Don't miss out! Read why fewer people are being found eligible for NHS CHC

Published 12/01/2024

NHS Continuing Healthcare Funding (CHC) is a free package of care provided by the NHS to individuals aged 18 or over, to meet their health and associated social care needs that have arisen as a result of disability, accident or illness. CHC is provided free at the point of need and is not means-tested. So, if you meet the eligibility criteria, the NHS will pay for all your assessed healthcare needs, free of charge. CHC Funding for care is provided by your local NHS Integrated Care Board (ICB).

However, whilst CHC should be accessible by all those who qualify, recent findings suggest that fewer people are being found eligible by their ICB for CHC Funding at a point in their lives when they need it most.

Assessments for CHC Funding are usually carried out by a Multi-Disciplinary Team (MDT). However, according to statistics compiled by NHS England in their Quarter 2, 2023-24 Care Report (published 09 November 2023), for the second quarter period, 1^st July to 30 September 2023, the total number of people referred for a standard MDT assessment was 16,147. Of this number 3,618 were discounted before assessment, leaving 12,529 people who were assessed via the standard MDT route (the vast majority, 11,852, using the standard Decision Support Tool). What is interesting is that the results show out of those 12,529 people assessed, only 2,568 were found eligible and awarded CHC Funding i.e. approximately a 20% conversion rate. By contrast, that means that there were 9,961 people (i.e. approximately 80%) who were assessed and found ineligible for CHC Funding.

When you consider that we generally have an ageing population, and if you think about those who are already being cared for at home, or indeed, in any type of care home or care facility, this seems to be a staggeringly low number getting access to CHC across the whole of England and Wales.

With ICBs expected to deliver huge cuts and savings from their budgets, it’s easy to see why less people may become eligible for CHC. But what other factors might be influencing this downturn in available funding?

Here are a few ideas exploring why so many people may be missing out on CHC:

In our experience, so few people have ever heard of CHC or know what it is. This is a major contributing factor as seen by the low numbers that were referred for assessment (16,147 in 3 months). For those who have come across CHC, most have no idea how to apply for an assessment to see if they are entitled to a fully-funded NHS package of free care. As we’ve said in previous blogs, the NHS don’t flaunt the availability of CHC and offer it. It has been described as the “NHS’s best kept secret”.

Rationing NHS Continuing Healthcare Funding – The ‘NHS’s Best Kept Secret’

What! You’re enquiring about care funding AND you’ve never heard of CHC??

Care funding is often a sensitive yet highly emotive topic of conversation on radio chat shows and in newspaper articles, with much mention of social care funding and families having to sell their parent’s home to pay for their care. But what is startling and equally frustrating and maddening, is that there is so little, if any, mention of CHC Funding! We estimate that many thousands of people are missing out on their entitlement to free NHS funded care.

Why is CHC always overlooked? Help spread the word…

Equally, those we speak to in the medical profession, GPs and Consultants alike, are typically clueless as to what CHC Funding is, and so fail to recommend their patients seek an assessment. So, if those working in the medical profession, and particularly within the NHS, haven’t heard of, or don’t really know or understand what CHC is, how can their patients be expected to know? Indeed, our recommended lawyers, Farley Dwek Solicitors, recently acted for two GPs who were unaware how to access CHC Funding for their own relative! Again, we wonder just how many thousands of NHS and private patients have missed out on CHC Funding due to ignorance.

Of course, care homes don’t often volunteer CHC to self-funding residents as a first port of call, because the fees they can charge a private-paying resident are usually far in excess of what they can get in CHC payments from the NHS for the same room.

How To Avoid Selling Your Home To Pay For Care…

Many people are told untruths or given wrong or misleading information which effectively puts them off having an assessment at all, or simply abandoning it if they get a negative MDT outcome – without necessarily understanding if their assessment was actually carried out fairly and robustly.

10 More Untruths About NHS Continuing Healthcare Funding

5 More Items of Fake News To Put You Off Claiming CHC Funding!

The 10 Most Outrageous Excuses For Not Having An NHS Continuing Healthcare Assessment

Any assessment as to eligibility for CHC Funding must first be done by the ICB before any discussion about funding takes place. However, that premise may not necessarily stop an ICB trying to divert a potentially eligible CHC candidate, by referring them to their Local Authority instead (where care will provided on a means-tested basis). For obvious budgeting reasons that might well suit the ICB because, if this tactic works, the NHS won’t have to fund the individual’s care. However, it could leave the individual frustrated if they are batted back and forth between their ICB and LA, until one body takes action and responsibility to provide and fund care.

