3 further myths about NHS Continuing Healthcare

Published 24/07/2017

Please note: This article was published prior to July 2022, and some information may be outdated.

Double check what you’re told by Continuing Healthcare professionals

There are many myths flying around about NHS Continuing Healthcare. We’ve heard three pieces of ‘advice’ recently that rang alarm bells – because the statements were hugely misleading. Read on for 3 further myths about NHS Continuing Healthcare…

The comments on our blog reflect just how many people are given incorrect information by Continuing Healthcare assessors and local authority representatives.

Families are also sometimes given incorrect information by Continuing Healthcare advisors and solicitors. Such advisors can – and do – play a vital role in helping families through the Continuing Healthcare process. At the same time, however, it’s always worth double checking the information you’re given – no matter what the source – because everyone is fallible at times.

Here are 3 further myths about NHS Continuing Healthcare we’ve recently read or heard:

1) You can’t have NHS Continuing Healthcare in a residential care home.

2) You have to leave hospital and start paying for care before you can have an NHS Continuing Healthcare assessment.

3) You can’t challenge the outcome of a Checklist assessment.

These are ALL incorrect.

Let’s look at them in a bit more detail and include some references to help you:

1) “You can’t have NHS Continuing Healthcare in a residential care home.”

This is absolute nonsense – and a very basic error – and any advisor or assessor fully aware of the National Framework guidelines will know this. If you’re told this, you can counter it by quoting the following reference:

National Framework page 10, paragraph 13:

“Eligibility for NHS continuing healthcare places no limits on the settings in which the package of support can be offered or on the type of service delivery.”

Page 21 para 56:

“NHS continuing healthcare may be provided in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility for NHS continuing healthcare is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care.”

Funded Nursing Care payments, on the other hand, are not available in residential homes/care homes without nursing. Read more about Funded Nursing Care here.

2) “You have to leave hospital and start paying for care before you can have an NHS Continuing Healthcare assessment.”

As many families have sadly discovered, once you’ve left hospital you have very little leverage to get the Continuing Healthcare assessment process started quickly. If you are discharged from hospital before the Continuing Healthcare assessment process gas been started, remember that the NHS is legally responsible for paying for care until the assessment process is complete.

3) “You can’t challenge the outcome of a Checklist assessment.”

This is incorrect. You certainly can challenge the outcome of a Checklist and ask for it to be done again. Also, a Checklist is not always essential; instead, a person can go straight to a full multidisciplinary assessment if their needs are such that they would obviously get through the Checklist stage.

These references may help you:

National Framework page 26, paragraph 76:

“Where the outcome is not to proceed [from the Checklist] to full assessment of eligibility, the written decision should also contain details of the individual’s right to ask the CCG to reconsider the decision. The CCG should give such requests due consideration, taking account of all the information available, including additional information from the individual or carer.”

National Framework page 27, paragraph 77:

“Once an individual has been referred for a full assessment for NHS continuing healthcare (following use of the Checklist or, if a Checklist is not used in an individual case, following direct referral for full consideration)…”

So remember that it’s always worth double checking any advice you receive – whomever it may be from – to make sure you have accurate information with which to argue your Continuing Healthcare case.

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Tagged Categories: CHC funding, NHS Continuing Healthcare

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15 Comments

Beverley Harding March 30, 2018 at 7:46 pm

My dad was hospitalised after another serious fall at home and was discharged into a nursing home. He was assessed for NHS Continuing Healthcare (CHC) and refused both, to the surprise of the nursing home and my family. They got dad assessed by another area and he was allowed Funded Nursing Care (FNC). The FNC payments took 6 months to come through, in the meantime he had to pay the full amount to the nursing home. I always believed he should have been entitled to the CHC. Sadly he passed away last week in the nursing home amid very sad circumstances which I can't go into as the family may take action. The nursing home has requested a review of his eligibility for funding. I am not holding my breath! Anyone else been able to make a successful claim after the person has passed away? This makes NO sense!

Evelyn July 25, 2017 at 7:58 pm

My mother in law was found retrospectively to be ineligible for N.H.S. Continuing Healthcare (CHC), the Multidisciplinary Team found that she had a health need but not a primary a health need, my husband and I disagreed with this finding, and had a half hour telephone appointment with a member of the Retrospective Review Team: Local Dispute Resolution and their argument is that there is not enough evidence to support a change of their opinion, the paper work recording her health needs had been mislaid, so the evidence that their decision based on was, very limited G.P. notes, and her health needs were being successfully managed by the care home, Mother was suffering from Alzheimers, was partially sighted, profoundly deaf, pre-diabetic, and suffering from foot ulcers one of which led to her death, she was also on her discharge from hospital into a care home assessed by social work and found to be self-funding, she had never been assessed for N.H.S. CHC, and although they agree this should have been done "unfortunately this cannot now be changed". We are undecided as to whether to take this case to N.H.S. England, it seems like its our word against theirs.

