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Paying for Care

Part 5 – NHS Continuing Care


Before consideration for Local Authority funding is made, an assessment for NHS Continuing Care funding should be made.

NHS Continuing Care funding is a complex area of assessment.  The easy part is the test, does the indivual have a primary healthcare need?  The answer is either yes or no, if yes their assessed care is paid for by the NHS, if the answer is no, then they are subject to means tested Local Authority funding. Simple!!  They can also qualify if they are “in the final stages of a terminal illness”.

When I’ve spoken to nurses, they tell me it is very hard to tell exactly when someone is going to die, they can be very unwell and rally and anecdotally I’ve had loads of clients do that.  So in order to be sure that they are in the final stages of a terminal illness, they wait until they are pretty sure that there is no chance to rally, so this funding in reality is granted for usually just few days in my experience.

So what is a “Primary Healthcare Need”?  It is very hard to tell and even the CCGs don’t agree.  I’ve got a case going at the moment, where one CCG has awarded it, but as the person was in another CCG area beforehand, they have asked them to pay and the other CCG don’t agree.  The argument between them is taking months, in the interim; my client has to wait for them to sort it out between themselves!!

The National Framework is the document used by the CCGs to work out if someone is eligible or not, including the process of how the process should be managed.  The National Framework says that the CCGs have to consider the Nature, Intensity, Complexity and Unpredictability of the individual.  The decision is not based on diagnosis, so it cannot be because of any specific condition such as dementia or Parkinson’s.  It is all about how the symptoms of that condition present and are the symptoms complex, intense and unpredictable.  In practical terms, usually the most important one of these 3 is unpredictability (although the CCGs might not agree, but that is what I see all the time).

I’ve spoken with a nurse assessor who works for the CCG and he advises me that although quite a lot of people are represented with these assessments, 60% are represented by someone who doesn’t know what they are doing.  I’ve done lots of these assessments where families have tried to get the funding and failed, then I become involved and we get funding, so in my experience, having someone who knows how to advocate on their behalf makes a difference.

It is a difficult and distressing issue for families to deal with, but the costs are stake can be considerable with care fees IRO£25,000-£35,000 per year.  It is well worth getting help with these claims and worth getting someone with experience.  If you need help from me, contact details are at: