NHS Continuing Healthcare funding pays 100% of the cost of care for eligible individuals. However, we’ve heard from families who have been told there was an upper care limit per week, leaving relatives to ‘top-up’ the outstanding amount to meet the care home weekly fee.
This is incorrect and another example of why the NHS Continuing Healthcare funding process is so complex and confusing.
NHS Continuing Healthcare funding pays 100% of the fees associated with an assessed and established primary healthcare need, there is no financial limit and the National Framework explicitly prohibits patients paying ‘top-up’ fees.
Tim Davies, CEO and non-practising solicitor at Compass CHC explains,
“Where it is established that a patient is entitled to NHS Continuing Healthcare funding the local Integrated Care Board is obligated to pay – in full – the cost of the care package required to meet the health needs of the particular individual. It is not the case that a generalised cap can be placed on this amount.”
In fact, the National Framework states “The NHS care package provided should meet the individual’s assessed health and associated social care needs as identified in their care plan. The care plan should set out the services to be funded and/or provided by the NHS. It may also identify services to be provided by other organisations such as local authorities, but the NHS element of the care should always be clearly identified.”
Clearly this cannot be achieved by applying a set maximum figure if no appropriate private care home can meet the needs of the individual at the set level. In one case recently, we secured an ongoing package of care for an individual with complex care needs at a cost of £3,000 a week.
Other clients have told our specialist advisors that they feel the National Framework is open to interpretation by the ICBs who seem to choose which parts to adhere to and which sections to ignore.
Tim Davies clarifies:
“The National framework is not open to interpretation or cherry-picking by different ICBs. However, I know first-hand that left unchallenged this can occur which is why I always encourage clients to use a reputable continuing healthcare expert when navigating the often-complex funding process.”
What does NHS Continuing Healthcare cover?
Care in your own home – The NHS will pay for healthcare, i.e. services from a nurse or therapist, and personal care, for example help with washing, dressing and laundry.
Care in a care home or nursing home – In addition to healthcare and personal care, the NHS will pay for your care home fees, including board and accommodation.
Unsure if you or a loved one qualifies?
If you think you or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
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