NHS Funded Care

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When you look after a parent with a health condition, who now requires continual care, you may not know where to turn.  It’s natural to be asking lots of questions; you’ll want to know who can help care for them, whether they can be cared for at home and if you can get funding towards healthcare.

NHS healthcare is always free (hospital treatment, a visit from a district nurse or a visit to a GP). NHS Funded Care is care that is arranged and funded by the NHS free of charge outside of hospital.  It is available for people who need ongoing healthcare and meet certain criteria. This is also known as ‘fully funded NHS care’.

In this section we’ll guide you through the NHS funded care options available for those who need ongoing care.

NHS Continuing Healthcare Funding

NHS Continuing Healthcare Funding

This NHS funded healthcare can be provided at home, in a care home or in a hospice when someone requires continual care due to significant health needs.  This health and social care package is fully funded by the NHS to meet health and personal care needs.

  • If someone in a care home is eligible for NHS continuing healthcare, this will cover all care home fees, including cost of accommodation, personal care and healthcare.
  • If NHS continuing healthcare is provided at home, it covers personal care and healthcare costs. It may also include support for carers.

You can read about NHS Continuing healthcare on their website.

Applying for healthcare funding

To apply for NHS Continuing Healthcare Funding, your parent must be assessed as having a ‘primary health need’, and have a complex medical condition and ongoing care needs.  Not everyone with a long-term condition or disability is eligible for healthcare funding.

In the first instance speak to your parent’s GP, Clinical Commissioning Group or their social worker to arrange for them to have an NHS continuing healthcare assessment.

The qualifying criteria for continuing care funding is ‘needs based’.

Local Authority’s Responsibility

Local Authority’s Responsibility

If your parent doesn’t qualify for NHS continuing healthcare, then their local authority will be responsible for their case assessment and providing health services if they are deemed to be eligible under their own assessment schemes.

 

Care packages

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There are other healthcare packages available, which involve some care from the NHS, should your parent not qualify for NHS continuing healthcare funding, but have been assessed as requiring care or nursing needs.

  • For a parent being cared for in their own home, this could be part of a joint package of care, with some services coming from the NHS and some from social services.
  • Or, if they move into a nursing home, the NHS may contribute funds towards their nursing care costs.

The assessment for continual care funding

There will be an initial assessment to determine if your parent meets the criteria needed to receive free healthcare; this will be carried out by a nurse, a doctor, a healthcare professional or a social worker.  If the criteria for NHS continuing healthcare funding is met, a full assessment will take place following a referral.

The assessment for continual care funding

The full assessment will be undertaken by a multi-disciplinary team made up of health and social care professionals already involved in your parent’s care. They will use a ‘decision support tool’ to determine if your parent is eligible for NHS continuing care which covers areas including mobility, nutrition, continence, breathing and skin.

Challenging the decision

For each of the issues a decision is made about the level of need – priority, severe, high, moderate or low.  If your parent has at least one priority need, or severe needs in at least two areas, they should be able to receive NHS continuing healthcare.

Challenging the decision

If you believe that your parent is entitled to free funding to support healthcare and don’t agree with the outcome of the assessment, you have the right to appeal.

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The assessment should consider your parent’s and your own views and you should be given a copy of the completed decision support tool document with clear reasons for the decision.

A copy of the formal appeals process should have been provided by the NHS during the assessment process.  Here are the steps to make your appeal:

  • Write to the Manager of the NHS Continuing Healthcare Team at the local Clinical Commissioning Group (CCG) within 6 months of the decision being made.
  • Make it clear that you disagree and give the reasons why you disagree. You also have the right to ask for the initial checklist or assessment to be repeated.
  • The CCG have 5 days to acknowledge receipt of your appeal and provide information of the Continuing Care appeal process.
  • Your appeal will be actioned within 3 months by the CCG. You will be notified if this timescale cannot be met.

Denied funding after an appeal

3months

In cases where the CCG still deny funding, but you still believe that your parent qualifies, you should contact NHS England to request an Independent Review Panel hearing.

