NHS CHC - Frequently Asked Questions

Nellie Supports are delighted to be launching our new NHS Continuing Healthcare

(‘CHC’) advice, support and appeal service. This will support clients at all stages of

their CHC journey - from the initial assessment through to appeals.

CHC is a complex area of health policy, and feeling overwhelmed by the process is

understandable.

Our in-house solicitor Ruth Tarr is here to answer some common questions

regarding CHC funding:

What is NHS CHC?

NHS CHC is a package of care arranged and fully funded by the NHS.

The funding is for adults who have complex, ongoing health needs – the NHS call

this a ‘primary health need’.

Care can be funded in several settings outside of hospital including care homes,

nursing homes, hospices and your own home.

Most importantly the funding isn’t means tested, so your own income/assets have no

bearing on eligibility.

Will my relative be eligible?

It will depend on the level of their needs. A ‘primary health need’ in essence means a

person’s needs are more health-related than social care related. This could be

because of a terminal illness, a complex and/or rapidly deteriorating health condition,

or because their needs are unpredictable.

What’s the process?

The first step the checklist – this is a screening tool designed to look at whether

someone should be referred for a full assessment. Most people will pass this stage.

Following this, a full assessment will take place which looks in-depth at the person’s

needs. This is often called a ‘DST Meeting’ and it should involve the key individuals

involved in the person’s care including professionals and family.

The assessment follows a set process looking at 12 ‘care domains’ including

breathing, mobility, cognition, skin, nutrition, continence and others. These are

considered in-depth and with reference to care/medical records.

The meeting is chaired by an NHS nurse and a social worker, and they use this

information to decide if the person is eligible for NHS CHC.

The quality of these assessments varies and sometimes evidence can be overlooked

or missed entirely. Families often report they have not had the process explained to

them properly, and that the meeting was rushed through.

How do I guarantee eligibility?

You can’t - and please be wary of any organisation promising you otherwise.

The threshold for CHC funding is purposefully high, and some people don’t qualify

because their needs don’t meet that threshold.

However, there are many who miss out on funding because their case wasn’t

presented strongly or accurately, or because mistakes were made during the

assessment. If awarded, CHC funding eases a significant financial burden, and so

it’s critically important to get the assessment process right.

Can I appeal?

Yes, there is an appeals process if you think the initial decision was wrong.

Your outcome letter will confirm the deadline for your appeal (usually six months) and

the next steps. The first stage is to attempt a Local Resolution.

If you are considering an appeal, it would be worthwhile to review your DST papers

first. Our DST review is a methodical analysis of your papers to determine if there

were any flaws with the assessment process, and whether you have a case for an

appeal.

I’m an attorney for someone else, can I get advice on their behalf?

Yes. If you believe seeking advice or representation on their behalf is in their best

interests and affordable to them, this is something you can pursue as an attorney.

For more info on how we can help please see our dedicated CHC page