The “NHS Continuing Healthcare Funding” refers to the funding service provided by the NHS where they will pay the full cost of care for any individual with sufficient “primary healthcare need” judged eligible.

Eligibility for NHS Continuing Healthcare Funding is assessed by the NHS using rules and guidelines set out in what’s known as The NHS Framework. This Framework sets out criteria by which entitlement for this is assessed.

In order to work out an individuals needs and care requirements and decide whether they will be entitled for Continuing Healthcare Funding, they will need to undertake a Continuing Healthcare Assessment, carried out by the NHS. Not everyone requiring care will have a primary healthcare need, so it’s important that this assessment is carried out in order to find out not only eligibility for funding but whether this should be the responsibility of the NHS or the Local Authority.

In the majority of cases, we will be dealing with the families of those in care and assisting them with this process, though in some cases, we may deal with the patient or relative directly.

Your right to continuing healthcare funding

Where an individual has a primary healthcare need, they have a right to be assessed for eligibility, and this should be done first before any conversations are held with Social Services, the Local Authority or anyone else concerning care arrangements.

However, though this is a right, there is no legal obligation for NHS staff to mention or carry out such an assessment unless there is judged to be a “need for such care”.

It is also possible in some cases that NHS staff may, unintentionally or otherwise, misinform patients of their rights and make inaccurate claims about eligibility. Any individual with primary care needs is entitled to the assessment, irrespective of what other conditions or circumstances they may find themselves in (such as suffering from dementia).

Where we at Care Fee Recovery can help is where the NHS has either failed to carry out this assessment or has carried out the assessment incorrectly.

The NHS or clinicians may carry out other ad hoc checks or assessments in hospital, but these are not equivalent, and should not be taken as a substitute for, the Continuing Healthcare Assessment. Even if a proper assessment has been performed, it could be deemed invalid if the patient was not informed it was taking place. In these circumstances another assessment may be requested.

The individual in need of care and their family should not sign or agree to anything, whether related to a care agreement or financial terms, without this assessment having taken place first.

Social services and clinicians should not ask any questions about payment or financial matters prior to the assessment, not only is it against the NHS Framework Advice, but these matters should have no bearing or influence upon the assessment and should only be raised after the Checklist Assessment has taken place.