NHS Continuing Healthcare is the name given to funding which is provided by your local Clinical Commissioning Group (CCG) and covers 100% of the cost of your care home fees.

The simple answer is that NHS Continuing Healthcare Funding is available for people suffering with dementia, but there are also people who don’t qualify for NHS Continuing Healthcare Funding, despite a diagnosis of dementia.

How is it that two people with the same diagnosed condition aren’t entitled to the same level of support? The answer lies in the fact that although your diagnosis may be an indication of the sort of care, medication and support you need, it does not necessarily account for the severity of your condition and sort of needs you present with, which tend to be unique to you.

The National Framework for NHS Continuing Healthcare Funding sets out how eligibility for NHS Continuing Healthcare should be assessed and the latest version can be found here.

At paragraph 55 it states as follows:

“An individual has a Primary Health Need if, having taken into account all of their needs, it can be said that the main aspects or majority part of the care they require is focussed on addressing and/or preventing health needs. Having a Primary Health Need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day-to-day care needs taken in their totality.”

Accordingly, a diagnosis of dementia (or any other condition for that matter) does not, of itself, mean that you are eligible for NHS Continuing Healthcare Funding. It is very important that no assumptions are made about the type of care you require, based simply on your medical diagnosis, without a full assessment of your needs having been undertaken.

This does not however mean that your diagnosed medical conditions are irrelevant to the assessment and if you are assessed for Continuing Healthcare Funding and important conditions are missed or glossed over then it is important that you speak up.

Another question people ask is why a diagnosis of dementia, being a recognised medical condition, doesn’t automatically mean that the majority of needs are medical or health needs, which would qualify for NHS Continuing Healthcare Funding.

Again, the answer lies in the fact that most people who require care and support have both health and social care needs arising from their medical condition. Therefore, irrespective of your dementia diagnosis, a detailed assessment of your needs is still required and you will be eligible for NHS Continuing Healthcare Funding if the majority of your care is focussed on treating or preventing healthcare needs. The assessors are expected to determine where the dividing line sits by considering whether your day-to-day needs are intense, complex or unpredictable.

James Urquhart-Burton is our specialist NHS Continuing Healthcare solicitor and he has assisted hundreds of families to secure the right funding for their loved ones. Get in touch with him on our freephone 0843 289 7130 for a free initial chat.

James Urquhart-Burton – Partner & Solicitor