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Busting the myths around NHS continuing healthcare

I am frequently asked questions about NHS Continuing healthcare by clients. Often these questions are not confined to the assessment process, but to wider issues relating to the process. Below is a list of FAQ’s that may be of help to those of you going through the NHS continuing healthcare process.
  • Does a diagnosis or prognosis guarantee my relative will receive NHS continuing healthcare funding?

No, eligibility for NHS continuing healthcare is based on ‘need’ and not on a specific diagnosis. However, the Fast Track Pathway Tool can be used when an individual’s health is deteriorating, and the prognosis is poor. This replaces the need for a checklist and DST to be completed.

  • Do I have to hold Power of Attorney for health and welfare for my relative in order to consent on their behalf to have an NHS continuing healthcare assessment?

No, if your relative lacks the mental capacity to agree to an assessment. Then in their best interests you can consent on their behalf.

  • How do I know if my relative meets the ‘primary health care need’ threshold?

The national framework says an individual has a primary health need if, having taken into account all of their needs following the completion of the DST Tool, it can be said that the main aspects or majority of the care they require is focused on addressing and /or preventing health care needs. Having a primary healthcare need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day to day care needs taken in their totality.

  • Is NHS continuing healthcare funding given for life?

No, NHS continuing healthcare funding is subject to a review by the relevant CCG after 3 months, and thereafter annually.

  • My relative’s local authority support package works well. They have now become eligible for NHS continuing healthcare – will my package change?

If you have concerns about any change to your relative’s care arrangements, the relevant CCG should talk to you about ways that it can provide you with a choice and as much control as possible. One option could be the use of a personal health budget or a direct payment for healthcare.

  • My relative resides in a nursing home and has been awarded NHS continuing healthcare. The CCG says the fees charged by the home are more than they would usually pay and has proposed a move to a different care home. I think the move will have a negative effect on my relative. What can we do?

If there is evidence that a move is likely to have a detrimental effect on your relative’s health or wellbeing, discuss this with the relevant CCG. The CCG should take your concerns into account when considering the most appropriate arrangements. Should the CCG decide to arrange an alternative placement, they should provide a reasonable choice of homes.

  • Is it possible to pay a top up fee for NHS continuing healthcare?

No, it is not possible to top up NHS continuing healthcare packages, like you can with local authority care packages. The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services an individual is assessed as needing from the NHS. These private services should be provided by different staff and preferably in a different setting.

If you need further advice and guidance in regards to any of the above questions, please do not hesitate to get in touch by calling me on 01926 354704 or emailing:

Blog by: Judy Timson | Clinical Advisor 

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