When Does The NHS Pay For Care?

If your relative enters care and you believe they have entered due to a primary health need, rather than a social need, then the NHS may be responsible for meeting the full cost of their care.

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When Does The NHS Pay For Care?

If your relative is assessed as having a primary health need, then the NHS is responsible for meeting the cost of care no matter where the setting is (ie at home, care home, nursing home).

NHS Continuing Healthcare is relevant for everyone at the point at which they believe they need on-going/continuing full time care. It covers 100% of care fees for someone whose needs are primarily health needs. This covers both physical and mental health problems.

Every elderly person who requires full time care should be assessed for NHS Continuing Healthcare at the outset, and certainly before they start paying for care. It is not the diagnosis of an illness that leads to the NHS paying for care, more the care needs that your relative has.

NHS Checklist

The first action to take is to request that a NHS Checklist is completed on your relative. This will provide an outline of their care needs. You have a right to be notified of this assessment, and allowed to attend as your relative’s representative.

If your relative has recently had a spell in Hospital, then the NHS are under a duty to complete a NHS Checklist before they are discharged. Unfortunately, this is frequently overlooked.

Decision Support Tool

If the NHS Checklist provides a positive result, then a professional involved in your relatives care will complete the Decision Support Tool. This basically, is a more in-depth version of the NHS Checklist and assesses the following areas of care:

  • Behaviour
  • Cognition
  • Mobility
  • Psychological and emotional needs
  • Communication
  • Nutrition
  • Continence
  • Skin viability
  • Drug therapies
  • Breathing
  • Altered states of consciousness.

Your relative will be assessed in each of these areas, and if the needs are high, then the primary health need test is applied.

Primary Health Test

If the Decision Support Tool indicates that your relative may be eligible for NHS Continuing Healthcare, the final aspect that is assessed is the totality of the needs.

The assessor will apply the primary health need test and this looks at the nature, complexity, unpredictability and intensity of the care needs. A decision will then be made.

Appealing A Decision

You (as your relative’s representative) or your relative, have the right to appeal the decision relating to NHS Continuing Healthcare. If it is found that your relative does not meet the threshold to be eligible for NHS continuing healthcare, then the NHS have to provide you with appeal details and full reasons why your relative has not been found eligible.

There is usually a 6 month limitation period in which to raise an appeal but should you receive the outcome of eligibility for NHS continuing healthcare, but there is no information on how to appeal the decision, you should contact the relevant NHS trust (usually the trust that has completed the Checklist and Decision Support Tool) in writing.

How We Can Help

At any point during the assessment, or if you wish to appeal the decision, you can contact one of our specialist solicitors to discuss your case. If you wish to obtain the legal position on your case, or need some assistance with the assessment/documentation, then please do not hesitate to contact us.

We work on a fixed fee basis so that you know from the outset what the legal costs will be and you can make an informal decision as to whether you want a professional on board. After initially assessing your case we can potentially work on a no win no fee basis.

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