommendation. If the Decision Support Tool scores are high enough you will qualify for Continuing Healthcare funding. It’s at this stage that the final decision for funding will be made and passed on to the family.
Can I recover costs already paid?
If you or a relative have been receiving care primarily for health needs, you may have wrongly been paying for care home fees. Known as retrospective recovery, Continuing Healthcare Direct can assist with recovering care costs which you have previously been paid.
How long does the Continuing Healthcare funding process take?
Clinical commissioning groups (CCGs), which are the NHS organisations that commission local health services, should normally make a decision about an individual’s eligibility for Continuing Healthcare funding within 28 days of receiving a completed checklist or request for full assessment (unless there are circumstances beyond their control). If it does take longer than 28 days, and the delay is unjustifiable, you should be refunded with any care costs from the 29th day until the date of their final decision. So, if you’re currently paying for healthcare costs, you should start the process as soon as possible so that funding can begin.