Service User Support

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Service User Support

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Making decisions about care provision for yourself or a loved one can be both confusing and emotionally draining. At Trailblazer Social Care we are here to help you every step of the way. On this page you will find essential information about accessing NHS Continuing Healthcare funding in England along with an outline of the other options that may be available to you – including what to do if you don’t agree with a decision about your funding eligibility. We’ve done our best to explain things in simple language but we understand that you may still have questions or some things may be unclear. We are always happy to answer any questions you may have. Simply call us on 0330 123 0585 or you can use the form on our Contact Us page to email us.

What is Continuing Healthcare?

NHS Continuing Healthcare is the name given to any care package funded by the NHS. It is for any individual who is not in hospital but still has ongoing complex healthcare needs.

Am I eligible for Continuing Healthcare?

NHS Continuing Healthcare is available for individuals over 18 years of age who have been assessed as having a substantial complex medical condition that results in ongoing care needs. In other words your main need for care must be as a result of your health.

Will I have to go into a home to qualify for help?

No. NHS Continuing Healthcare will meet the cost of your care in a setting best suited to your needs. This may be in a care or nursing home, in which case the NHS will pay for your care home fees as well as your healthcare and personal care needs, or it may be in your own home, in which case the NHS will fund your healthcare such as visits from a community nurse or personal care needs such as help with bathing, dressing and laundry.

How will I be assessed to see if I qualify for Continuing Healthcare?

Assessment is carried out by a healthcare professional and usually begins with the Checklist Tool.  This is a screening tool that helps the healthcare professional determine whether a full assessment needs to be carried out. The Checklist will not indicate whether you are eligible for NHS Continuing Healthcare – it is purely a tool to help the assessor decide whether a full assessment needs to be carried out. If it looks like you or the person you are applying on behalf of may be eligible for NHS Continuing Healthcare funding the assessor will contact your Clinical Commissioning Group or CCG. Each CCG is lead by the GPs in your area, ensuring that decisions are based on healthcare needs. Your CCG will arrange a full assessment of your care needs. This will be carried out by a multi-disciplinary team made up of two or more health and social care professionals who are involved in your or your relative’s care. The multi-disciplinary team may also ask other specialists to contribute to the assessment if you agree. This is to ensure you or your relative is to receive the right type of care.

After the assessment the multi-disciplinary team will make a recommendation to the CCG about your eligibility for funding. A clear recommendation of eligibility for NHS Continuing Healthcare would be expected if the following criteria are met:

  • A level of priority needs in any one of the four areas that carry this level.
  • A total of two or more incidences of identified severe needs across all care areas.

The CCG may also recommend funding if one of the following criteria are met:

  • One area is recorded as severe, together with needs in a number of other areas
  • A number of areas assessed as having high and/or moderate needs

Whatever the CCG decides, you will be sent a written decision telling you if you are entitled to NHS Continuing Healthcare funding as well as an explanation of what the decision was based on.

You will receive a writen explanation of how the CCG arrived at its decision

If your local CCG decides that you are not entitled to care funding there are still things you can do to try and have the decision changed.

What to do if you don’t agree with the decision

Ask for a healthcare needs assessment

The NHS has a duty to take reasonable steps to ensure that an assessment is carried out to see if there may be a healthcare need.  However, this may not happen automatically. You can and should ask for an assessment to be made ideally as early in your assessment as possible.

Check and revise the assessment

When a full assessment has been carried out, you should be asked to comment on the Decision Support Tool that was used by the CCG in making its decision. You should check this document and any supporting evidence to make sure that the scores reflect a true picture of your healthcare needs.  For example, are any of your needs scored as ‘moderate’ when they should be ‘high’, ‘severe’ or ‘priority’?

Tell the CCG that you are not happy with the decision

If you disagree with a decision you can ask the CCG to register a review by putting your comments in writing.  You should ask for your comments to be presented to the CCG, alongside the decision support tool and the multi-disciplinary team’s recommendations.  The decision on NHS Continuing Healthcare funding will normally be made by a CCG panel at a closed meeting (you will not be allowed to attend).  It is important to act quickly as there may be a deadline for registering any appeal.

If the CCG review maintains the original decision, you can ask for the case to be referred to the CCGs Independent Review Panel .  You may also apply directly to the Independent Review Panel if the local resolution stage is taking too long.

If you’re still not satisfied with the outcome of an independent review, you can ask for your case to be reviewed by the Parliamentary and Health Service Ombudsman.

Ask for a re-assessment

If you do not qualify for NHS Continuing Healthcare funding and your health changes you should ask the CCG to reassess your eligibility.

Funding your own care

If you are not eligible for NHS Continuing Healthcare funding, you will need to fund your care privately. This can be a complex matter and we highly recommend that you seek advice from Independent Financial Advisors who specialise in Care Fees.

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This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.