Eligibility assessment deadlines for NHS continuing healthcare funding
People who think they or a relative may be eligible for continuing healthcare funding by the NHS but who have not yet applied for it are urged to do so promptly.
NHS continuing healthcare is the name given to care arranged and paid for by the NHS for people not in hospital but whose primary need, as a result of disability, accident or illness, is for healthcare (rather than social care).
Most people who receive continuing healthcare funding live in residential care but some people are in their own homes. The funding is subject to review. If people’s care needs change, their funding arrangements may also change.
The Department of Health has set cut off dates for funding assessment because the responsibility for continuing healthcare funding is moving from Primary Care Trusts to Clinical Commissioning Groups.
Deadlines being introduced as a result of the reorganisation of the NHS mean that applications must be in by 30 September for claims between 1 April 2004 and 31 March 2011.
People whose care was received between 1 April 2011 and 31 March 2012 need to apply by 31 March 2013.
People who received care across both time periods must submit before the first deadline – 30 September 2012 – for the entire period of care to be assessed.
Applications after the deadline will not be considered unless there are exceptional circumstances.
The Department of Health deadlines apply to people or their families who have not been assessed for continuing healthcare funding before.
The deadlines
• People whose care was received between 1 April 2004 and 31 March 2011 need to apply by 30 September 2012
• People whose care was received between 1 April 2011 and 31 March 2012 need to apply by 31 March 2013.
To apply for assessment
People or family members who think they could be affected need to contact the following:
For residents of Dartford, Gravesham, Swanley, Medway and Swale
Janet Manuel
Head of NHS Continuing Healthcare Assessment North
NHS Kent and Medway
50 Pembroke Court
Chatham Maritime
Kent ME4 4EL
Tel: 01634 335045
For residents of West Kent
Helen Phillips
NHS Continuing Healthcare Team Manager
NHS Kent and Medway
11 Station Road
Maidstone Kent ME14 1QH
Tel: 01622 680627
For residents of East Kent
Valerie Winter
Head of NHS Continuing Healthcare Assessment South
NHS Kent and Medway
Templar House
Tannery Lane
Ashford Kent TN23 1PL
Tel: 01233 618173
For further information, visithttp://www.easternandcoastalkent.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=222699
Notes to editors
• In the past, each of the 28 strategic health authorities had their own rules and processes for deciding who was eligible for NHS-funded care.
• In October 2007, a single National Framework was introduced in England to give guidance for deciding on eligibility for NHS continuing healthcare.
• In 2007, a similar process was carried out to identify funding eligibility for cases receiving care before 1 April 2004.
• The Department of Health deadlines and the takeover of responsibility by the Clinical Commissioning Groups will not affect any of the eligibility criteria set out in the National Framework.
• There are two deadlines to make sure people or families have a minimum of 12 months to request an assessment from the start date of their care time period.
The assessment process
Health and social care staff work identify if someone needs a full assessment of eligibility for continuing healthcare.
Two or more health and social care professionals involved in the person’s care will ask the person’s permission to speak to all professionals involved in their care. They might also ask for specialist assessments.
Eligibility is then determined by looking at 11 types of needs, such as mobility, nutrition and behaviour and then deciding the nature, complexity, intensity and unpredictability of the person’s needs.
If the primary needs are health needs, they will make a recommendation that the person should receive NHS continuing healthcare. The person will receive the outcome of their decision in writing, setting out the reasons.
NHS Continuing Healthcare is reviewed after the first three months and then annually.
Those not eligible may still have health needs. The NHS may pay for part of the support package without charge. The local authority may also part fund the person’s care package and you may have to pay a contribution, depending on your income and savings.
If someone is unhappy with the outcome of their assessment for eligibility for NHS continuing healthcare, they can ask NHS Kent and Medway to reconsider the decision.