NHS Continuing Healthcare Funding

NHS Continuing Healthcare funding is paid for care you receive if you have a primary healthcare need that is not met by main stream services and your health needs are intense, complex and unpredictable as set out in The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (revised).

You can be assessed for eligibility:-

in your own home
in hospital
if you are resident in a nursing/care home

We will determine if we are the responsible commissioner (if we are the Primary Care Trust that is responsible for funding), this will depend on the location of your general practitioner (GP).

If you are in hospital and your GP is out of our area we can still undertake the assessment and then refer your case to the correct Primary Care Trust (PCT).
If you are in your own home or a care home we can refer you to another PCT if applicable.

NHS Continuing Healthcare Cut-off Dates

Do you think you were entitled to NHS Continuing Healthcare between 1 April 2004 and 31 March 2012?

In March 2012, the Department of Health (DOH) announced the introduction of deadlines for individuals to request an assessment of eligibility for NHS Continuing Healthcare funding for cases during the period 1 April 2004 - 31 March 2012.

If you have never applied for NHS Continuing Healthcare, but think you may have been entitled to receive it, you can apply to your local PCT for an assessment - but you must do so before the cut-off date that was announced by the Department of Health:-

for NHS Continuing Healthcare that people believe they should have, or are entitled to receive, anytime between 1 April 2011 and 31 March 2012, the cut-off date is 31 March 2013. You will be assessed against The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (revised).

The deadline for the time period from 1 April 2004 – 31 March 2011 was 30 September 2012 and is now closed.

Continuing Healthcare is care provided over an extended period of time to meet physical or mental health needs that have arisen as a result of disability, accident or illness. It is only provided where an individual requires long term healthcare and NOT social or residential care. If you have any questions please call the Continuing Healthcare Team on 01305 368084.

For additional information or to apply for retrospective funding please click on the following documents:-

How to Apply for Current Funding

For current funding you can request an assessment through your GP or district nurse.

Assessments for eligibility are also carried out by the multidisciplinary team on the ward in hospital or in a care home.

Alternatively you can apply in writing for current funding to the Continuing Healthcare Senior Operational Manager and we will send you an application form along with a consent form to be completed by you or your legal representative.

Or you can download and complete the application form and return to:-

Continuing Healthcare Team (New Application)

NHS Bournemouth and Poole

Canford House

Discovery Court Business Centre

551-553 Wallisdown Road

Poole

BH12 5AG

Your application will be acknowledged by letter and you will be informed of the next stage.

Assessments

The NHS Continuing Healthcare Checklist is completed by NHS clinical staff and if indicated they will recommend for referral for a full assessment (Decision Support Tool) to be completed.

All applications for funding are considered by a multidisciplinary team (MDT) who will complete a Decision Support Tool. This assessment will determine the level of health needs for each of the domains described in The National Framework.

The Decision Support Tool with supporting evidence is then sent to the PCT for ratification. Where possible the PCT will uphold the recommendation, however on occasions the evidence does not support the recommendation. In these circumstances the PCT will provide a full rationale for their decision.

Consent

The PCT will require consent from the patient in order to carry out any assessments and to gather any evidence/information required to assess eligibility.

When collecting or using personal information the Primary Care Trust complies with Principle 1 of the Data Protection Act 1998. For additional information about this please visit the Trust's web page Using Your Information.

If a patient is unable to sign the consent form the PCT will accept a signature from a person who is legally entitled to represent the patient, i.e. a person named in the Lasting Power of Attorney document, Grant of Probate, Deputy appointed by the Court of Protection or named in the Best Interest Decision Form.

Under all circumstances the PCT will require supporting legal evidence for any signature on the consent form other than the patient’s own.

Payments

If NHS Bournemouth and Poole agrees to fund your care you will be asked to provide copies of relevant invoices/receipts and corresponding bank statements in order to arrange reimbursement from the date of the eligibility decision.

NHS Bournemouth and Poole will ensure that invoicing arrangements are in place with immediate effect from the date of the eligibility decision.

The NHS will only meet direct care costs. Other incidental costs such as hairdressing, chiropody and newspapers will not be met.

If your needs change in the future, you may cease to be entitled to NHS Continuing Healthcare funding. If this happens and care and support is still required, the PCT will refer you to the local authority for an assessment of your community care needs.

Appeals

Requests for appeals should be made in writing after you have received written confirmation of the eligibility decision. You have up to 6 months from the date of your decision letter to appeal the eligibility decision.

You will be asked to complete and return an appeal application form and return it to us with the evidence you have to substantiate your appeal.

The Department of Health guidance states that if someone is determined as not eligible the 'not eligible' decision stands until the appeal process is completed which may or may not uphold the initial decision.

PCTs can cease funding from the date of the decision, but will give 28 days notice from the date of the decision letter to cease funding.

Decision Making Panels

There are two types of panel meetings:-

The NHS Bournemouth and Poole Continuing Healthcare Decision Making Panel. This panel meets three times a week and reviews both current and backdated (retrospective) eligibility.

The NHS Bournemouth and Poole Continuing Healthcare Multidisciplinary Appeals Panel. This panel meets once or twice a month and reviews appeal cases.

Your health