NHS continuing healthcare (CHC) funding criteria
The general CHC funding criteria revolves around an individual’s health needs and not their current or future health diagnosis. The eligibility criteria, therefore, includes:
‘Priority’ level of need – If an individual’s needs are assessed using the Decision Support Tool (DST) to be a priority in any of the 4 care domains, they automatically qualify for full funding.
‘Severe’ level of need’ – If an individual’s needs are assessed to be severe in any of the 2 care domains, they automatically qualify for full funding.
Primary health need – This refers to the quality or quantity of care required and whether it meets or exceeds the limits of the local authority’s scope of responsibilities. If an individual does not have a priority level or two severe levels of need following the completion of the DST then the primary health needs test will be applied. This will consider the nature, intensity, complexity and unpredictability of an individual’s needs. If any of these indicators are found to be present an individual will be deemed to have a primary health need and be eligible for funding.
Nature– This looks at the particular characteristics of an individual’s needs and the type of those needs. It also considers the overall effective of need on the individual including the type of interventions required to manage them.
Intensity– This look at both the extent (quantity) and severity (degree) of the needs and the support required to meet them.
Complexity – This examines how different health care needs interact with each other as this affects the level of care that’s required.
Unpredictability – This aspect of the criteria for continuing healthcare funding refers to how often, how much, and how unexpectedly an individual’s health condition changes.
What is the fast track CHC funding criteria?
The Fast Track CHC Funding Criteria applies to an individual who has a rapidly deteriorating health condition, one which is likely about to enter a terminal phase. This criteria exists to pave the way for a rapid assessment and decision so that the NHS can kickstart funding without delay.
To be eligible, the individual must have:
- A condition that is rapidly deteriorating
- A condition that may be entering the terminal phase
If the individual meets eligibility for continuing healthcare (fast track), then funding for their health needs should be in place within 48 hours. The individual should also be moved to their preferred or ideal place of care, if they aren’t already there, that is.
How to qualify for continuing healthcare?
To qualify for Continuing Healthcare (NHS), you or your loved one needs to be assessed by an MDT (multidisciplinary team) and you must have a primary health need.
The MDT is responsible for assessing your care needs. This includes the complexity, intensity, and unpredictability of your needs.
In addition, eligibility also requires that you:
- Have a primary health need – this essentially means that the majority of your health care needs are focused towards dealing with or preventing health needs.
- Have care needs which have arisen only due to an illness, disability, or accident.
What qualifies for continuing healthcare?
It’s worth reiterating that to understand what qualifies for Continuing Healthcare, you must have a primary health need. What this means is that nearly all of your care needs are for healthcare reasons, and not personal or social ones.
Additionally, your needs must be classified as ‘complex’, ‘intense’, or ‘unpredictable’. Your needs must also not be incidental/ancillary to what your local authority can provide or accommodate in terms of funding.
Your needs should be something that the social services department cannot cover or provide for. And, finally, your needs must be both ongoing and significant, whether that be physical or mental (or both), in order to meet Continuing Healthcare funding eligibility.
Eligibility for CHC funding
It’s also important to understand that eligibility for CHC funding is based upon the affected person’s day-to-day needs only and not their long term needs. The decision to provide access to funding is made by an MDT comprising healthcare and social care professionals, once a thorough assessment has been concluded.
Once again, the eligibility criteria for NHS funded nursing care is:
- The majority of the care should be focused on addressing current health needs.
- The affected individual must have a primary health need – that is, the individual’s primary need is for healthcare, and not social or personal care which is not related to the primary care needs.
Conclusion: Meeting the criteria for NHS funded nursing care
NHS Funded Nursing Care is different to NHS Continuing Healthcare. NHS FNC pays for the nursing element of an individual’s care if they have health needs but they are not deemed to be primary health needs.Here’s what you should know:
- You need to be 18 years or older.
- You must not be eligible for CHC as you cannot qualify for both FNC and CHC at the same time.
- You must have eligible nursing needs.
- You must currently be a resident in a care home which has been registered to provide nursing care.
- You must have a registered nurse assess your needs first and then recommend you for FNC.
Once the above conditions have been met, the local ICB (Integrated Care Board) will determine your eligibility for FNC.
If you want to learn more about NHS funded nursing care eligibility criteria or eligibility for NHS continuing healthcare, our friendly, understanding, and accommodating solicitors are only a phone call away.