We sometimes wonder whether some ICB assessors move the goal posts at MDT assessments, or raise the already lofty bar to achieving CHC, even higher, to make less people eligible? The flaw in the assessment process is that the interpretation and application of the eligibility criteria is entirely subjective. So, that, in theory, gives flexibility and discretion to assessors to reach negative decisions refusing CHC, which may be flawed or considered unfair or not robust. Over the years, we have heard too many horror stories of unfair or incompetent assessments being carried out.

On a similar theme, is the NHS National Framework – the rule book on CHC Funding – being interpreted and applied correctly by the appointed ICB’s assessors? What formal training and experience have they had to undertake these life-changing assessments? And why do a high percentage of negative decisions then go on to be successfully appealed further down the line? From the experiences of others shared on our website one can be forgiven for thinking that some NHS assessors are ‘asked’ to tow the party line and find people ineligible, simply to protect budgets, however shocking this may seem.

‘Fighting for NHS funding for my mother was as complex as my work on the nuclear deterrent…’

With stretched staffing resources, do care home accurately record daily entries appertaining to a patient’s daily care needs? Inaccurate, incorrect, misleading or missing entries, can have a significantly adverse effect on your chances of getting CHC awarded. Whilst the NHS assessors can, and should speak to care home staff and family members as to the individual’s healthcare needs, often what’s written in black and white carries far more weight. Poor record keeping can produce incorrect outcomes.

Do Care Homes Play A Part In Preventing Successful Outcomes For CHC Funding?

Whilst the CHC assessment process is intended to be user-friendly for the public to access, we often wonder how many people are having the wool pulled over their eyes. As we’ve already said, the public really have little actual knowledge of how the CHC process works or how to best present their case for Funding. Some have inflated ideas about their own knowledge of CHC or ability to present their case succinctly, but unfortunately, soon realise they are out of their depth against trained and hard-seasoned ICB assessors – often left coming away from their MDT with a feeling of mistrust or frustration. Others may have no idea that they have unwittingly been edged out of the assessment process. Good preparation and advocacy and support are critical.

Preparing for the Multi-Disciplinary Team Assessment

Can The MDT Panel Refuse To Proceed If I Have An Advocate?

Preparation, Preparation, Preparation! Never Take MDT Outcomes For Granted

Even if the CHC assessors do recommend that an individual is eligible for CHC at MDT, the ICB is the ultimate decision-maker and, therefore, have the power to reject any positive recommendation for funding. Admittedly, the circumstances have to be exceptional, but anecdotally, it seems to be happening too often.

Never count your chickens… Why MDT assessments are still a cause for concern!

Delays in getting assessed are an issue, too. According to the NHS Quarter 2 Care Report, as at August 2023, there were an estimated 249,589 people waiting for an assessment, of whom an estimated 84,788 had been waiting for over 6 months! If you are in need of an urgent CHC-funded care package for your relative, this is an inordinately long time to wait – the outcome of which could materially decide whether you need to sell an asset, such as your home, to pay for your own care (ie self-fund), or whether it will be provided free of charge by the NHS.

Summary

Of course, not every application for CHC will be successful. But there are too few people who know about CHC, and those who do try to access it, are often wrongly rejected. There needs to be so much more public awareness and training and that includes the medical profession, too!

Care To Be Different is a renowned resource website, helping families in the CHC arena, and excels in filling in the gaps, giving you practical guidance and tips on how to get CHC Funding, where applicable.

Here’s how we can help you!

Read our free blogs
Email us your enquiry
Call us on 0161 979 0430
Book an appointment with our Nurse Advice Helpline for specialist advice
Join our Facebook community and get help from others with similar experiences.
Don’t miss our helpful book: “How To Get The NHS To Pay For Care” available as a paperback or PDF download

If there is a particular topic you would like us to cover, we’d love to hear from you! Just send an email via our “Contact Us” page with the subject “blog request” and we’ll do our best to cover your suggested topic.

If you have wrongly been rejected for CHC, share your experience here with others who can benefit and learn…

Tagged Categories: CHC eligibility, CHC essentials, CHC funding, NHS Continuing Healthcare

Share this article

6 Comments

Kryssi January 20, 2024 at 9:28 am

My mother is 87 and has Alzheimer's. She was forced into a home where if it wasn't for me she would have surely died. Due to my constant complaints her social worker backed by the local authority dragged me throug the courts to take away my lasting power of attorney. All because I wanted my mother home and not left with strangers to die. They were unsuccessful and the court decided that my mother should be returned home. Now I am in another battle about to who and how her section 117 funding should be paid. They want my mother of 87 to become am employer if she chooses someone to help me with her care. I am refusing this as after everything my mother will be required to pay as an employer does not leave much to pay a carer. I contacted the ICB and they have told me they can not help and will not even consider CHC and can not help me. It is so ridiculous how difficult it is to get help or to actually be able to sit down and discuss anything with anyone. Everything is online be it meetings or even sometimes court hearings and in most of those you are totally ignored while they all waffle between themselves. It makes me wonder if all this stress is done deliberately, a form of Elderly Genocide by proxy......

