Continuing Healthcare is a NHS package of care for those receiving care in any setting outside of hospital and have ‘continuing healthcare needs’ that are significant and ongoing. People who meet the eligibility requirements will have the full cost of their care and, if in a care home setting, their accommodation funded by the NHS.

Unfortunately, there is no one size fits all. The starting point is that an individual requires care primarily for health needs and that those health needs are complex, intense and/or unpredictable in nature. The individual’s needs are assessed against 12 ‘care domains’ and each domain is scored against one of the following: no need, low need, medium need, high need, severe need or priority need. Not many people know about NHS Continuing care and as such, it is important to request an assessment to find out if you qualify.

The difficulty is, there is no defined meaning for a Primary Healthcare need. It is appreciated that everyone is different and needs also vary. As such, primary healthcare need is not constrained to a specific definition. As such, there is not a list of conditions or diagnosis that automatically qualify as a primary healthcare need. Therefore, an assessment is paramount to establish if you have a primary healthcare need. Where an individual is found to have a primary healthcare need, it will be over and above the care that can be lawfully provided by social services and therefore the NHS has a responsibility to meet them.

It is the initial checklist assessment which determines whether a full assessment (also known as a Decision Support Tool) is required. A checklist is usually completed by a nurse assessor or social worker. At the assessment the assessor will go through each of the 12 domains and rate them and score against a criteria. A representative is able to attend and it is highly advisable that they do so that they can challenge any low scores, provide input as to the extent of care required and ensure all needs are considered. Advucate regularly attends checklists which are followed by full assessments.

Decision Support Tool, also known as a DST is where a full assessment is carried out. The assessment is carried out by a multi-disciplinary team of clinicians (referred to as an MDT), often a social worker, social healthcare professional, a GP and a nurse assessor. They will consider each care domain and consider if the need in each domain is sufficient in nature, intense, complex and unpredictable. The DST is the main toolkit used by the MDT when assessing the individuals healthcare needs. It is important to understand the toolkit and be ready to evidence to the MDT the nature of care needed for each domain. This could mean going through all the care notes, letters and health records to see what can be used to support each domain. This can become complicated and time consuming, however our team at Advucate are expertise in this area with nurse and pharmacists on hand.

It does not make a difference as to what setting care is being received. This was clarified by Parliament and the Health Service Ombudsman in 2003. An individual could be entitled to NHS continuing healthcare funding whether they receive care in their own or a relatives house, or in a care home.

It is not uncommon for people to not have heard of continuing healthcare, especially when an assessment should have taken place for the individual. It seems some individuals slip through the net. This usually happens when the individual is self-funding and choose their own care home or service. However, we can request that an assessment take place, we are often contacted by families of individuals who have never heard of continuing healthcare funding and have been eligible.

Whilst there is no hard and fast rule, in our experience more often that not, in order to represent your loved one you will need a Lasting Power of Attorney in place as otherwise you are not entitled to make health or financial decisions on behalf of your relative. Lasting Power of Attorney is a legal document that enables a nominated person to make decisions on an individual’s behalf if they lack the mental capacity to do so themselves. It should be noted that a Lasting Power of Attorney is only valid if the individual has the mental capacity to set it up, as such, we advise that this is discussed with the individual and your family as early as possible so that an informed decision can be made. Nonetheless, you will never be deterred from contributing to assessments, this is in fact encouraged, even if you instruct us, we still advise that you attend assessments with us. The National Framework also places great importance on the involvement of the person who is being assessed and/or their representative and recognises that the person’s representatives are often experts on the care needs of the person in question.

Where the care is received is never questioned, whether this be in your own home or the individual’s home or in a residential care home therefore the individual will not be moved from their preferred location.

There are three main stages: Stage 1: initially a checklist will need to be completed by a nurse assessor or social worker. If the checklist indicates there is a primary healthcare need, the individual will be referred for a full assessment using the Decision Support Tool to assess their eligibility. Stage 2: a full assessment will need to be carried out using the decision support tool. Here a multi-disciplinary team will consider each domain alongside each needs nature, intensity, complexity and unpredictability. Stage 3: a separate panel will consider the information provided from Stage 2 - the full assessment and consider the recommendations of the multi-disciplinary team and make a decision as to whether the individual is eligible.

The individuals needs are assessed against 12 ‘care domains’, these are: · Behaviour · Cognition · Psychological and Emotional needs · Communication · Mobility · Nutrition · Continence · Skin Integrity (including wounds, ulcers, tissue viability) · Breathing · Drug Therapies and Medication · Altered States of Consciousness · Other significant care needs will also be taken into consideration

Advucate provides expert advice and representation to individuals and/or their family members who are trying to get their heads around continuing healthcare. We provide specialist advice and carry out casework in relation to continuing healthcare at any stage of the process. We offer a free consultation where we provide honest advice and guidance with no obligation to engage out services. If you feel you require more in-depth support and are looking for guidance throughout the process we are more than happy to assist you. We provide a bespoke service to ensure that you understand the process each step of the way and make informed decisions. Advucate is made up of a team of qualified legal professionals, such as Miss Kang who is a qualified barrister and advocate, and registered nurses and pharmacists so that you are equipped with have the strongest possible prospects of success in securing continuing healthcare funding. Before we accept any instructions, we carry out an assessment and provide open honest advice on your prospects. We will never take on your case if we feel you have minimal to no chance of securing continuing healthcare funding, as we are able to do so with confidence and conviction due to our expertise in the field. Where there is reasonable prospects of success, we will discuss this further and accept instructions to proceed.

Continuing healthcare is not means tested and therefore no financial considerations will be taken into account. You will not and should not be asked questions about finances. The only assessment will be in regard to the individual’s healthcare needs.

A McKenzie Friends attends court with someone who does not have a lawyer (also known as a litigant in person). The term comes from a case called McKenzie -v- McKenzie where it was decided that an unrepresented party should be allowed to have a friend in court who was supporting them. Given the changes to Legal Aid, the number of unrepresented parties has increased. For those who are not eligible for legal aid and who cannot afford a solicitor, a McKenzie friend can provide a valuable service. Advucate provides important emotional support to those without a lawyer and help guide them through the court process.

Whilst all our McKenzie Friends are legally qualified, we cannot represent you or act as your lawyer. However, what we can do is help you with court proceedings, by advising and guiding you, providing you with support, taking notes for you during court proceedings and quietly giving advice during the hearing when needed.

We offer a range of support services for most hearings, including but not limited to: · First hearing (dispute resolution) · Directional hearings · Fact finding hearings · Final hearings · Application hearings (such as child arrangement and enforcement hearings) · Existing care review hearings · Divorce hearings We also help with applications and orders, such as but not limited to: · Orders (non-molestation/occupational) · Applications (child arrangement and enforcement) · C100 forms We can also fully manage your case from start to finish and advise you each step of the way whilst providing unwavering support.