NHS Continuing Healthcare and ESA

twister

Hi, NHS Continuing HealthCare and ESA - does getting this stop you getting ESA plus support component or is being resident in a care home that provides limited nursing care stop you.

If the answer is yes then I'm losing money as not the same as when I was on IB/SDA

any advice?

gnmeads

Hi and welcome to the community
I think the best thing you can do is call the benefits help line on :0345 608 8545. Sorry can't help more than that

Liam_Alumni

Hi @twister!

Welcome to Scope's online community! It's great to have you on board.

I've moved this discussion to our Ask a Benefits Advisor category, where @BenefitsTrainingCo may be able to advise.

If you have any other questions, please do get in touch!

BenefitsTrainingCo

Hi twister,

If you are a patient for more than 52 weeks then the support component is not included any longer. The 52 weeks has to be continuous. You're a 'patient' for these purposes if you are being maintained free of charge whilst undergoing medical or other treatment as a hospital in-patient. If you're at home, even if you're getting NHS continuing care, you don't count as a patient and the support component should continue.

If you're resident in a care home there are different rules. The support component isn't affected at all. Other parts of income-related ESA might be affected if your PIP daily living, DLA care or AA stop due to being in the care home for 28 days where the costs are met out of public funds.

Finally, if the NHS is providing nursing services in a care home you can be treated as a patient for the purposes of AA, DLA and PIP - which could mean you don't get any of these benefits (not even the mobility component) after 28 days. Again, if these benefits stop, that can affect income-related ESA. 

I hope this helps but do get back to us if you have other questions. If you've been moved from incapacity benefit, you may be on contributory ESA, so would not have to worry unless you were in fact in hospital or you're getting some income-related ESA as well.

Will

BenefitsTrainingCo

Hi again twister,

Just to clarify, because this might be your situation. If you are in a care home where you have substantial nursing needs and the NHS have assessed you and made a decision to fully fund the care home place, then you count as a patient, as long as the DWP think that the home is a 'similar institution' to a hospital.

If that happens then after 52 weeks as a patient, the support component of ESA would stop. 

It's important to say that you don't count as a patient just because the NHS contribute to your nursing care. There must have been an assessment and a decision that the NHS are responsible for continuing care and that you should be fully funded by the NHS.

Does that help?

Will

twister

Thanks Will

Got a follow on question, it is my belief that DWP got the whole thing wrong, and in fact should have been paid ESA at rate of previous Incap award ie £105 p/w as opposed to £73.10. (transfer in 2014)If this is the case how long does the transitional allowance last for and if my understanding is true that I should have got the £105 until ESA matched this sum how would the extra money due be awarded particularly as not entitled to any components?

BenefitsTrainingCo

Hi Twister

Generally speaking transitional additions in ESA due to a previously higher entitlement to incapacity benefit and/or income support are paid throughout your entitlement to ESA. They are not increased with inflation and are due to end by 2020.

It may be possible to challenge the decision if you think it is wrong. But we will be unable to do this on this forum and i suggest you contact a local advice service for face to face advice.

David