NHS care funding: how to fight for your rights

If you have an elderly parent or relative about to go into a care home or needing extra support at home, one of your biggest questions might be about who pays the fees.

Retired woman having professional careAt a time of transition and often upheaval, it’s understandable you don’t want to be worrying about finances. At the same time, care home fees can be hefty, so making sure you get the right type of funding in place really is important in the long term.

Nursing care for elderly people isn’t confined to nursing homes, either. Many older people need to access NHS care services, such as community nurses, specialist therapists and need support with personal domestic care like bathing and shopping. And again, there are different types of funding available depending on circumstances.

Whether you are planning for your own needs or those of an elderly spouse, parent or relative, keeping fully informed about what’s available can not only make financial sense, but also helps to make sure the right care and support is in place.

NHS continuing healthcare

This package of care is for those needing healthcare support outside hospital and applies to both care in residential and nursing homes and care in a person’s own home.

You will be assessed across four areas to see if you have what’s known as a ‘primary health need’ – which does not discriminate according to specific illnesses or conditions.

These are:

  • Nature. To determine individual needs and the interventions needed to manage them.
  • Complexity. How the needs are presented and the level of skill needed to monitor and treat them.
  • Intensity. The extent and severity of these needs.
  • Unpredictability. Any unforeseen changes in needs can create extra challenges in managing them.

Who is eligible?

  • In the first instance, a health or social care worker will carry out an initial checklist. If they think you may be eligible, you’ll then be invited to apply for a full assessment.
  • A multidisciplinary team from your Clinical Commissioning Group (CCG) will carry out this assessment, speaking to all health and social care professionals involved in your care. They will then make their recommendations to the CCG.
  • If you’re not eligible for NHS continuing healthcare, you may still qualify for NHS-funded nursing care.

NHS-funded nursing care

Under this system, the NHS makes a payment directly to the care home, and it is a standard rate contribution to the cost of registered nursing care.

Who is eligible?

  • Anyone who is resident in a care home registered to provide nursing care.
  • Those who have been assessed as needing the services of a registered nurse but who don’t qualify for NHS continuing healthcare.

Contesting your care package

Unfortunately, many people are put off from even applying for NHS continuing healthcare because they don’t even know it exists. Others have been deterred at the start by health professionals who instantly declare they won’t be eligible, or some people hear that others have been refused and assume the same will apply to them.

You won’t know if you’re eligible until you try. So try. And if you’re turned down, you can appeal.

Young and older person holding handsA local authority assessment is not the same as an NHS continuing healthcare assessment. If your local authority has carried out a financial assessment, this is to determine if they need to support you in any way. It is still very important to have an NHS continuing healthcare assessment to establish whether your care support should be funded by the NHS.

And sometimes the outcomes are wrong. If you have had your application for NHS continuing healthcare turned down, please don’t give up. Only you and your family really know your circumstances, and health and social professionals will only get a short time to make their assessments. If you are unhappy with the outcome of the assessment, you can write to your NHS Clinical Commissioning Group to ask for a review.

When it comes to care funding, you do need to be prepared to push, making sure that you are getting the care that you – or your relatives – are not only entitled to but deserve. Don’t be put off by paperwork or the thought of assessments – if your need is genuine then you can make the system work for you.

It sometimes takes a little patience and persistence.

Find out more…

Rosamund Evans

About Rosamund Evans

I’m the founder and principal solicitor of Barker Evans Private Client Law. When I started my own law practice I wanted to make it easier for my clients to get the help they need at a price they can afford and in a way that makes them feel comfortable and fully supported. You can access a variety of legal advice on my website, plus how-to guides and blogs.