Alison Tucker July 25, 2017 at 6:06 pm

Hi, i have to go before appeal panel on 9th Aug for mum who has advanced dementia. Reading your excellent website can i insist under Care Act the local authorities limits test is applied. Mum has never been given a social worker so there will be noone on panel from social services. What is your advice please? Thanks

Alison Tucker July 26, 2017 at 4:47 pm

Hi Steve. Many thanks for your comments. I've called Continuing Healthcare (CHC) this afternoon. Its a local resolution meeting i am attending on 9th Aug. CHC lady said there is nothing in the framework to say a social worker has to be present. She said Local authority limits were done at the original Decision Support Tool meeting . No one at the meeting will have met my mum. Please any comments would be a greah help thank you. Alison

Steve July 26, 2017 at 10:01 am

I would immediately get social services involved. Request that a social worker be assigned and ask for representation at the appeal. By law a Local Authority (LA) can only accept responsibility for care that is "incidental or ancillary to the provision of accommodation". If the LA declines that responsibility, then it falls to the NHS to provide it (via Continuing Healthcare (CHC)). But if the LA is not represented, how can it ensure that a legal decision is made? I would suggest that failing to be represented at an appeal would be an act of negligence.

J KEITH PATTISON July 25, 2017 at 2:25 pm

Hello Everyone
My wife of 64 years of marriage has been in a care home now for just over a year with advanced dementia, in recent weeks Joyce aged 85 had what i was told an unobserved fall and sadly broke her hip, in the was in Hospital a week, before been discharged back to the care home. During this time and since her return no one has mentioned continuous care. My poor wife has a community nurse to dress a weeping sore 3/4 times a week. Our Doctor can see no benefit of returning Joyce to hospital because of her advanced dementia. We are both 85 and I miss her very much. It is not for any financial gain I just want to provide care for My Joyce.
Thank you. Keith.

Poppy July 25, 2017 at 2:13 pm

My mother passed the first stage Checklist and was referred for the Decision Support Tool (DST) meeting for full Continuing Healthcare (CHC). This was delayed for three weeks due to staff illness. On the day it eventually took place Mum was Fast Tracked immediately to CHC from that date. Also her home had been valued prior to CHC consideration, to be used in the deferred payment scheme. It was valued almost 2 months before she was due to become totally self funding. As she became CHC , the valuation, at high cost which we have had to pay the Local Authority for, was unnecessary. Should CHC funding start from the date of the first Checklist or the day of Fast Tracking? Also, has anyone else found themselves paying large bills for valuations that were somewhat premature?

Chris July 25, 2017 at 12:24 pm

There are very good resources on this website for putting these myths to bed. Unfortunately, it can be the case where the Continuing Healthcare (CHC) decisions have been made without the knowledge in place for the family to challenge. It then all becomes retrospective which takes ages to get put right. Finally, after two and half years, I have received my refund for care fees that were unnecessarily paid where CHC funding should have been in place. It was a long hard struggle, where the CHC teams use every trick to their favour and delaying tactics. Keep up the good work Angela.

Angela Sherman July 25, 2017 at 12:53 pm

Can you let us know which paragraphs have gaps, Catherine. We've checked the text - but we're curious as to what may not be appearing on screen for you. Thanks.

Angela Sherman July 25, 2017 at 12:52 pm

Thank you for your very kind words, Chris - and well done for persevering with your case.

Catherine July 25, 2017 at 11:44 am

There appears to be gaps in the text. My Sister has learning difficulties and other issues. She has been assessed and refused any help. The most upsetting aspect is that the report was sent from the ''experts '' directly to my Sister which has caused her to suffer more distress and anxiety. She is already suicidal and awaiting an assessment from specialists before being admitted to a unit. The report outlines all aspects of her life from birth. She can barely read but a friend has read the report to her. So wrong.

Ann Hutchinson July 25, 2017 at 11:17 am

I totally despair at the state of our NHS Continuing Healthcare and Social care. I will 'never stop fighting the unfairness and disgraceful treatment of our elderly and vulnerable'. I have witnessed first hand the deceit and ruthless tactics in pursuit of cutting costs! It is one heck of a fight to secure any quality of life for patient and carer alike! You simply do not try to make a profit out of someone's misfortune or ill health. The only people who believe in this pathway are those who stand to gain!

Meggie July 25, 2017 at 10:24 am

I would like to add a further myth: "Continuing Healthcare (CHC) provides a maximum of four care visits a day." After Dad, who has Alzheimers, deteriorated rapidly/physically and went into hospital , I asked about Fast Track and was told by a discharge nurse who offered to "help" that Fast Track only meant 4 care visits a day. I asked what she meant, explaining that as I understood CHC, all needs were met, even up to 24 hour care if that was necessary. She said, no, CHC provided for a maximum of four visits per day for patients living at home. A hospital social worker told us the same thing, until I asked if she was aware of anyone in the local area who received CHC and had a more substantial care package? She then admitted there were people who received more than four visits per day. This "four visits per day" myth was repeated by a District Nurse, who claimed 37 years experience, and insisted repeatedly that we would not get more than four visits per day, it would never happen. I believe the GP, who Fast Tracked Dad after discharge after visiting him at home, also misunderstood Fast Track. She instigated four care visits per day and access to palliative care visits from the District Nurse service.
Had I not questioned this (more angry telephone conversations with the CCG) this is all the CHC Dad would have been offered, with family members, as ever, providing all other care 24 hours per day, for someone considered end of life, bed bound and entirely dependent on others for all needs.
I believe the nurses believed what they told us. Who is telling them that this is how CHC/Fast Track works?

Steve July 25, 2017 at 9:48 am

I would add that since the purpose of a Checklist is to determine whether a full assessment is justified, it should produce a favourable result at a level somewhat lower and certainly no higher than necessary for Coughlan compliancy. In my view, the same arguments that would be used to challenge a full assessment should be valid to challenge a Checklist decision.