old people and carer in care home garden

Are you eligible for NHS funding for your Care?

When starting to look at care options, one of the most asked questions, and incidentally one of the worst answered, is “when is someone eligible for the NHS to fund their care?”

This is a deeply misunderstood subject, but we will try and pick through some of the broader details here.

The basic answer to this question is that the NHS is responsible for meeting healthcare needs but is not responsible for funding an individual’s social care needs. This may be confusing and seem slightly subjective and the line between health care and social care can sometimes be slightly blurred.

Why is CHC Funding such a positive outcome?

If you are assessed as eligible for NHS continuing healthcare, the financial benefits are very positive and people can save a great deal of money on long-term residential care. This is because the NHS will pay all of your care fees.

CHC Funding is not means-tested, this means that if you qualify it does not matter what financial resources you have you will not have to contribute to the cost of your care.

NHS continuing healthcare

Continuing healthcare is fully-funded NHS care for adults who are severely ill and need care over an extended period.

You may have a disability, injury, or illness and need help with physical or mental health needs. If you qualify for NHS continuing healthcare, all your care fees are funded by the NHS. This includes any care provided:

At home
In a nursing home
In a hospice

If you have a high level of healthcare needs, ask for an NHS continuing healthcare assessment. In the future, you can request a reassessment for NHS continuing healthcare if your health deteriorates.

Your NHS continuing healthcare assessment

The technical description that Nurses use to decide if you are entitled to CHC funding is based on whether your “primary need” is healthcare or social care. Every individual will have a combination of health care needs and social care needs, whether you qualify will depend on which is assessed as being the “primary need”. It seems simple:

You qualify if you have a combination of health and social care needs and your primary need is health
You will not qualify if you have a combination of health and social care needs and your primary need is social

To qualify for NHS continuing healthcare, you’re first assessed by two (or more) nurses from your primary care trust. They do this using a ‘decision support tool’ to assess each area of need.

Continuing healthcare assessments are very strict, if they were not and everybody received such funding the NHS would quickly run out of money. Following an assessment, many people will feel disappointed because they need significant levels of care and support but do not qualify for CHC funding.

For example, many people will be very frail and have long-term care needs but don’t have any medical issues and therefore don’t qualify for NHS continuing healthcare. This can be the case despite you having long-term care needs.

Primary health need

To be eligible for NHS continuing healthcare your assessment must determine that you have a ‘primary health need’. This primary health need must have arisen because of disability, accident, or illness.

Social care needs are often described as being mainly focused on an individual’s daily living activities. These include eating and drinking, getting dressed, getting up or going to bed, mobilising and moving or washing and showering, or taking medication. This category also covers helping someone stay independent, enjoy social interaction, or maintain family relationships as well as protecting vulnerable people from worrying situations.

Needing help from and being dependent on other people for support and assistance is does not in itself qualify as a Primary Health Need

A healthcare need on the other hand is related to the “treatment, control or prevention of disease, illness, injury or disability; and the care or aftercare of a person with those needs”. Working out whether someone has a primary health need involves assessing all of their relevant needs and assessing which are the primary ones.

Establishing eligibility and the NHS continuing healthcare checklist

There’s no simple list of what health conditions and illnesses qualify for funding. However, there is some clear national guidance that helps clinicians assess eligibility, this helps to ensure there is a consistent approach. This eligibility is measured against a checklist of 12 areas of care, known as ‘domains’.

The NHS continuing healthcare checklist can help you see if you should have a full assessment to determine your eligibility.