Continuing Healthcare: What Is NHS Continuing Healthcare

Most individuals in the UK must pay an amount towards the care they receive. However, some individuals who have significant ongoing health needs can have the NHS pay for their care through NHS ‘continuing healthcare’.

NHS continuing healthcare (CHC) or NHS ‘continuous healthcare’ is a government-funded care package for individuals who have been assessed to have a primary health need. All the care is arranged and paid for by the NHS, in this case.

Many people who have always wanted to know “What is NHS CHC?” should be familiar with these two aspects of NHS’s continuing healthcare process:

If you will be receiving the care in your own home or place of residence, the NHS will cover the cost of the care administered and support you, in order to meet your assessed health and associate care needs. This includes personal care such as assistance with washing, for example, or getting dressed.
If you are going to be receiving CHC or continuing healthcare in a care home or facility, then the NHS will pay your care home fees, and not pay you directly.

What is NHS continuing healthcare?

Within England, Northern Ireland, and Wales, if you have a disability or a complex health problem which requires ongoing assistance, then you may qualify for NHS continuous healthcare at no cost to you. The cost is covered entirely by the NHS and includes:

Accommodation if your care is administered in a care home
Support for carers if your care is being administered at your residence
Covering costs associated with specialist therapy
Assistance with washing and/or dressing

However, you do need to be assessed as having a ‘primary health need’, in which case, the NHS will be funding your care needs, even if you’re not admitted to a hospital. So, for example, you could be in a care home, hospice, or your own home, and the NHS will provide all the funding for your care needs.

How does the continuing healthcare process work?

In order to understand what is NHS continuing care and how the process works in general, you must first understand the eligibility criteria.

Ask your GP, social worker, or NHS CHC solicitor to arrange for an assessment in order to determine if you qualify for CHC (continuing healthcare). Your eligibility to get funding is based on your assessed needs, and not necessarily on a specific diagnosis, for example, or a certain health condition. If these assessed needs change, so will your eligibility.

Just to give you a better idea of the continuing healthcare process, you might quality if you have:

Significant or major health needs because of an accident, illness, or disability
Complex care demands which go beyond what social services or the local council can provide
Post-hospital discharge which requires a high and persistent level of care
An ongoing care review which has determined that your needs have changed or increased

When you qualify for NHS funded nursing care, your solicitor will work with you to arrange an appropriate care and support package which fully meets with your assessed needs. Depending on what those needs are, certain options might work better for you than others. This is why it is important to consult a CHC continuing healthcare solicitor at the first opportunity you get.

What does continuing health care mean?

The NHS’s ‘continuous health care’, also known as continuing healthcare, is an ongoing care package where funding is solely taken care of by them. If you are 18 years or older and have been found to have a ‘primary health need’ due to an accident, illness, or disability, then you can take advantage of the free funding.

With that in mind, your care package needs to meet your assessed health needs and this is where it can get tricky for most people.

Speak to one of our friendly, courteous, experienced, and professional solicitors who can help with assessing your needs and ensuring that you receive complete funding for the right ongoing care option.

How to get NHS Continuing Healthcare?

Gaining NHS Continuing Healthcare eligibility can be difficult. To qualify, you must demonstrate your needs are:

Complex, intense or unpredictable;
Not incidental or ancillary to the accommodation your local authority is under a duty to provide; and
Not of a nature typically provided for by a social services department.

There are two key stages when applying for NHS Continuing Healthcare eligibility:

Checklist assessment:
This is a screening tool which determines whether an individual’s needs warrant completing the Decision Support Tool.
Completion of a Decision Support Tool (DST):
This is an assessment tool which is conducted to investigate whether an individual’s needs are primarily healthcare needs that would qualify for NHS Continuing Healthcare. The assessment looks at the full range of care needs, but focuses on 12 care domains which include cognition, behaviour, nutrition and mobility.
As part of the DST, the individual in question will be given a level of need in each of the 12 care domains. There are six levels, ranging from no needs to priority.

If a patient’s level of need is assessed as being priority in any area, eligibility for full funding is automatic (however you should note that the priority level of need is only applicable to four of the 12 care domains). If a patient’s level of need is assessed as being severe in any two areas, eligibility for full funding is also automatic.

