NHS Continuing Healthcare

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What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS. A person may be eligible for this if their needs are primarily medical rather than social. This could include if a person’s medical condition is unstable, unpredictable and means that they need constant round the clock specialist or intensive nursing care. NHS Continuing Healthcare focuses on health needs rather than social needs such as dressing, feeding and moving around.

What are the rules that govern NHS Continuing Healthcare?

There is a National framework based on best practice principals where a person’s needs are assessed over eleven different domains.

Who is assessed for Continuing Heath Care (“CHC”)?

Before being discharged from hospital everyone should have an assessment carried out by the hospital staff using the Checklist. The Checklist will determine whether a full CHC Assessment should be carried out or not. An eligible person could fail to qualify at this stage. If a full CHC assessment is thought to be needed the Decision Support Tool will be used assessing the person’s needs over the eleven different domains.

Am I entitled to see the Decision?

The person who is the subject of the assessment is entitled to see the decision. Strictly speaking, nobody else is entitled without the person’s authority (if they have mental capacity) or without a Health and Welfare Lasting Power of Attorney or Deputyship Order. You should always ask for a copy of the assessment. If you are refused, ask why.

Can I challenge the decision of the Clinical Commissioning Group?

Here at Wilson Browne we have a specialist team who can assist you if you decide to challenge the decision of the Clinical Commissioning Group. You can challenge in the following circumstances:

The person has been denied NHS Continuing Healthcare funding from the outset;
The person was receiving NHS Continuing Healthcare funding and has now been assessed as no longer eligible;
The person has died and you believe that they should have been entitled to Continuing Healthcare funding. In this situation you can make a claim on behalf of the deceased person’s estate.

Why use a Solicitor?

A specialist from Wilson Browne will meet with you as soon as possible to discuss the matter and offer their opinion on whether or not you should proceed with the challenge. If you decide to proceed we can arrange for our own expert to visit the person requiring care to carry out a reassessment. Once this has been carried out our expert will prepare a full report on how to proceed. We can also arrange for our expert to represent you at any future independent review panel, if you wish.

How much will it cost?

In some cases, for example where the person or estate has suffered a loss because they were told that they were not eligible to CHC funding, we may be able to act for you on a contingency fee basis (that is you pay nothing up front other than initial agreed disbursements and then we are paid a percentage of any damages awarded). In other cases, where the person has been denied CHC funding from the outset or loses CHC, we can act on a time spent basis. We will discuss the fees with you before commencement as each case is dealt with individually.