Third party payments

NHS Continuing Healthcare (CHC)

NHS CHC is a package of continuing care that is arranged and funded solely by the NHS. This is free of charge, wherever it is delivered. NHS CHC support may be provided in a nursing or residential care home or in a person’s own home.

People eligible for NHS CHC will have been assessed as having a primary health need and are likely to have complex medical needs and substantial or intense ongoing care needs.

National guidance says that the NHS CHC assessment should be person-centred. This means that the person being assessed should be fully involved in the assessment process. They should be kept informed and have their views, needs and support considered. Carers should also be consulted where appropriate. It is a good idea for carers to make it clear that they would like to participate fully in the assessment process.

A decision about eligibility should usually be made within 28 days of a referral being made to the NHS clinical commissioning group. If you are already receiving support from us, your social care worker will be able to give you more information about NHS CHC. An NHS CHC screening checklist can be completed with you, from which a referral for assessment can be made if you are entitled to it. Your GP or community nursing service should be able to give you advice or make a referral with you if you are not currently receiving support from us.

If you are waiting to hear whether you are eligible for NHS CHC, any services provided by us will continue to be charged and must be paid upfront. Any claim refunded by NHS CHC will be paid to you once the refund has been received and processed.

Running out of money

If your capital is likely to reduce to £23,250 because of paying for care, you must let us know well in advance as we may step in to help with your care fees. We must assess your care and support needs to determine whether we could contribute.

Understanding your rights before receiving formal care services is essential. There are several financial products and specialist companies who may be able to help. It is important to seek advice before committing yourself. There are details of some organisations that can help you with financial matters on page 52.

Fees charged by some homes may be higher than the maximum rate that we can pay for someone with your level of needs. If we are funding your care and the home you choose costs more than this rate, you can choose someone else to make an additional payment.

This means that they will have to pay the difference between our rate and the amount the home charges. This additional payment is often referred to as a ‘top-up’ or ‘third party payment’.

The law says that you or your spouse or partner cannot make this additional payment, except in limited circumstances, such as when you have a Deferred Payment Agreement (explained on page 54). Therefore, the additional payment must normally be made by someone else. For example, a family member or charity. Before anyone agrees to make additional payments on your behalf, they should be aware that the amount could increase, and they need to be confident that they can sustain the payments for as long as they are required. If the additional payments stop being paid, for any reason, then you should seek help and advice from us via our Customer Service Centre. See page 5 for contact details.

Once it has been established that someone is willing and able to make these payments, they will be asked to sign an agreement to formalise the arrangement.