Has anyone successfully applied for continuous healthcare when it wasn’t a palliative care situation

The assessor in my mum's case was very obviously intent on dismissing the areas where my mum met the criteria, and dismissed evidence submitted by my mum's care company, and her integrated care nurse. My evidence was deemed completely irrelevant.

Our of interest OP which document have you used do far to consider his needs? The initial checklist has a much lower bar to make sure no one is missed but on the full DST document it is much harder to score in the higher levels.

It's an absolute non-starter as well if someone isn't keeping meticulous daily records about his needs and how intense/complex/unpredictable they are.

My mum was refused it two months before she died. The person conducting the assessment had no interest in anything other than denying she met the criteria. She would have got it in the past, they're really only allowing it in extreme circumstances now. At least in my area.

Please don't pay a company to help.

There seems to be a theory that the assessors don't want people to get CHC, whoch simply isn't true, it's just that the bar is very high. Someone may have e.g dementia and seem completely unmanageable, but in the right setting it'll be bread and butter care.

The DST is used, the evidence has to be there, and if it's not then you won't get CHC.

As a social worker I see plenty of people awarded it because they meet the criteria of having primary health care needs of a nature, complexity, unpredictability or intensity that mean they are over and above what can lawfully be funded by social care/ privately.

I also see plenty of families who are told they will be eligible by companies they have to pay to assist them do what adult social care would do for free if they also felt the person may be eligible. They actively tout for business on threads like this as well.

Simply having nursing needs isn't sufficient, the nursing needs have to be over and above the normal standard of nursing care that could typically be provided in a standard nursing home. The homes themselves are usually pretty good at identifying any residents they feel would meet the CHC criteria and asking for the assessments to happen.

I did, for my Grandad, he had it for about 5 years. They took it away 9 months before he died and our appeal wasn't heard for almost a year after they took the funding away.

I would say that the key thing is to achieve either a Priority or 2 Severe categories as they are the only way that they can't refuse to give CHC funding. Everything else is basically down to interpretation.

I assume you have got this:

https://assets.publishing.service.gov.uk/media/635165f38fa8f554cb9dc2e8/NHS-continuing-healthcare-decision-support-tool-guidance-2022.pdf

I would go down it in advance and see which category you think he falls into for each domain.

Then work out why he falls into the higher, not the lower category, I.e. your arguments for when they disagree with that categorisation. If he is in a care home, have a meeting with the care home worker who will be coming to the MDT before hand.

It's also worth reading up on the procedures - e.g. if the MDT are in disagreement they are obliged to use the higher of the options they disagree on.

Yes, my mother had it. She had very complex needs but I was also convinced that the hospital supported it because they had been negligent & didn't want us to sue, but I will never know if that was true. I think she had it initially for 3 months & then it was reviewed. She lived for 7 months after being awarded it.
Just to add, this was 9 years ago.

Yes, we did. We paid for charity support to prepare the application and attend the meetings.

DMiL had dementia, bed sores, incontinent and chest infections. She was quite erratic in her behaviours.
Her GP supported the application. The nursing home also supported because they were providing medical care.

Funding was agreed for 6 months with a 6 monthly review. The review meeting, in person, felt like a done deal before we had provided any additional, updated evidence of her medical needs. It was an awful experience with harsh comments from the staff making the decision.

The team at the review meeting concluded that DMIL was well and didn't require medical care. She died 6 days later.

The needs of the person have to be very complex and unpredictable. It’s really hard (and seems to be getting harder) to qualify for CHC funding.

Do you want to share a little more? Between us we might be able to help.

Yes got it for my mother in law who went from hospital to nursing home - its was 25% contribution awarded of her nursing costs so not great but helped - this was about 10 years ago

I applied 5 months before my dad died. He did get it a month before he died. I think the only way you realistically can get it is through the palliative health care team. And the only reason I knew of their existence was due t my dad having a hospital admission so it might be worth looking them up.

I had a long battle to try to get funding for my mum, which ended up being unsuccessful. Please don’t make the mistake that I did - I was talked into using Compass to handle my mums application. When we had an initial discussion they were very encouraging and insisted that my mum was very likely to qualify for CHC funding and thst they could present my case much better than I could. They turned out to be completely useless and the only thing they were good at was relieving me of a substantial amount of money for their abysmal services. I handled the local appeal myself and also appealed to NHS England, again both were unsuccessful. You can get a free 30 minute consultation from Beacon Healthcare which was more helpful than anything Compass did, so I would suggest contacting Beacon. They will look through your application and give you advice. Good luck - it’s extremely hard to get unless, as you say, the person is receiving palliative care.

No, we tried for my Dad , who was terminal , (CMML)but it was turned down , it's known to be practically impossible to get. l am sorry to say .