What is NHS continuing healthcare (CHC)?
NHS continuing healthcare is the term used to describe NHS funding that pays for the whole of your package of care. The eligibility threshold in order to get continuing healthcare is high - you (or your loved one) must have significant and intense 'primary health needs'.
The assessment process and decision-making should be person-centred. This means placing the individual at the heart of the assessment and care-planning process. In light of the Covid pandemic, the assessment process is tending to vary across the country and many families are not experiencing fair and transparent assessments - we will shortly publish further guidance on how eligibility should be determined and your right to be properly involved in the process.
This recent report by the CMA is also of concern. The report shines a spotlight on the difficulties families’ face when, having been found eligible for CHC funding, the local clinical commisiong group (the CCG ) then provide insufficient monies to cover the full costs of the package of care; often suggesting a bespoke room over and above what is required to meet the person’s care needs.
In reality, when someone is placed in a care home very little choice is in fact given regarding rooms and in our experience few people “choose” to have a bespoke room – say with a garden view. Instead families’ endeavour to identify the best home to meet the person’s needs and are simply advised by the provider what the weekly rate for the room is. Unfortunately however, the CCG, when they have agreed to provide the funding, will then endeavour to cap the amount of monies that they will pay and the care home will turn to the family to seek a top up. This is often expressed as “hotel costs” or “supplemental charges”.
Th CMA report shines a spotlight on this practice and highlights in this specific case that the provider made paying the “shortfall fee” a condition of admitting residents which is contrary to the Enterprise Act 2002 and the National Framework for Continuing Healthcare and NHS-funded Nursing Care 2018.
The NHS constitution and the laws and Framework that govern this area are very clear:
- NHS services are free at the point of delivery, and
- If you are eligible for CHC then the NHS should meet the full cost of your care.
The only way that NHS continuing healthcare packages can be topped up privately is if the family pay for additional private services over and above the services needed to meet the individual’s needs. These private services should be delivered by different staff and preferably in a different setting. They should be entirely voluntary and care providers should not make this a condition of receiving NHS funded provision.
The funding provided by CCGs should be sufficient to meet the needs identified in the care plan. Despite current practices, there should be no cap or sealing on the level of funding provided and whilst the CCG may seek to implement paraments or guidelines, all funding should be agreed on a case by case basis.
Families should never be pressured to make additional payments towards the package of care and only in exceptional circumstances is it envisaged that top ups would be paid. Remember, if found eligible the entire costs should be met by the NHS and it is a matter for the home and the local CCG to determine what is the appropriate weekly fee. The provider should not be pressuring the family to meet any shortfall.
In some cases, families’ may genuinely request that additional services are provided, such as hairdressing, aromotherapy or beauty treatments. In those cases, the CCG could say this is over and above what the individual requires to meet his needs and we accept this would be reasonable. If however there is dispute regarding the provider’s general charges, both the provider and family should stand firm and challenge the CCG if they refuse to agree to pay the allocated room rate.
Finally, we have encountered many cases where an individual has been resident in a care home for some while and then subsequently has been found eligible for CHC funding. Often a debate then ensues as to whether the CCG will agree to continue to fund the existing placement where the fees are higher than the CCG would “usually” expect to pay .
In such a situation, the CCG must justify why they will not continue to pay the full costs of care; particularly in light of their obligation to pay for the entire costs of care. To compel a person to move to a different home in such circumstances would be a brave decision and even more so if the person lacks capacity to agree to this and a move could involve significant risk to the person’s health and wellbeing.
Sadly, in light of the current pandemic, families are often feeling pressured to make financial decisions without taking legal advice and are often entirely unaware that they are being asked to contribute when in fact they are entitled to free care. It is helpful that the CMA have published their report and we hope this will assist to raise both public awareness and also ensure care providers are similarly acting in accordance with the National Framework.
Care UK will be offering repayments to those affected which is approximately 160 residents at over 20 Care UK premium homes and will be contacting eligible individuals during November 2020. Refunds of more than £1,000 are likely to be received with some receiving substantially more based on individual circumstances. As well as offering refunds, Care UK has committed to stop charging this additional fee altogether for residents at its homes.
If you believe that you or your family member is eligible and you have not been contacted by Care UK by the end of November 2020, then you can contact CHC.Fundingoffice@careuk.com.
Here to help
If you have any questions regarding NHS continuing healthcare, we are here to help.
- Are you paying additional fees?
- Have you received NHS continuing healthcare funding during Covid-19 but are at risk of it being withdrawn?
- Have you been waiting for a CHC assessment?
- Have you already been paying care fees but have not been assessed for NHS continuing healthcare funding?
- Have you been told you need to pay for care because you have savings or a home?
- Appeals of decision
- Annual reviews
- Retrospective applications
Our team can assist you at any stage of the process and we offer a fixed price consultancy service. For more details of this, please click here.
For full details of the National Framework, please click here.