Is Your NHS Continuing Healthcare Funding Being Reviewed?
Understanding Reviews to Existing NHS Continuing Healthcare Funding
If you or a loved one already receives NHS Continuing Healthcare (CHC) funding, the NHS should periodically review your care needs and arrangements.
A CHC review can seem routine, but it is an important stage. If the Integrated Care Board (ICB) believes your needs have changed sufficiently, it may recommend a full reassessment of your eligibility for CHC funding. This could ultimately put your existing funding at risk.
At Winston Solicitors, our specialist CHC solicitors can advise and represent you before and during the review of your existing Continuing Healthcare Funding, helping to ensure your needs are properly understood and the correct process is followed.
We can help you:
- prepare for an upcoming CHC review;
- review your previous assessment and current care needs;
- consider up-to-date care records and other evidence;
- advise whether there has been a significant change in needs;
- liaise with the ICB before the review;
- attend the review and represent you; and
- challenge a recommendation for reassessment where appropriate.
What happens at a CHC review?
Once someone is eligible for CHC, their care arrangements should be kept under review. The first review should normally take place within three months of the eligibility decision, with further reviews taking place at least annually. Importantly, a CHC review is not supposed to be an automatic reassessment of eligibility.
The National Framework says that reviews should primarily focus on whether the existing care plan and arrangements remain appropriate. In the majority of cases, there should be no need to reassess eligibility.
A full reassessment should only take place where there is clear evidence of a change in needs to such an extent that it may affect CHC eligibility. The previous Decision Support Tool (DST) should normally be used as the point of reference when considering whether needs have changed.
Why Getting Advice for Reviews to Existing Continuing Healthcare Funding Early Matters
If the ICB recommends a new DST, the focus can quickly move away from the review and towards a fresh assessment of whether the person remains eligible for CHC. It is, therefore, important to consider at the review stage whether there really has been a significant change in needs which justifies reassessment.
Early advice can help ensure that the ICB properly considers the previous DST, current care needs and the support required to manage them before deciding whether eligibility should be reassessed.
Have Needs Reduced Or Are They Simply Well Managed?
A person can appear stable precisely because they are receiving the right care.
For example, fewer falls, fewer incidents of challenging behaviour or an improvement in nutrition may result from effective supervision, experienced carers or appropriate treatment. This does not necessarily mean that the underlying care need has disappeared.
The National Framework specifically warns against treating well-managed needs as a reduction in a person's actual day-to-day care needs. This can be an important issue at a CHC review.
How Our CHC Solicitors Can Help with Reviews to Your Existing Continuing Healthcare Funding
We tailor our service to the circumstances of each case. Our CHC experts can review the previous DST and current evidence, advise you before the meeting and raise any concerns with the ICB in advance. We can also attend the review and represent you, making sure the relevant evidence is considered and asking appropriate questions about any suggested change in needs.
If the ICB recommends a full reassessment, we can advise whether there are grounds to challenge that decision. If a new DST does proceed, we can continue to advise and represent you through the assessment and, where necessary, any subsequent appeal.
When Should I Contact a CHC Solicitor?
Ideally, as soon as you are notified that a review to existing NHS Continuing Healthcare Funding is going to take place. You may particularly benefit from advice if:
- you are concerned that existing CHC funding may be at risk;
- the ICB appears to be treating the review as a reassessment of eligibility rather than a review of the existing care and support;
- a new DST or reassessment has been proposed without it being clear what significant change in needs has occurred;
- you have been told that needs have reduced;
- your relative’s needs appear more stable because of significant care and support; or
- you have concerns about how the review is being conducted.
Getting advice before a review to existing NHS Continuing Healthcare Funding gives us the best opportunity to protect your position before a decision is made to reassess eligibility.
What About Fast Track CHC Funding Reviews?
If CHC funding was awarded through the Fast Track pathway, the person's care needs and the effectiveness of their care arrangements should also be reviewed regularly.
A Fast Track review does not automatically mean that CHC funding should end or that eligibility should be reassessed. However, where there has been a change in needs, the ICB may consider whether a review of CHC eligibility is appropriate. Any such decision should be made carefully and sensitively.
If you or a loved one receives Fast Track CHC funding and a review has been arranged, we can advise you about the review and any proposal to reassess, change or withdraw the existing funding.
Speak to Our CHC Solicitors About an Upcoming Review
If you or a loved one already receives NHS Continuing Healthcare funding and a review has been arranged, we can help you understand what the review means and how best to prepare.
Our specialist CHC solicitors can advise you before the review, help you prepare the evidence, represent you at the meeting and challenge the process where appropriate. Contact us as early as possible after receiving notice of a CHC review.
