How do I apply for NHS Continuing Healthcare?
The process usually starts with an NHS Continuing Healthcare Checklist, which helps decide whether a full assessment is needed. This can be requested through a GP, social worker, care home, hospital discharge team or the relevant NHS body. We can help you understand the process and prepare the right evidence before an assessment takes place.
What happens during a NHS CHC assessment?
If a full assessment is needed, a multidisciplinary team will review your loved one’s care needs using the Decision Support Tool. They will consider areas such as mobility, cognition, behaviour, nutrition, continence, medication, skin integrity and other health needs before making a recommendation on eligibility.
What is the difference between NHS Continuing Healthcare and social care funding?
NHS Continuing Healthcare is arranged and funded by the NHS for adults with a primary health need and is not means-tested. Social care funding is usually arranged by the local authority and is financially assessed, meaning savings, income and assets may be taken into account.
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Emerald Law, specifically Heather Boyd, have been extremely efficient and professional throughout the process. Any information has been passed on or received in a timely manner and I would recommend Emerald Law without reservation.
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Clear communication throughout. Would use again.
I am so pleased that I engaged Emerald Law to investigate the possibility that my aunt should have been eligible for NHS Continuing Health Care funding. Emerald Law discovered that this was in fact the case, have recovered a substantial amount of care fees and we have at last received our proper inheritance, just as my aunt had intended.
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Can I challenge a past NHS CHC decision?
Yes, in some cases. If your loved one was refused NHS Continuing Healthcare, you may be able to challenge the decision if needs were not properly considered, evidence was missed, or the criteria were not applied correctly. Time limits can apply, so it is important to seek advice promptly.
Can someone receive NHS CHC funding at home?
Yes. NHS Continuing Healthcare can fund care in a person’s own home, as well as in a care home, nursing home or other care setting. Eligibility depends on the person’s assessed health and care needs, not where they receive care.
How can you help with appeals?
We can review the decision, identify potential grounds of challenge, gather supporting evidence and help present your loved one’s needs clearly under the NHS Continuing Healthcare criteria. We can also support you through local resolution and, where appropriate, further review stages.
Can you help recover care fees that were wrongly paid?
Yes, where there may be grounds to argue that your loved one should have been assessed or found eligible for NHS Continuing Healthcare during a past period of care. We can advise on whether a retrospective review may be possible and help prepare the evidence needed to pursue a claim.
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Frequently asked questions about NHS Continuing Healthcare funding
Can relatives of representatives take part in the NHS CHC process?
Yes. The person being assessed should be involved throughout the process wherever possible. With appropriate consent, relatives, carers, advocates or legal representatives can also contribute information, attend meetings and help ensure the person’s needs are accurately understood. Their evidence can be particularly important where the individual has difficulty communicating, lacks capacity or experiences fluctuating needs. Representatives may also request records, review assessment documents and raise concerns where the evidence does not accurately reflect the care required.
Will NHS Continuing Healthcare funding continue permanently?
Not necessarily. Eligibility is based on a person’s current needs and is normally reviewed after funding has been awarded. A review should consider whether the existing care package remains suitable and whether the person’s needs have changed. Funding should not be withdrawn simply because a review is taking place. Where eligibility may be reconsidered, the NHS should complete an appropriate reassessment and provide a clear written decision that can be challenged if necessary.
What is Fast Track NHS Continuing Healthcare?
The Fast Track pathway is for people whose condition is rapidly deteriorating and who may be entering a terminal phase. It allows an appropriate clinician to recommend immediate NHS Continuing Healthcare funding without first completing the standard Checklist or Decision Support Tool. Fast Track eligibility is based on the person’s clinical condition and need for an urgent package of care, rather than a specific diagnosis or predetermined life expectancy.
What happens if my loved one does not pass the NHS CHC Checklist?
A negative Checklist means the person will not usually progress to a full NHS Continuing Healthcare assessment at that time. However, the Checklist is only a screening tool and is not a final eligibility assessment. You can ask for the completed Checklist and an explanation of the decision. If relevant needs were overlooked, incorrectly recorded or unsupported by the available evidence, it may be possible to appeal.
Are savings, income, or property considered when deciding eligibility?
No, a person’s savings, income, investments or property does not determine whether they qualify. Eligibility is based on their assessed health and associated care needs. When someone is found eligible, the NHS is responsible for arranging and funding the agreed package of care. This differs from local-authority social care, where a financial assessment may be used to determine how much someone must contribute.
Do you need a particular diagnosis to qualify?
Eligibility for NHS Continuing Healthcare is not determined by having a particular illness, disability or diagnosis. Two people with the same condition may receive different decisions because their day-to-day needs differ. The assessment focuses on the person’s needs and the support required to manage them. This may include needs relating to cognition, behaviour, mobility, nutrition, medication, breathing, and continence.
Who is eligible for NHS Continuing Healthcare funding?
NHS Continuing Healthcare may be available to adults aged 18 or over who are assessed as having a “primary health need”. Eligibility is based on the nature, intensity, complexity and unpredictability of the person’s overall care needs, not simply their diagnosis or where they receive care. The assessment should consider how those needs interact and the level of skill, monitoring and intervention required to manage them safely.