NHS Continuing Healthcare is the name given to the funding and support which the NHS is legally required to provide to people who need care, if, following a detailed assessment of their needs, it is decided that they have a Primary Health Need.

The local Clinical Commissioning Group (CCG) is responsible for arranging Continuing Healthcare packages in your area and a request for an assessment should usually be made to them. But what happens if they refuse to do an assessment? Here are some examples of common reasons given for refusal:

“You are in a residential care home and so you don’t need an assessment.”

“You don’t need an assessment because your health needs are being met by primary care services, such as the district nurse or the GP.”

“Your loved one’s needs are being met by the care home.”

“A referral needs to be made by a social worker at the Local Authority. We can’t do a Continuing Healthcare assessment without one.”

Strictly speaking, none of the above are good reasons to decline an NHS Continuing Healthcare assessment. To understand why, we have to go back to basics…

The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 places a legal duty to undertake an assessment wherever it appears that there is a need.

CCGs may have their own processes for arranging Continuing Healthcare assessments and ensuring that they are done, and there is only one legally recognised process for screening people in and out of the assessment process, and that by completing an NHS Checklist, which can be found here.

This can be completed by any health or social care professional who has an understanding of NHS Continuing Healthcare assessments and who is in a position to comment on the needs of the person being assessed.

Whilst therefore a CCG may have a referral process in place, the CCG has a legal duty to assess wherever it appears there is a need and so, if you find yourself going round in circles trying to get an assessment arranged, let the CCG know what the patient’s needs are and make use of their formal complaints process if you need to.

Equally, the National Framework for Continuing Healthcare makes it clear that the setting in which the care is provided is not a factor to be taken into account when determining eligibility, nor is the fact that needs are managed by the care provider or because qualified healthcare professionals are not providing the care.

Even if your loved one is not eligible for NHS Continuing Healthcare, a detailed assessment is required, by law, to determine eligibility, but given restraints on NHS resource, some will have to shout to be heard and to get access to the eligibility assessments that they or their loved ones are entitled to.

If you need legal help on advice, get in touch on our freephone 0800 8 60 62 65.

James Urquhart-Burton – Partner & Solicitor