Complex Care Funding

Paying for your care and support within your own home is one dilemma many people in need and their families struggle with. In fact, it’s just as vital as finding the right home care provider.

There are a number of resources available to those looking to get help with complex care funding. With the NHS and local authorities able to assist eligible candidates.

Most funding streams are accessed through assessment. Both your health and social care needs will be evaluated to determine whether you can get help from the NHS or your local authority. As a rule of thumb however, those eligible for health related care will be funded by NHS continuing healthcare (CHC). While social care funding is generally accessible via your local authority if you are eligible.

NHS Funding – Continuing Healthcare (CHC)

For people with long-term complex health care requirements, NHS continuing healthcare is often the first port of call should you be found in need following assessment. Care packages available through CHC are arranged and funded by the NHS to meet primary health needs. This NHS-funded care can be given in any setting, with many choosing to receive their care package within their own home to aid independence and enhance dignity. NHS-funded care packages are free of charge for the service user.

To apply for NHS continuing healthcare funding, enquire with your GP, hospital discharge team or another health care professional. They will be able to arrange an assessment.

Eligibility

Eligibility for NHS-funded care is determined by assessment. During the assessment process, your care needs will be evaluated with what help you require, what your complex needs are, the need intensity and health risks should you remain without the right care identified. Your eligibility is not determined by your diagnosis or condition.

Review

As your needs change so too does your eligibility. Should your needs change or your circumstances alter, a review will be undertaken. As in your initial assessment, you will be fully involved in the entire process. Carers and family members will also be consulted where necessary.

PHB's

Personal Health Budgets (PHBs) are available from your local council if it is determined that you are eligible for funding help. This Personal Budget can then be used to pay for the social care and support you need. With PHBs, you have more choice in how you are cared for with all decisions about how it’s spent down to you.

Please note, eligibility for NHS continuing healthcare is only available to people aged 18 or over. Applicants must have long-term, complex care needs that are related directly to their health.

Eligibility for CHC funding is not influenced by:

  • Your diagnosis or health condition
  • Your current care provider
  • The setting in which care is delivered

Those with disabilities or long-term illness diagnosis are not automatically eligible for NHS continuing healthcare funding. Eligibility is determined by assessment only. You can find out more about NHS continuing healthcare assessment here.

Local Authority Funding

Those looking for funding for social care packages should contact their local authority or social worker to get started. Your local authority or social worker will arrange an assessment on your behalf so your care and support requirements can be professionally appraised.

Whilst NHS continuing healthcare funding is free of charge for eligible people, social care is not free for everyone. As part of the assessment process, your finances are taken into account to decipher whether you need assistance from the local authority or whether you can pay for all, or part, of your care yourself. For further information on when the council might pay for your care, please click here.

Following assessment if you are determined to be in need of support, a Personal Budget will be arranged by your local authority. Your Personal Budget is then made available to you in one of three ways, as a managed Personal Budget, direct payment or mixed package.

Personal Budget

If you would prefer for the council to manage your Personal Budget for you, you can ask for assistance. They will then arrange your care and support in accordance with your agreed care plan. Before arrangements are put into place you will have to confirm you are happy with the care they are organising on your behalf.

Direct Payments

Your Personal Budget can be paid directly to you to ensure you have the freedom and flexibility to make your own care choices. You can choose your own carers and personal assistants. Your carers must however meet the requirements of your agreed care plan. The council may also ask for evidence of how your Personal Budget has been spent every 3 months.

Mixed Package

If you’d like a combination of the two methods mentioned above, a mixed package will be the right choice for you. Known as ‘mix and match’, the mixed package allows the council to arrange some of your care, leaving you to spend the rest of your Personal Budget on care of your choice. Your Personal Budget can also be paid directly to another organisation, such as your home care provider.

Your Personal Budget may be determined and given by your local council but with direct payments and the mixed package, you can have control over how your social care and support is delivered. Alternatively, you can leave the local council with the responsibility of arranging how your care needs are met and by whom. This option is great for families who are tasked with managing the care of a loved one. You can also nominate another person to manage your Personal Budget on your behalf.

Following a needs assessment, your Personal Budget will be determined by another assessment, where what kind of care and support you require, its cost and your financial status will be identified.

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