nigel duckworth January 19, 2024 at 6:28 pm

I am one of those in the set of statistics mentioned.. CHC refused. Although my father in law, for whom I was acting. ( he is in care) got 5As on the checklist, nearly all his DST needs were marked as low, so that the assessors could get the result they clearly wanted. They failed to take well managed needs into account, saying that they would be discussed after the Domains completion. But immediately after that completion, they terminated the whole assessment. They failed to assess and mention the limits of LA care provision, as they did with the Coughlan test. They failed also to evaluate risks and underlying needs, the latter being particularly important because my relative has paranoid schizophrenia and is subject to relapses when, amongst other behaviour, he has attacked care home staff and patients, tried to escape, been sectioned under S2 MHA, almost starved himself to death, failed to recognise his only daughter and also been arrested by police for being at night on the embankment of the M1 motorway with voices in his head telling him to stop the traffic. None of this was taken into account because the assessors were only evaluating his current needs and he was having at that time one of his better spells There was a year delay between when assessment should have taken place and when it did, contributing to me not being able to put forward as relevant, all those instances I have mentioned. That is down to the ICB. My relative's illness is incurable but manageable for periods-until the next relapse. I had prepared arguments on the law about LA limits of care and also Coughlan but they were not allowed, because of the termination of my involvement before we got to primary health need tests. The lead assessor said, when I asked whether Coughlan would be taken into account, at the DST outset, that she was not sure what I meant! So clearly she had no idea of the law despite the fact that the Coughlan test is paramount and she had no qualifications in mental health. Ironically, my brother who took notes for me, had 35 years as an RMN, RGN and latterly Assistant Director of nursing for mental health and also Clinical Director. Even so, we had no chance. I wrote a 6 page closely typed well argued (I thought) letter after the assessment to the director of adult services about all the failings and got precisely nowhere. It was read and then ignored. I am a lawyer. What chance do those who are not and must conduct their own DST assessment stand? Deliberate shambles does not begin to describe this farrago.

Andrea January 19, 2024 at 5:16 pm

You question (point 8) whether the National Framework is being interpreted and applied correctly by assessors. In my experience, it was clearly being misapplied and, as a result, the ICB was acting unlawfully. The scale of the wrongdoing in my case could not be put down to errors or differences in interpretation; it must be down to staff following policy decisions which have been made in order to protect this particular budget at all costs, even if it results in the law being broken. It's a national scandal. I have successfully challenged the ICB twice; once at the initial MDT and again at the 3-month review. The second time, they acknowledged their failings and said that they would be introducing staff training. They should not have to be schooled by a member of the public. It is intimidating to have to challenge the very people you are hoping will find in your favour and they know this. Even the Local Authority warned me that the ICB was 'very big'. I replied they were also 'very wrong'. I fought them, not just on behalf of my Mother, but also on behalf of others who are being wronged by a system which should be there to protect them. The fight will continue, as the annual review approaches...

Care to be Different January 26, 2024 at 1:52 pm

Thanks for your post Andrea - keep up the fight! If you would like any support with it please do not hesitate to get in touch enquiries@caretobedifferent.co.uk kind regards

JU January 19, 2024 at 1:52 pm

Although my late husband was 100% disabled - oh, but he could see, speak, swallow, breathe and also he could move his hands, his scores were downgraded by the CHC dept. The Nurse Assessor at the hospital, following my late husband's discharge, awarded him 2As, one for non mobility and one for his skin issues. He should also have been awarded one for hisType 2 diabetes with complications (diabetic neuropathy in his hands & feet) - A little known fact! I then contacted the Parliamentary Health Ombudsman (I thought that they were impartial) but they informed me that there was no malpractice! I decided that I would not pay the invoice, mainly because my late husband signed the Contract and also for the fraudulent activity going on within the departments. The Bailiffs have now stated that they do not want to take me to Court but I am not afraid to expose the fraudulent activity going on within the CHC department. I have photographs of the way my late husband suffered but I cannot get the CQC to downgrade the Nursing Home from Good to Needs Improvement or to even close them down. I am fighting for justice for my late husband and the many elderly people who have been treated with contempt. The National Framework is based on Mrs Coughlan who was 100% disabled but at least she could use a wheelchair, unlike my late husband who could not and Mrs Grogan who suffered from Odema, just like my late husband. He had many medical issues, which made him 100% disabled.

Care to be Different January 19, 2024 at 3:34 pm

Many thanks for sharing this. Please do get in touch if you would like any assistance with it. Kind regards. 0161 979 0430