I am a solicitor and partner at Ridley & Hall Solicitors. For the last 13 years, I have helped individuals and their families to secure NHS Continuing Healthcare Funding and ensure that their care fees are paid by the NHS when by law they should be.

I am often asked by members of the public how to go about seeking an NHS Continuing Healthcare assessment, and I am concerned by how little information there is out there and how often people seem to get stuck. Common misconceptions can also arise, and I want to dispel any myths by explaining  how to seek a Continuing Healthcare assessment for your loved one.

This blog is intended to help people who are seeking an eligibility assessment for someone who is living.

It’s also possible to seek retrospective assessments on behalf of individuals who have now passed away, but the process is different. If you need more information about that, then read my blog about claiming back care home fees.

• The NHS Continuing Healthcare Checklist
• Ask a Nurse or Social Worker
• Get in touch with your local Integrated Care Board (ICB)
• Overcoming Barriers and Getting Professional Support

The NHS Continuing Healthcare Checklist

The starting point for getting an assessment done for a living patient is for the NHS Checklist to be completed. This is a screening tool which should be completed and used to determine who might need a full eligibility assessment for NHS Continuing Healthcare. The Checklist is published here.

Guidance for the completion of the Checklist can also be found via the above link, but you should also take a look at the latest National Framework for Continuing Healthcare, the latest version of which you’ll find doing a quick google and following the results to the www.gov.uk website. As at January 2024, the latest National Framework can be found here, and the relevant provisions are from paragraph 111 onwards.

Briefly, the NHS Checklist can be completed by any health or social care practitioner who has been trained in its use. The outcome of the Checklist will either be positive (referral for a full eligibility assessment is required) or negative (referral for a full eligibility assessment is not required).

Ask a Nurse or Social Worker

If your loved one has an appointed Social Worker, or there’s a Nurse who takes care of them at a care home or in their own home, you can ask if they would be happy to complete the Checklist for your loved one and submit it to the Integrated Care Board (“ICB”).

Sometimes these professionals might refuse to complete a Checklist; they might not feel comfortable doing so because they don’t know enough about Continuing Healthcare, which is a good reason not to complete one. However, if you’re told that your loved one “won’t qualify for the funding, so there’s no point in completing the Checklist”, that should ring alarm bells and I’d make enquiry elsewhere. The only lawful way to know if someone is entitled to an assessment of their eligibility is for the Checklist to be completed, and whilst anyone is entitled to their own opinion, you should ensure that your loved one is considered in the proper way by ensuring that process is followed.

Get in touch with your local Integrated Care Board (ICB)

The ICB has a legal duty to “take reasonable steps to ensure that an assessment of eligibility for NHS Continuing Healthcare is carried out in respect of a person for which that body has responsibility in all cases where it appears to that body that there may be a need for such care”. See Regulation 21(2) The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012.

Therefore if you are in any doubt then make direct contact with the organisation which has the duty to assess; the ICB, to let it now that an assessment is needed. Contact details for the ICB can be found on their website. If you’re not sure which is your local ICB, ask your loved one’s GP to confirm.

Overcoming Barriers and Getting Professional Support

Getting advice from an expert in Continuing Healthcare at an early stage will usually maximise your chances of securing funding, because the assessment and appeals process is very complex.

Given the average cost of care fees, it’s usually proportionate to involve a professional such a solicitor to help in the fight to secure funding, but the question of proportionality is something which I discuss in full with every single one of my clients. The key benefit to instructing my firm is that you get bespoke advice tailored to your particular circumstances, from a qualified and experienced solicitor.

If you’d like to discuss your particular case with me, don’t hesitate to contact my firm, Ridley & Hall Solicitors on 0800 860 62 65.

James Urquhart Burton – Solicitor