Is it becoming harder to qualify for (free) NHS Continuing Healthcare?

posted in: News

Last week, the National Audit Office produced a detailed report on the current state of NHS Continuing Healthcare (NHS CHC). The report looks at how effective the process is for assessing NHS CHC.

In the report, NHS England estimates that at least 124,000 standard (non fast-track) screenings and 83,000 fast-track tools were completed in 2015-16, and that around 62% of people who were screened using the checklist went on to have a full assessment however only approximately 18% of screenings undertaken led to the person being assessed as eligible for NHS CHC.

Also, many people are waiting longer than the set 28 day time frame for making eligibility decisions, in fact in 2015-16, about one-third of full assessments (24,901) took longer than 28 days.

Another interesting point is that between 2011-12 and 2015-16, the estimated proportion of people referred for a full assessment that resulted in that person being assessed as eligible for NHS CHC fell from 34% to 29%.

So what this information tells us is that:

The NHS is under increasing fiscal pressure
The percentage of people being assessed that go on to receive CHC is falling
It is more important than ever that individuals understand the processes involved in establishing eligibility

Whilst is has been recognised by NHS England that the current assessment process for NHS CHC funding raises people’s expectations about whether they will receive funding and that there is room for vast improvement, we’re not sure what changes will be made and how any changes will effect those going through the assessment in the future. It is likely that as a result of the confusing nature of the application process that more people will require independent guidance and advice around how to apply for NHS CHC and how to present their case.

Ultimately if someone is assessed as eligible for NHS CHC their health and social care costs are paid for by their local CCG. If however they are assessed as not eligible, the local authority and/or the individual may have to pay their social care costs instead.

My Care Consultant has produced a practical guide designed to help those needing care and their families, advisers and professional representatives to navigate the NHS CHC assessment process, including what’s involved and how to dispute decisions. If you would like a copy of the guide please email and reference your request: NHS CHC.