Continuing Healthcare funding and choice of care home: Part 1

Do you have to move to a different care home once you receive Continuing Healthcare funding?

This two-part article looks at an issue raised frequently by families on our blog: It’s about Continuing Healthcare funding and choice of care home or care provider.

When you receive NHS Continuing Healthcare funding do you have to move to a different (cheaper) care home or change your care provider at home?

Families are also often told that if they want their relative to stay where they are currently, the family will have to pay part of the cost, i.e. top up the NHS Continuing Healthcare funding payments themselves – effectively paying for NHS care.

Let’s look at what the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care says about this. (The National Framework is the main set of guidelines for Continuing Healthcare assessments.)

But before we do, remember that the following 5 principals hold true regardless:

1. NHS Continuing Healthcare funding cannot be topped up. Top ups are only relevant to local authority means test care – not NHS care.

2. Continuing Healthcare funding must cover ALL assessed care needs regardless of where your relative is receiving that care. The NHS cannot neglect to fund all care needs identified during the assessment process.

3. Some Clinical Commissioning Groups (CCGs) are trying to impose a financial limit beyond above they will not pay for care. However, if your relative’s needs are high and their care costs are more than the NHS wants to pay, it doesn’t matter; the NHS must fund all the assessed care needs regardless.

4. Remember that when a person receives NHS Continuing Healthcare it’s because their care needs are such that they require NHS care and the NHS is legally responsible for paying – even if the actual care is provided by a private care home or care provider. It’s a bit like receiving care in hospital – you don’t have to pay. In England, just because a person is outside hospital when receiving their care, this principle does not change.

5. Continuing Healthcare is not dependent on where your relative is, i.e. in a care home, at home or elsewhere.

That said, there are certain paragraphs in the National Framework guidelines that are useful to mention here.

Let’s look at pages 117-119 of the National Framework…

Paragraph 99.1 states:

“The funding provided by CCGs in NHS continuing healthcare packages should be sufficient to meet the needs identified in the care plan, based on the CCG’s knowledge of the costs of services for the relevant needs in the locality where they are to be provided.”

“It is also important that the models of support and the provider used are appropriate to the individual’s needs and have the confidence of the person receiving the services.”

So…

• all the care needs identified during the Continuing Healthcare assessment process must be included in the care plan AND must be funded by the NHS through Continuing Healthcare
• the CCG must appreciate that there may be cost variances in different areas of the country
• the care provider must have the resource and ability to care for all of those needs – and if the cost is higher because of the needs of the person, the NHS still covers the cost.

Paragraph 99.2 states:

“…it will not usually be permissible for individuals to pay for higher-cost services and/or accommodation (as distinct from purchasing additional services).”

Paragraph 99.3:

“‘Topping-up’…is not permissible under NHS legislation.”

In other words, you cannot top up NHS Continuing Healthcare funding – and you should not be asked to do so. This would be illegal. It is NHS care funding. Top ups are relevant only to local authority means tested care.

Pages 114-115 of the National Framework also cover this issue, including page 114 paragraph 96.1c, which says:

“…patients should never be charged for their NHS care, or be allowed to pay towards an NHS service (except where specific legislation is in place to allow this) as this would contravene the founding principles and legislation of the NHS.”

It’s worth reading the whole of pages 114-115 in the National Framework in this respect.

What if you already have a higher-cost care provider or care home once you become eligible for Continuing Healthcare?

We’re going back now to pages 117-119.

Paragraph 99.3 states:

“…there are some circumstances where a CCG may propose a move to different accommodation or a change in care provision.’

Paragraph 99.4:

“In such situations, CCGs should consider whether there are reasons why they should meet the full cost of the care package, notwithstanding that it is at a higher rate, such as that the frailty, mental health needs or other relevant needs of the individual mean that a move to other accommodation could involve significant risk to their health and well being.”

Paragraph 99.6:

“CCGs should deal with the above situations with sensitivity and in close liaison with the individuals affected…”

In other words, it comes back to the care needs every time. This must be the priority.

If it would be detrimental to your relative for them to be moved to another care home, the NHS may have a duty to fund all care where they are at present – and to continue to do so. People with cognitive, behavioural and/or psychological challenges often need familiarity as a priority; moving someone with such needs to a new care home or care provider can be extremely damaging to their health and wellbeing.

But what if your relative does have to move to a cheaper care home or switch care provider? We look at this in Part 2.

What’s your experience of having to change care provider or move to a different care home?