This independent review should take place within 3 months.  If there are reasons why this timescale cannot be met, you will be notified.

The decision from the Independent Review Panel will be made within 6 months of their review.

If you are still unhappy with the decision, you have 12 months to contact the Parliamentary Health Service Ombudsman.

You can read a leaflet online from NHS England which gives in overview of the NHS Continuing Healthcare Independent Review Panel process.

Deteriorating Condition

Deteriorating Condition

If your parent’s condition is deteriorating fast and their need for care and funding rises, they should be assessed under the NHS continuing care fast track pathway, to put in place a care package as soon as possible. Government guidance says that care should be put in place within 48 hours of someone being found eligible under the fast track pathway.

NHS Intermediate Care

Intermediate care is another form of NHS funded care which includes free care at home for 6 weeks following a stay in hospital or for care to continue in the home when there is a breakdown in care services (for example, a caring partner has been taken in to hospital).

NHS Intermediate Care will give you peace of mind as a hospital discharge care plan will be drawn up prior to your parent returning home from hospital.

If your parent needs care at home, contact their local social services department, and make sure you let the department know that it is an emergency situation.

There is more information on the NHS website regarding intermediate care available after discharge from hospital.

NHS Funded Nursing Care

NHS Funded Nursing Care

This nursing care, funded by the NHS, is provided by a registered nurse for those living in a care home which has been registered to provide nursing care.  To be eligible for NHS funded nursing care, the person living in a care home does not qualify for NHS continuing healthcare, but has been assessed as needing ongoing care.

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This registered nursing care contribution is a tax-free, non-means tested benefit paid by the NHS to cover nursing needs or medical care. It’s paid whether the care is self-financed or funded by the local authority or trust.

It is paid directly to the care home to reimburse them for the nursing care that is being provided.  If you are self-funding all your own care, then your payments will be reduced by the Nursing Care Contribution amount.

If the care fees are part-funded, you might also get a reduction through the Contribution. It should also be paid if your parent’s stay in the care home is temporary, and if the stay is for six weeks or less, then there is no need for a formal assessment. This is particularly useful for periods of respite care.

You can ask for an assessment for Nursing Care Contribution at the same time as the Local Authority undertakes a needs assessment; or you can contact them afterwards and asked for a separate assessment.

Other NHS services available in care homes include continence aids and specialist/support or services such as chiropody, physiotherapy, pressure relief mattresses and mobility or communications aids.

The NHS have a guide on funded nursing care which you can read about here.

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Questions and Answers

We’ve put together answers to five commonly asked questions regarding caring for someone with a chronic condition and NHS continuing healthcare funding:

My mum has been diagnosed with a chronic condition and I believe my mum needs care.  We’re worried we can’t afford healthcare, will she be eligible for NHS continuing healthcare funding?
 
To receive NHS continuing healthcare, the person must be assessed as having a ‘primary health need’.  Diagnosis of a condition does not always mean that the person qualifies for this NHS funding, as the assessment will take into consideration the severity of the condition.
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Who decides whether my parent qualifies for NHS continuing healthcare?
Your local Clinical Commissioning Group, made up of local GPS, determine whether the patients they assess qualify for this NHS funding to help with their care.
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My dad needs healthcare, but he’s relatively young, he’s only in his 60’s.  Is this type of funding only for the very elderly? 
This funding is for any stage of adult life; it’s not just for an elderly person requiring care.
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If my parents do qualify for NHS continuing healthcare funding, will we still have to pay towards their health and personal care as they have savings? 
This healthcare funding is purely ‘needs based’ not ‘means tested’ and it is not capped, so your savings are safe and should not be used to pay for their health and personal care.
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My mum is ill and needs a lot of care.  She needs help to pay for healthcare, will I need to sell my parents’ house to help cover care costs and fees?
  If your mum has been assessed as having a primary health need, then no.
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moreinformation

More Information

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