NHS Continuing Healthcare Funding - am I eligible? 

 
NHS Continuing Healthcare (CHC) is a funding stream whereby, if eligible, an individual will have all costs associated with their care paid for by the NHS. 
 
As healthcare in the UK is free at the point of access, if you can show, via a testing system, that your needs are predominately healthcare based as opposed to social care based, then fees arising for the provision of this care will be covered.
 
What is the test?
 
The National Framework for NHS CHC and NHS-funded Nursing Care 2018 govern the application and assessment process for any eligibility determination. An individual must establish that they demonstrate a “primary health need” in that their care needs go above and beyond that of social care provision. 
 
Needs are assessed both individually and collectively in a 2-stage process. Individually, 12 care domains are considered including behaviour, cognition, nutrition and mobility and weighted between having no needs to high or in some domains where it’s available, severe or priority needs. 
 
Once the 12 domains have been assessed, the NHS will then consider these needs collectively to ascertain whether they go beyond the social care remit. This looks at whether their needs demonstrate an intensity, complexity or unpredictability of need or whether the overall nature of the condition(s)/needs are predominantly healthcare based. This part of the test is clinically led, but will consider the frequency of interventions, the skills needed to meet need, how stable a condition is and the level of support an individual requires.
 
Should someone score either 1 priority or 2 severe needs during the first stage, the National Framework determines that this should be sufficient to demonstrate a primary health need.
 
Where can funding be provided?

 
NHS CHC funding is eligible for anyone who meets the criteria. It does not matter if they are in a care home, nursing home or living in their own home with a care package. The National Framework makes no distinction on where that care can be administered.
 
My loved one has dementia. I have been told that they will not be eligible, is this true?
 
No, this is not always true. Whilst dementia is sadly becoming more and more common, there are no medical conditions that automatically mean someone is not eligible for funding. Equally, there is not one condition that means someone will automatically be eligible for funding. The assessment purely looks at their needs and how they manifest and what support they require on a day-to-day basis.  

Where possible, you should seek advice from a specialist with experience in this area of law who will ensure the test gets done. Click here to find an SFE solicitor near you

 

 

 

 

Naomi Wilkes


Partner at Moore Barlow 

Naomi is a specialist Private Wealth solicitor with high quality experience in providing advice to individuals and families on issues such as Wills, Powers of Attorney, Estate Administration, Estate Planning, Tax Planning including Inheritance Tax advice and the use of Trusts

Nicholas Endean

Associate at Moore Barlow 

Nicholas Endean is a community care lawyer and specialises in NHS Continuing Healthcare applications and appeals as well as mental capacity and best interest decision making for health and welfare matters. 

Moore Barlow 

Moore Barlow is one of the UK’s leading law firms, focused primarily on meeting the needs of private individuals & families, owners and leaders of fast-moving organisations and businesses, and people whose lives have been affected by serious accidents or negligence.  With 70 partners, 272 lawyers and legal professionals, and a total staff of nearly 500, Moore Barlow has offices in Southampton, Guildford, Woking and Lymington, as well as two locations in London (Richmond and the City). 

How Moore Barlow can help

At Moore Barlow we specialise in NHS CHC applications and appeals and offer a free preliminary assessment on eligibility. Please contact us our expert team for more information