How do I apply for NHS CHC to cover my care bills?

Care fees are steep and many families struggle to meet them, but financial help is available based on your health needs.

You can apply for funding known as ‘NHS continuing healthcare’ for yourself, or a loved one – but the assessments and red tape can be challenging. 

James Urquhart-Burton, partner at Ridley & Hall Solicitors and an expert in care funding, explains how to make an application for NHS CHC.

If you or a relative have substantial needs arising from any health condition, you should explore whether the NHS continuing healthcare fund should be paying 100 per cent of the care fees.

Eligibility for this funding should be assessed, whether you have just started having a care package or received care for a long time.

It’s never too late to ask for an assessment of eligibility, which is decided by your local Clinical Commissioning Group, but you will have to be proactive.

The CCG is not always necessarily aware of who you are or that you have substantial care needs and need an assessment.

It’s really important that you know about your right to an assessment, how to ask for it and how to maximise your chances of being found eligible to have your care fees paid.

NHS CHC can be granted for care in your own home, in a residential care home or in a nursing home, and where you live shouldn’t affect your eligibility.

Whether your finances are at stake or you are acting on behalf of a relative who is forking out their life savings or selling their home to pay for their care, it is crucial to regularly check your eligibility, otherwise you could be spending thousands of pounds needlessly.

James Urquhart-Burton: It’s never too late to ask for an assessment of eligibility for NHS CHC

There is an initial assessment, and if you get through that a second, more detailed one will follow. Here are the steps you need to take.

1. Contact your CCG about an assessment

To find the contact details for your CCG, search for your GP surgery here.

The name of the CCG will appear at the bottom of your GP surgery details page. Click on the CCG for its full contact details.

Make your request for an assessment in writing, include the date and keep a copy, so that you can prove when you requested it in case it is overlooked.

A key point to note is that if you have been paying for care for a while now and believe you should have had an assessment some time ago, you can also ask the CCG to undertake a ‘retrospective assessment of your eligibility’.

If the CCG decides that you should have been eligible for some time, it is obliged to refund you the care fees you have already paid.

2. Prepare for an assessment of your eligibility

The CCG should make arrangements for an ‘NHS checklist’ to be completed. You should familiarise yourself with this document in advance of your assessment meeting. You can find it here.

If you can, it’s helpful to print a copy of the checklist. Work through it yourself thoroughly in advance of your meeting, or have a relative do it with you.

Score your needs based on what you think – if you know that you are at a high risk of falls, give yourself an ‘A’ for mobility.

3. Make your opinions known at the assessment

The NHS checklist is not the main assessment of your eligibility but a quick indication as to whether or not you need a full NHS continuing healthcare assessment.

The nurse or social worker who completes your NHS checklist must get to grips with all of your needs across the ‘care domains’.

This means any needs you have in communication, mobility and nutrition to name only a few.

If you have gone through the checklist in detail in advance, this will help you feel more prepared to discuss your needs with the assessor when they arrive.

4. Make a complaint if you are wrongly turned down for a full assessment

The CCG should be willing to discuss the NHS checklist with you if you are unhappy, but you shouldn’t delay putting a complaint to it in writing as a 12-month deadline usually applies.

It is helpful to summarise which care domains you feel are understated, as well as any failure to consider relevant information about your needs.

5. Prepare for the full assessment of your eligibility

If you are referred for a full assessment, familiarise yourself with the ‘decision support tool’.

The DST is similar to the NHS checklist but it is more detailed. You have met the threshold to have a full eligibility assessment, so the assessors need to make a recommendation that you are eligible or not eligible for NHS CHC.

You can find the DST here. 

Following a similar approach to that taken with the checklist, read the DST thoroughly in advance and have a think about your needs and what score you would give to them.

As in the earlier example, you might feel you should score high in mobility because you are at a high risk of falls.

6. Ask for confirmation of the full assessment decision in writing

Whatever the decision, ensure it is confirmed in writing and get a copy of your DST.

If you are eligible for NHS CHC – well done! The CCG will pay for your care until your next review.

If you are not eligible, consider whether you need to appeal.

Think about whether your needs have been under-assessed. You will usually only have six months to appeal. Do so in writing and to gather any evidence you feel you may need.

You do not necessarily need a professional adviser to help you with NHS CHC assessments or appeals, but many people choose to engage one to help them construct persuasive arguments which are backed up well with evidence.

Turned down? James Urquhart-Burton explains how to mount an appeal