What it is about

People with significant healthcare needs may be entitled to funding by the NHS.  This means that nursing home or care home fees, or in some cases the cost of care provided in the individual’s home, will be paid for. This can of course result in huge savings for the individual and his/her family.

Assessment: this often takes place when someone is in hospital and decisions are being made about where they should live on discharge.  There is an initial assessment carried out by a doctor, nurse or social worker, and unless it is clear that Continuing Care will not apply a full assessment and decision about funding will be made by the “clinical commissioning group”, which may be the GP surgery.  The local authority will be consulted as part of the process.

The assessment is based on a detailed questionnaire called the Decision Support Tool, which is designed to allow the recording of the person’s health needs by reference to various criteria.  The results lead to a decision about whether the person is entitled to NHS Continuing Care, and you can ask for a review of the decision by the clinical commissioning group, and thereafter if necessary by NHS England.  These reviews are subject to time limits.

There is a ‘fast track’ procedure for those diagnosed with a terminal illness.

What you should do

  1. Ask for an assessment if you think one is needed.  There have been many cases where people have had to arrange and pay for their own care when they were in fact entitled to NHS Continuing Care.  If a full assessment is refused at the first stage this should be questioned unless it is absolutely clear that result of a full assessment would not result in Continuing Care funding.
  1. Participate in the assessment.  The decision is based on the evidence collected, and the person concerned and his/her family can contribute to this, and correct where necessary any errors.  For example whether a person “sleeps through the night” or “becomes distressed when left alone” can make the difference in some cases. Correcting mistakes after an assessment has been completed is often very difficult.
  1. Seek legal advice at an early stage in the process.  The individual and his/her family will usually be the only people involved in the process not familiar with it and in many cases will benefit from professional support.  The legal issues are complex, and can be considered as part of an in-depth review of the person’s finances and care arrangements.

Tassells have extensive experience in dealing with Continuing Care cases.   Please contact us and ask to speak with James Matthews or Ann Astbury.