Do you know you may be eligible for NHS funded nursing care if you can’t take care of yourself?

It’s helpful knowing more….

Understanding NHS Continuing Healthcare and Funding Eligibility  

An Introduction to NHS Continuing Healthcare.

If you or a relative has a primary health care need, they may be eligible for healthcare funded by the NHS. NHS Continuing Healthcare is often referred to as one of the best-kept secrets within the NHS. However, if you understand the requirements and the process, you may find yourself eligible for this funding.

Healthcare Needs vs. Social Care Needs

When an individual's health reaches a point where they can no longer look after themselves, their care falls either under the responsibility of the NHS and is provided for free, or it becomes the responsibility of their local authority, which means it will be means-tested. This could potentially involve using savings or selling the family home. The current threshold at which the local authority provides funding is £23,250 (expected to rise to £100,000 by October 2025)

NHS Continuing Healthcare Assessment.

In order to decide whether the NHS or the local authority should provide support (in England), the local NHS Integrated Care Board will organize an NHS Continuing Healthcare assessment. This assessment aims to determine whether an individual has a "primary health need," which qualifies them for a "package of ongoing care that is arranged and funded solely by the National Health Service (NHS)." The assessment process can take several weeks, but if someone is considered "End of Life," it can be fast-tracked, making funding available within days.

Challenges and Awareness.

Unfortunately, the knowledge about  NHS Continuing Healthcare and its availability is not widely spread. Success in obtaining funding depends on the family representative fully understanding how the system works and the rules outlined in the over 180-page-long National Framework Document, as well as having tenacity. In 2022, nearly 50,000 cases were considered, and only 22% of the applications were successful, leading many people to give up. The key to success is being prepared to challenge the decision made if you believe you meet the eligibility criteria.

The Importance of Understanding Healthcare Needs.

It's crucial to understand the difference between healthcare needs and social care needs. Social care needs are related to support for day-to-day living, while eligibility for NHS funding depends on having a primary health need. However, the assessment also considers the interplay between the intensity, unpredictability, and complexity of the healthcare needs. Under S169 of the National Framework, a combination of these factors can be sufficient to be considered a primary health care need. 

Seeking Support : At Better Endings, we have provided support to families seeking access to CHC funded healthcare, and have successfully appealed initial decisions where a family member wasn’t deemed eligible. If you believe you or your relative may be eligible and wish to discuss this further, please don't hesitate to get in touch via our website or on social media

Which magazine provide this helpful resource on paying for care in later life