Challenges Accessing CHC Funding
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Challenges in Accessing NHS Continuing Healthcare (CHC) Navigating the NHS Continuing Healthcare (CHC) process is notoriously complex, with eligibility often falling into a grey area between healthcare needs and social care needs. This distinction is crucial because NHS-funded care is free at the point of use, whereas social care is means-tested, requiring individuals to contribute financially. Unfortunately, the line between the two is often blurred, and some families find that the NHS incorrectly categorises health needs as social care needs—effectively shifting the funding burden onto individuals or local authorities. A Complicated and Opaque Process The only way to determine eligibility is through an in-depth assessment conducted by a multidisciplinary team (MDT), which evaluates the totality of a person’s needs. However, many families struggle to navigate this process, feeling overwhelmed, confused, and unprepared to challenge incorrect decisions. • Many give up due to the sheer volume of NHS policies and guidance, which are difficult to absorb while also managing their loved one’s care. • Relatives are sometimes excluded from the assessment process, only to be later informed that a Checklist has already been completed without their knowledge. • Families have the right to see the completed Checklist, and if it cannot be produced, they should insist on having a new one done. Checklist: A Barrier Rather Than a Gateway? The CHC Checklist is meant to determine whether an individual qualifies for a full assessment, but in reality, many families feel it is used more as a filtering mechanism to exclude people from further evaluation. • The outcome of a Checklist can be revisited but not appealed, limiting the ability to challenge an unfair decision. • Some healthcare professionals lack sufficient training in CHC procedures, leading to incorrect Checklist decisions. • Individuals who may qualify for funding are often told their needs aren’t serious enough to proceed to a full assessment. Subjectivity and Inconsistencies in Funding Decisions Even when individuals progress to the full assessment, many still face barriers in securing CHC funding. The Decision Support Tool (DST), used in these assessments, is open to subjective interpretation, leading to:
The Overlooked Option: CHC for Home Care Another major issue is the lack of awareness that CHC funding is available for full-time care at home, not just in care homes. Many families are steered towards care home placements, even when home care would be a more appropriate option—simply because assessors fail to inform them of this choice. Staggering Statistics: Many Are Assessed, Few Qualify According to NHS England’s Q2 2023-24 Care Report (July 1 – September 30, 2023): • 16,147 people were referred for a full CHC assessment. • 3,618 referrals were dismissed before an assessment even began. • 12,529 individuals proceeded to the Decision Support Tool evaluation. • Of those, only 2,568 people (approximately 20%) were deemed eligible for CHC funding. This means that a staggering 80% (or 9,961 people) went through the full assessment but were denied funding—highlighting the systemic difficulties families face in securing the care they are entitled to. Know Your Rights! If you believe your loved one has a primary health need, it is critical to: • Insist on a fair assessment process. • Request a copy of all assessment documents. • Challenge incorrect decisions with evidence. • Seek expert guidance if needed. Given the complexity and subjectivity of CHC assessments, understanding the process and advocating for your rights can make the difference between securing life-changing funding or being forced to self-fund care unnecessarily. |
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