It is still possible to be found eligible without a priority or two severe measurements, however the rules are open to interpretation. The higher the level of need, the more likely it is that an individual will be found eligible for NHS Continuing healthcare.

Free no-obligation assessment

Key contact

Lisa Morgan

Partner

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 25 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

Lisa Morgan

Partner

Head of Nursing Care

Email: [email protected]

Contact number: 0808 501 6986

Connect with Lisa Morgan

Expertise:

Lisa Morgan is a Partner and Head of the Nursing Care department. She is regarded as an experienced and specialist solicitor leading in the niche area of continuing healthcare.

She has been instrumental in developing a niche legal department in Hugh James, which comprises of 25 fee earners who solely act for the elderly and families in recovering wrongly paid nursing fees.

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David’s story

Our client David speaks out about how he navigated the complexities of reclaiming NHS Continuing Healthcare Funding for his mother. This video case study unveils the challenges endured by David’s family and their ultimate triumph in securing vital support for long-term care. From initial setbacks to fragmented assessments, David’s mum’s case sheds light on the arduous path many families face in accessing essential healthcare funding. Guided by the expertise of the Hugh James Nursing Care Team, this case study illustrates the power of perseverance and strategic advocacy. Explore the stages of the NHS Continuing Healthcare process, the obstacles encountered, and the remarkable outcome of reclaiming approximately £160,000 on behalf of David’s mum’s estate. This poignant narrative serves as a beacon of hope for families navigating similar struggles.

Read more about David’s story here.

View more stories

It is possible for you to pursue a claim independently without instructing a solicitor or advocate. However, it is a difficult process and we have many clients who have initially tried themselves and found the process challenging.

There are many companies who specialise in this area. However, as solicitors we are regulated and very experienced in what we do.

The team at Hugh James have more than 15 years of experience and have won awards from The Law Society and Age Cymru for their work.

Some of our clients question how non-medically qualified professionals can challenge health decisions. Whilst the people making decisions regarding eligibility for continuing healthcare are health and social care professionals, their decisions are being challenged and it is our job to demonstrate they are unsound by analysing medical evidence and applying it to the criteria. Whilst the process is not legal, it is a dispute resolution process and many Independent Review Panel chairs are former solicitors and barristers.

Due to Hugh James experience and depth of knowledge, we are respected by health and social care professions and panel chairs for the work we do.

The skills developed by lawyers – analytical, evaluating, interpreting and advocacy is key in being successful and it is of no surprise that all companies employ law graduates to undertake this work.

Unlike solicitors, unregulated advocacy companies are not obliged to provide clients with the best advice and be clear and transparent about their charges. They cannot advise on the option of court proceedings against health authorities for unsound decisions by way of Judicial Review, as they cannot by law undertake reserved legal activities. NHS Continuing Healthcare: Can you challenge an Independent Review Panel decision?

The other added advantage of instructing a solicitor is protection if something goes wrong. Sadly, we have seen first-hand, companies not providing accurate advice leading to clients losing the chance to proceed or companies no longer being in business. Solicitor practices are far more stable, but in the unlikely event that something does go wrong, clients can at least rely on solicitor’s professional insurance policy. They can also have recourse to the Solicitors Compensation Fund.

While we will ask the case proceeds as soon as possible, we have no control over the speed in which the health authorities progress the claim and it depends on the decisions made by the health authority. In our experience, it takes 24 months for a case to reach a retrospective panel. However, current assessment should be undertaken in a timely manner and are usually completed within 3-6 months. We will always keep you up to date as your case progresses.

Our team have been working in this area for over 15 years and have been successful for over 6000 families in securing free NHS funding through current assessment and/or retrospective reviews.

We provide a free initial assessment and we will advise you at the outset whether you have a case.

We have recovered £200m for our clients. The most any one firm or company has recovered in the UK.

Read what our clients say about our service here.

We understand that instructing a solicitor may be daunting, but unlike advocacy firms, as solicitors we must be open and transparent about our costs. There cannot be any hidden charges.

Following a free initial assessment of your case, we offer a number of funding.

