NHS Continuing Healthcare is a phrase used within the care and health sector, however it’s a topic many people don’t understand or feel slightly confused about. But where did it all start, and what is the history of Continuing Healthcare?
What is Continuing Healthcare?
Continuing healthcare is a name given to the package of support and care that is paid for and arranged by the NHS. Designed to assess an individual’s care needs and to recommend whether their needs are health based or social care needs, which would be paid for by the individual or the local council. NHS Continuing Healthcare is available to those living in their own home or within a care facility.
Eligibility isn’t solely based on their medical condition or age, the NHS requires a person to have medical needs that are intense, complex or unpredictable in their nature. If someone meets the criteria for funding, the costs of their care in full would be met by the NHS rather than the patient or the local council.
Marie Curie describes in further detail what would make a person eligible for CHC:
“Having a terminal diagnosis isn’t enough on its own to make a person eligible for NHS Continuing Healthcare. They have to be very ill to get it. The NHS says the person must have ‘a complex medical condition with substantial, ongoing care needs’. To get it, people are assessed. If they meet the criteria, they are said to have a ‘primary health need’. That means the NHS now has responsibility for their care costs.”
The history of Continuing Healthcare
Before the NHS framework was launched in 2007, the entitlement for someone looking to be granted NHS healthcare funding was seen as somewhat unfair.
Back in 1995, some local areas formed a continuing healthcare framework template, until the NHS and local authorities expressed concerns around complaints about long-term decisions that were then deemed incorrect. The local policies were finally discarded and deemed unfit for national exposure.
In 1999, it was determined that local authorities should be paying for the care of chronically ill patients. However, this was soon changed and a decision was made that if the person’s healthcare need is a primary one, the costs should be covered by the NHS.
2003 saw another bump in the road, suggesting that the new guidance had not been solving the problem of local variation and the restrictive and somewhat confusing criteria could be the issue. This led to the 2007 report being launched where the decision was finally made that funding should fall solely with the NHS if the person’s need for care is a primary health need.
Who is eligible for Continuing Healthcare funding?
The NHS website outlines who is eligible for funding:
“Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
You should be fully involved in the assessment process, kept informed, and have your views regarding your needs and support taken into account. Carers and family members should also be consulted where appropriate.
A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.”
The guidance for eligibility is strict and often misleading. The assessed needs should meet the criteria of the NHS funding assessment and be confirmed as a primary health need that requires full-time care from a team of professional experts, only then will the costs of the care be completely covered by the NHS.
The National Framework for continuing healthcare funding confirms that ‘where an individual has a primary health need and is therefore eligible for NHS continuing healthcare, the NHS is responsible for providing all of that individual’s assessed needs – including accommodation if that is part of the overall need’.
However, one individual’s interpretation of a primary health care need can differ to another, sometimes it can take an expert to advocate for you and help evidence if someone truly has a primary health care need.
There are four characteristics that are tested to establish whether someone has a primary health care need. These are:
- Nature: “This characteristic looks at the individual’s needs, and the care interventions required to meet those needs. The National Framework for continuing healthcare funding provides a number of questions that can be useful in determining whether an individual’s needs constitute the required nature characteristic to be considered primary health needs”
- Intensity: “The characteristic of intensity looks at the quantity, severity and continuity of needs.”
- Complexity: “This characteristic looks at the level of skill and knowledge required to meet the individual’s needs as well as the interaction between two or more domains.”
- Unpredictability: “This characteristic considers the degree at which needs fluctuate and create challenges in managing the needs.”
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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