NHS Continuing Healthcare: Check This Before Anything Else
NHS Continuing Healthcare (CHC) is a package of care funded entirely by the NHS for people who have a primary health need — that is, whose primary need for care is a health need rather than a social care need. Where CHC is awarded, the NHS pays all care costs in full, regardless of the person's assets or income. There is no means test. This makes CHC the most important funding route to check before considering any use of property equity.
The eligibility assessment for NHS CHC involves a Multi-Disciplinary Team (MDT) assessment using the National Framework for NHS CHC. The team evaluates the person's care needs across twelve care domains — behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other significant care needs. The assessment determines whether the overall care needs are of sufficient severity, complexity, and unpredictability to constitute a primary health need. Cognitive impairment alone does not automatically qualify, but severe dementia with significant behavioural, risk, or physical needs often does.
Many people who are entitled to NHS CHC are not assessed for it, or are incorrectly refused. Local authorities have a financial interest in directing individuals toward self-funding or local authority funding rather than NHS funding, and the system is complex and inconsistent across different Integrated Care Boards. If your relative is in care or about to enter care, requesting a formal CHC assessment in writing — before any financial arrangements are made — is essential. Specialist CHC advocates and solicitors can support this process and challenge incorrect refusals.
Where CHC is not awarded, a lower level of NHS-funded nursing care (FNC) may still be available for those in nursing homes who have assessed nursing needs. FNC is a fixed weekly contribution from the NHS currently set at £235.88 per week, which reduces (but does not eliminate) the cost of nursing home care. Even this contribution is worth checking and claiming if applicable.
Deprivation of Assets: The Critical Legal Risk
Deprivation of Assets is the legal concept that prevents people from deliberately reducing their assets — by transferring property, giving money away, or spending down savings — in order to qualify for local authority care funding. If a local authority considers that assets have been deliberately disposed of to avoid care fees, it can treat the person as still owning those assets (notional capital) and refuse to fund care on that basis, or seek to recover costs from the person who received the transferred assets.
There is no fixed time limit on when a transfer must have occurred for Deprivation of Assets to apply — the local authority can look back at transactions made at any point if the purpose of avoiding care fees is considered to have been a significant factor. A transfer made decades ago when the person had no reason to anticipate needing care is unlikely to be challenged. A transfer made shortly before or after a care need becomes apparent is much more likely to be scrutinised.
Property is the most common asset affected by Deprivation of Assets concerns. If a family home was transferred to children or other family members in the years before care fees arose, the local authority may challenge the transfer and include the property value in the care funding means test. Using a secured loan to extract equity from a property that is then given to family members would raise the same concern — the loan proceeds represent value extracted from the property, and if given away, the local authority could treat them as notional capital.
The practical implication is that secured loan proceeds used for personal benefit — funding the care directly, maintaining the property, making reasonable gifts — are unlikely to raise Deprivation of Assets concerns. Using them to make substantial transfers to children or other beneficiaries in the context of a care situation requires careful legal advice. A solicitor specialising in elderly client law or Court of Protection matters can advise on the boundaries and help structure any arrangements defensibly.
