Accessing NHS funded care is becoming increasingly difficult as the NHS struggles to meet the demand for healthcare services. With the advent of the Coronavirus pandemic, it seems highly likely that securing non-means tested NHS funded care is set to become even more of a challenge as public bodies work through the backlog of NHS funded care assessments and appeals.

What is fully funded NHS care?

‘Fully funded NHS care’ is simply another way of describing NHS Continuing Healthcare.

NHS Continuing Healthcare or ‘fully funded NHS care’ means an individual has been assessed and identified to present with a ‘primary health need’ meaning their needs go above and beyond what a Local Authority is lawfully able to provide.

If an adult (aged 18+) has a ‘primary health need’, it is the NHS’ statutory responsibility to ensure any needs identified are met. NHS Continuing Healthcare or ‘fully funded NHS care’ is non-means tested.

This means any care, support or accommodation required must be provided without a charge.

Who gets NHS funded nursing care?

The NHS funded nursing contribution (FNC) is a set, weekly rate of £187.60 which is paid directly to a provider to assist with the cost of nursing care where an individual has been assessed not to be eligible for NHS Continuing Healthcare but requires care from a registered nurse and is living in a nursing home. FNC is not available to those who require residential care only. The weekly rate is subject to change.

If a Clinical Commissioning Group decides following an eligibility assessment not to award NHS Continuing Healthcare funding, can the decision be challenged?

Yes. There is an established appeals procedure that must be followed in full. The process consists of two stages. The first stage involves a request for a ‘local review’ of the decision whereby the original decision-making body is asked to re-consider its decision at a local level. If not successful at the local resolution stage, you are at liberty to appeal to NHS England to request an independent review panel is convened. More information with regard to the process for challenging NHS funded care or NHS Continuing Healthcare decisions can be found by clicking here to access our free information sheet.

Can I challenge the withdrawal of NHS Continuing Healthcare funding?

Yes. Please click here to access our recent article which explains the process for challenging a withdrawal of NHS Continuing Healthcare following an annual review.

The case study available by clicking here demonstrates how it is possible to successfully challenge a decision to withdraw funding in appropriate circumstances.

Is the process different for children and young people?

Yes. It is common practice in the case of children and young people for those requiring support to meet health care needs to receive a package of Continuing Care, whereby the cost of meeting needs is shared between NHS bodies and Local Authorities. More information on Continuing Care for Children & Young Persons can be found by clicking here.

How does the Coronavirus Act 2020 impact accessing NHS funded care?

As our recent articles explain in detail, this new legislation simplifies the Hospital Discharge process and the way NHS funded care will be dealt with during the COVID-19 emergency period.

The key changes to note include but are not limited to:

• The Hospital Discharge process. The focus of Discharge to Assess will be on discharging patients deemed medically safe for discharge that same day.

A detailed explanation of the revised Discharge to Assess process can be found by clicking here.

• Support provided by virtue of the revised Discharge to Assess process will be paid for by the NHS to ensure the focus is on moving patients from acute hospitals as soon as possible.

This means any care required in order to discharge a patient should be provided on a non-means tested basis, free, at no cost.

There is, however, the possibility that retrospective charges may be raised in respect of any social care provided.

It would be wise, therefore, to begin preparing evidence to support eligibility for NHS Continuing Healthcare whilst receiving funded care so that you are ready to participate in eligibility assessment processes.

How can our community NHS Continuing Healthcare solicitors assist?

At Lester Aldridge, we provide specialist legal advice and support to individuals and/or their representatives to help them access health services from the NHS, in a way that meets their needs and preferences.

The types of NHS funding issues we can assist with include:

• Assistance to navigate the simplified Hospital Discharge process and ensuring a preferred choice of care is followed up and implemented if a patient’s first choice is not available at the point of discharge.
• Advising on eligibility for NHS Continuing Healthcare funding (for Adults) or Continuing Care funding (for Children and Young Persons) and providing representation throughout assessment processes.
• Assistance to begin evidencing the case for eligibility for NHS funded care in preparation for retrospective assessments where Discharge Today care is provided free of charge by the NHS during the emergency period.
• Representation to challenge NHS funding decisions through the Local Resolution or Independent Review Panel processes.
• Brokering directly commissioned care packages or personal health budgets once eligibility for NHS funded care has been agreed.
• Personal health budgets are often a useful mechanism to help personalise care and support and can provide you with more control over your NHS funded care.
• Advising on how to challenge refusals to fund medical treatment.
• Navigating the difficulties accessing NHS wheelchair services.

Click on the links on the right-hand side under the heading ‘related files’ to view more information, download or print our freely accessible NHS provision information sheets.

How can my NHS funded care case be funded?

There are a variety of funding options for community care cases.