Being involved in someone’s assessment for NHS Continuing Healthcare funding

Advice about whether you should be involved when a relative or friend is assessed for NHS Continuing Healthcare (CHC) funding, and steps you can take if you haven’t been included.

Question:

‘My partner has dementia and lives in a care home in Devon. I’ve been told he was turned down for NHS Continuing Healthcare funding, but I wasn’t involved in any assessment.’

Answer:

You should have been involved in the assessment of whether your partner is eligible for NHS Continuing Healthcare (CHC) funding, assuming they’re happy for you to be. 

In England, a national framework says that a person’s ‘representative’ should have the information they need to take part.

This could be a friend, family member, someone the person’s appointed as attorney or deputy, or an organisation representing them. 

CHC is a package of care arranged and fully funded by the NHS. A person might be eligible if most of their care is to manage health needs, rather than social care needs such as help with washing, dressing and independence.

An assessment for CHC funding looks at how intense, unpredictable and complex someone’s needs are. 

There are variations in how funding operates in different parts of the UK. People in Wales could expect similar processes to England, while CHC processes in Northern Ireland are currently undergoing reform. 

What should happen? 

In England, the first step is usually the completion of a checklist by a health or social care professional to see whether someone should be offered a full assessment. 

The person and their representative should have the opportunity to be present while the checklist is done. They should also be told in writing as soon as possible whether a full assessment will be done, and the reasons why. 

If there’s an assessment, the person and their representative should play a central role in it. Their view of the person’s needs, including any supporting evidence, should be properly considered alongside professional views.

If the person can’t contribute themselves, it’s even more important that they have a representative doing this on their behalf. 

What could I do? 

As you weren’t involved in the assessment, you can challenge the decision not to award your partner CHC funding on the basis that the correct processes weren’t followed.

You could also appeal if you had been involved but felt the decision wasn’t right. 

The first stage of your appeal would be a local resolution process, and how this is done will vary. If this doesn’t change the decision, the second stage would be an independent review panel convened by NHS England. You should expect to have input into this too. 

Further advice 

  • If you’re thinking of appealing against a decision to refuse or withdraw CHC funding for a person with dementia, our CHC Appeals Support Service may be able to help you through the process. Contact us to find out more.
  • In England, a social enterprise called Beacon can provide up to 90 minutes of free advice on CHC issues, and you can also download their helpful toolkit. 
  • In Wales, Age Cymru could provide advice. 
  • In Northern Ireland, the Law Centre NI may be able to advise. 
Legal and financial

The various financial and legal issues that someone with dementia and their carer may want to consider and looks at sources of help and support

Read more

Dementia together magazine: June/July 21

Dementia together magazine is for all Alzheimer’s Society supporters and anyone affected by the condition.
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Dementia together magazine is for all Alzheimer’s Society supporters and anyone affected by the condition.
Subscribe now

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