Continuing Healthcare Funding

When assessing whether a person will qualify for CHC, the only criteria that is relevant is the person’s health and care needs. Where it is decided that somebody’s primary needs are medical rather than social care needs, the NHS will fully fund an individual’s care, be that in a nursing care placement or, if safe and appropriate, in a community setting, i.e. at home.

To establish whether a person’s care needs are predominantly medical rather than social an initial assessment is completed using a CHC Checklist  Checklist.  If the person is shown to have a specified level of needs than a full CHC assessment is undertaking using a Decision Support Tool at a multi-disciplinary meeting.

The person requiring care and their family (or representatives) are often unaware of the purpose of the meeting  and usually have no understanding of the significance of the outcome . Sometimes leading to information being missed or downplayed  which could resulted in continuing healthcare funding being awarded.

You should contact Sydney Mitchell if this is the case.

The full assessment using the Decision Support Tool (DST) is a more extensive assessment, during this assessment, a wide range of ‘domains’ (areas of need) are reviewed.  Assessments are usually lengthy and can be complex often dealing with medical issues which are outside the family’s understanding.  It is crucial that all aspects of a person’s health needs are raised and taken into account appropriately at this meeting and that the best possible case is made for you or your relative.

The assessment ought to be multi-disciplinary in nature i.e. drawing on information from various professionals regarding the individuals care needs.

You should be given adequate advance notice of the date and time of the proposed Assessment in order for you to attend. Again if an assessment has taken place without your knowledge you should contact us.

On completion of the DST assessment the individual or their representatives ought to be told what the assessors

recommendation is. This recommendation is not a final decision. The completed DST will be agreed by the professionals present and is then submitted to a CHC panel for ratification.  The panel makes the final decision based on the evidence provided, or in some cases may ask for further evidence or information to enable them to make a decision.

If continuing health care funding is agreed , the DST will be reviewed within three months. When the review is undertaken this should be with the person or their representative.

If ongoing continuing healthcare funding is approved,  it is normally subject to review on a yearly basis or earlier if there have been any significant changes to the person’s care needs.

If CHC funding is declined at panel, the individual or their representative has the right to appeal the decision.

At Sydney Mitchell we have an experienced team with both the legal skills and medical understanding to assist you in negotiating this complex assessment process.