Claims for NHS Continuing Healthcare

We are all living longer and over a quarter of our population are now aged over 65. The health and social care sector has grown at the same rate with an increased development of specialist care services. This does also mean that more people now have to sell their homes, or use their life savings, to meet the cost of care in later life. However, depending on a person’s level of health and nursing care needs, they may not need to do this and may instead be eligible for NHS Continuing Healthcare (“NHS CHC”) funding.

What is NHS CHC?

According to NHS England, NHS CHC is a package of care for adults aged 18 or over which is arranged and funded in full by the NHS. It is a non-means-tested package of care, and is awarded to individuals whose needs are deemed to be primarily for healthcare. To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals, who will then make a decision as to whether you are entitled to NHS CHC.

What sort of claim can be made?

In many cases, you or a relative may have been wrongly assessed as not being eligible for NHS CHC. If you feel that is the case, you may wish to consider seeking advice as to whether you might have a potential claim for retrospective NHS CHC funding. This type of claim can be made whilst a person alive, or after they have passed away. However, it is important to note that the Department of Health deadlines for England mean that a request to review NHS CHC can only be made in relation to care received from 1 April 2012 onwards.

Eligibility for NHS CHC

The test for eligibility is set out the National Framework. In order to prove that a person should have been entitled to NHS CHC, you must show that their health and nursing care needs were more than what a social services department could provide. If that is the case, then their needs could have been deemed to be primarily for healthcare and they could be entitled to NHS CHC.

When considering eligibility, healthcare professionals will consider different levels of need and determine which one they feel the person falls under. If a person’s level of need is assessed as being ‘priority’ in any area, they will automatically be eligible for NHS CHC. Similarly, if the level of need is assessed as being severe in any two areas, eligibility will also be automatic. In general, the lower a person’s level of need the less likely they are to be considered eligible for NHS CHC. For those in the final stages of life, it is possible to request an urgent assessment and secure fast tracked funding.

Decisions about eligibility are based largely on a person’s daily health and care needs, not their diagnosis or the length of time they are expected to live. For example, just because someone has a diagnosis of dementia that does not necessarily mean that they are eligible for NHS CHC.

How can we help?

Our Healthcare Team can provide you with concise, comprehensive and practical advice on this issue. If you wish to discuss a potential claim, please contact Henrietta Frew by email at Henrietta.Frew@ellisjones.co.uk  or phone 01202 057863.