NHS Continuing Healthcare (CHC)
CHC is one of the most contentious issues in healthcare because the financial support it offers is in effect life-changing. The process can seem quite overwhelming and many families will feel that they have come through something akin to a rather tortuous job interview at a time when they are already under considerable stress.
In simple terms once CHC has been awarded it pays for all healthcare costs including accommodation. Research online and you will find exactly that – CHC pays all healthcare costs. In theory. In practise if your relative is in a care home that charges above average fees you will find that you are expected to pay a ‘top-up’ although such payments are arguably illegal. There is no official cap to CHC but all CHC funding groups operate with a cap – usually about £720. My mother has CHC but I still have to pay about £1450 a month which is the balance between the fee charged by the home and the £720 that CHC pay. You could of course refuse to pay the top-up but:
1. The care home would be likely to ask your relative to leave unless NHS pays the balance.
2. The NHS will not pay the balance but will offer to transfer your relative to a cheaper home where the fee is equal to the CHC payment (say £720).
3. If you refuse to pay the top-up you could contest the decision to transfer your relative but you would have to prove that they would suffer ‘harm’ as a result of such a move. And that is difficult to prove.
National Framework for NHS CHC
Since 2007 there has been a National Framework setting out the criteria under which CHC is awarded. There are twelve criteria including cognition, mobility, behaviour and nutrition which are scaled according to a scale of needs rising from low to severe (and priority in two cases). The Framework sets out the overall ‘score’ required to achieve CHC funding. Although this is intended to be objective there is inevitably a degree of subjectivity which is where issues can arise between a family desperate to achieve funding and a NHS practitioner who has to balance healthcare needs against a tight budget. Inevitably disputes arise and many families find themselves fighting their way through an appeals procedure.
NHS CHC is funded solely by the NHS and awarded if the criteria are met to individuals not in hospital but who may be living in a range of other situations including residential care, a hospice or even at home. The key is that your primary need for care is related to your health. It would not therefore be awarded to someone in the early stages of dementia that perhaps needed assistance with personal care or help with shopping.
Following the initial award of CHC funding there will be a review after three months and thereafter at least once every twelve months. Clearly if the needs of an individual change a review may well conclude that the individual is no longer legible for funding.