In most cases our clients are offered the choice of a ‘no win no fee’ Contingency Fee Agreement and an hourly rate basis. The Contingency Fee Agreement is popular with our clients as it provides certainty; they know exactly what we will charge if we win the case and it makes no difference how much time we spend pursuing the claim to a successful conclusion. In addition, there is peace of mind that if we pursue the claim and we lose, you do not pay us anything.

Retrospective cases

This is where money paid for care home fees is recovered.

If we succeed with a retrospective claim (monies are recovered), we take 25% plus VAT of the monies recovered.

It is common, as NHS Continuing Healthcare is based on the type and amount of care needs, that eligibility is only awarded for part of the period in care. Our average amount to recover is £30,000 and our average fee is £7,500 plus VAT.

Current assessments

Where someone is awarded free NHS funding.

If a current assessment awards full NHS funding, our fee is 25% plus VAT of the monies we preserve for you for the first four months, or until eligibility for NHS CHC is lost, whichever is first.

If, for example, the date of a current assessment is 1 June and eligibility is found and you were paying £800 per week, and over four months £12,800. You will pay us £3,200 plus VAT.

Hourly rate charging basis

All our clients are also offered an hourly rate option. Our current hourly rate is £200 plus VAT.

We will provide you with an estimate of costs. Giving an estimate at the outset of a case is difficult and is dependent on the circumstance of each case. Many of the factors which will influence the eventual amount of costs are unknown. Whilst it is difficult for us to say how long the claim may take and how much work we will need to do (since often this will depend on the way that the health authority deals with the claim) our estimate of our costs will be provided to cover the work for assessing all the medical records, advising on merit, requesting an assessment and appeals.

It is difficult to estimate how much time is spent on a case, but we suggest a typical case from start to finish will be 40-60 hours.

We regularly update you on the costs incurred. Our costs are payable win or lose on an hourly rate basis.

Will there be any surprise costs at any time

No. At the outset of the claim, we will write to you to explain the funding options. As a firm of solicitors, we must be clear and transparent about our costs.

Whilst we do not envisage you will be unhappy with the cost or service we provide, it is good for you to know that if you were unhappy, unlike unregulated advocacy companies, you can make a complaint through our internal complaints procedure. If you are not satisfied once you have been through our complaints procedure, you can contact the Legal Ombudsman.

The process will depend on a number of factors, such as whether you are starting your claim from scratch or if you are coming to us to appeal a negative decision; whether you are claiming on behalf of a loved one who has since passed away or has just moved into long-term care.

If you believe that you or a family member has wrongly paid care fees, then the first step is to complete our questionnaire. This will be assessed by our Nursing Care legal team who will be able to advise on whether or not you have a case, and if so, what the process will be. This initial questionnaire is free to complete and there is no obligation on you to proceed with a claim should you decide not to.

We believe we are one of the leading national experts in the recovery of wrongly paid care home fees. Here are just some of the reasons why our clients choose to work with us:

We have recovered over £250 million in wrongly paid nursing home fees since the department was set up in 2006.
Our success and client stories are regularly featured in the press as we are recognised as leading the way in reclaiming wrongly paid care home fees. This includes The One Show, Dispatches, ITV News, The Telegraph, The Sunday Times and The Mirror.
We work in partnership with many of the leading older peoples’ charities, helping us to ensure our service meets the needs of the people we, and the charities, represent.
Unlike many other companies who focus on reclaiming wrongly paid care fees, we are a firm of solicitors regulated by the Solicitors Regulatory Authority (SRA) and comply with the solicitors’ code of conduct.
The Hugh James Nursing Care team is the leading and most experienced team in the niche area of continuing healthcare, giving you complete peace of mind that your case is being dealt with by fully qualified lawyers who specialise in reclaiming nursing and care home fees.
The team is also one of the biggest teams focusing exclusively on this area in the UK with over 40 dedicated lawyers.
We promise to deal with your claim from start to finish and will not pass your claim on to a third party. We offer a complete service for you with dedicated team members to contact.
Head of the team, Lisa Morgan, won the highly acclaimed Law Society Junior Lawyer of the Year 2010 Excellence Award due to her work in this area. She was also recently awarded the Cardiff University Simon Mumford award. In 2017, the department was highly commended at the Age Cymru Awards in the large business category for its commitment to helping older people.