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NHS Continuing Healthcare

Learn about who can get NHS Continuing Healthcare and how the assessment process works.
5 min read
In this article
What is Continuing Healthcare? Who can get NHS Continuing Healthcare? How is Continuing Healthcare eligibility assessed?
Making the decision Fast Track Tool What happens next?

What is Continuing Healthcare?

Continuing Healthcare is care arranged and funded by the NHS, for individuals who have a need for ongoing health care outside of hospital.

Who can get NHS Continuing Healthcare?

Anyone aged over 18 years who is assessed by the NHS as having ‘a primary health need’ (where care is an integral part of that person’s health and wellbeing). 

 

This form of care is most often awarded to people in care homes who have the most complex or unpredictable medical care needs due to disability, accident or illness. It means that the full cost of the care home fees are covered, including room and board. In some cases it can also be awarded for care in the home.

 

It can be considered:

  • at the end of a period of NHS Intermediate Care
  • as part of a needs assessment, which is frequently done as part of discharge from hospital or can be arranged at home
  • if the person receiving care has a rapidly deteriorating condition.


Health and social care professionals will normally discuss whether to consider the person you’re looking after for additional NHS funding at home or in a care home. If it’s decided that they are eligible for this funding, your loved one would then be assessed automatically.

 

The NHS criteria for Continuing Healthcare are very complex and can be difficult to access, but nevertheless it’s worth pursuing if you think the person you are looking after may qualify and their social worker isn’t following it up on their behalf.

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How is Continuing Healthcare eligibility assessed?

In England

 

Although there appears to be elements of a ‘postcode lottery’ in qualifying for Continuing Healthcare payments, all assessments should be completed in line with the National Framework, which sets out the following criteria that all local NHS Commissioning Groups should be basing their decisions on:

  • nature
  • complexity
  • intensity 
  • unpredictability.


To find out if someone is eligible for NHS Continuing Healthcare, they will be assessed as follows.

1

A member of the NHS or social services staff will carry out a brief assessment of the patient to see if it would be appropriate to undertake a full eligibility assessment (known as the Checklist Tool).

2

If they decide it’s appropriate, a full assessment is carried out by a multi-disciplinary team (MDT) of two or more health/social care professionals. With permission, they might interview other professionals involved in the patient's care to build up a full picture of their needs. Sometimes, the multi-disciplinary team will ask for more detailed specialist assessments from these professionals.

3

The multi-disciplinary team will then use the information from the assessment to complete a Decision Support Tool. This looks at 12 different types of need (for example, mobility, nutrition and behaviour) to help decide on the nature, complexity, intensity and unpredictability of the patient's needs.

4

Using the information from the assessment and the Decision Support Tool, the team will decide if the patient has a primary health need. They will then make a recommendation to their Clinical Commissioning Group (CCG, led by GPs and other health professionals, responsible for buying and arranging care packages for patients) about eligibility. 

 

Your loved one is allowed to have someone with them during their assessment. It can be very helpful to have someone present to help them communicate their needs and take notes.

 

For more detailed information about the Decision Support Tool, read the national framework for NHS Continuing Healthcare from the Department of Health.

 

In Scotland

 

NHS Continuing Healthcare is limited to hospital patients in Scotland. This means that anyone getting an assessment, who lives in a care home or a hospice that isn’t run by the NHS doesn’t qualify.

 

Those with complex needs have to pay accommodation fees and (depending on individual circumstances) contribute either fully or partly towards the cost of their care. People who receive treatment at home also have to pay care costs.

 

The recommendation is considered by the Local Health Board.

 

In Wales

 

The Decision Support Tool consists of 12 ‘domains’ to help decide on the nature, complexity, intensity and unpredictability of needs. 

 

Following the assessment, the recommendation is considered by the Local Health Board, but each individual is allocated a specific care coordinator who will be their liaison point and keep them informed. For more information, read this NHS Wales public information leaflet.

Making the decision

The NHS should make a decision within 28 days of it being decided that your loved one needs a full assessment for Continuing Healthcare. If it takes longer than this and the person you’re supporting is deemed eligible for this support, then the NHS should pay retrospectively to the due date of completion.

The NHS should make a decision within 28 days of it being decided that your loved one needs a full assessment for continuing healthcare. 

Challenging the decision

There are examples of people who are turned down for Continuing Healthcare going on to successfully challenge the decision. If your loved one is refused NHS funding, then information should be given by the NHS about how to challenge the decision.

 

Fast Track Tool

If the person you’re looking after has urgent needs – because their condition is deteriorating rapidly due to a terminal illness, for example – a Fast Track Tool (in Wales, this is known as the Fast Track Assessment) is used instead of the Decision Support Tool to confirm eligibility.

 

If your loved one is found to be eligible, their funding from the NHS should be provided as quickly as possible. 

 

Their needs may subsequently be reviewed using the Decision Support Tool, following the fast track decision. It’s possible that this could result in a different decision and the NHS Continuing Healthcare could be withdrawn.

What happens next?

Following any assessment, the person you’re supporting should get a statement of the decision outcome and why it was made.

 

If they are found to be eligible for NHS Continuing Healthcare, the NHS will pay for:

Checklist (ticks)
  • At home: healthcare, such as services from a community nurse or specialist therapist; associated social care needs, such as personal care and domestic tasks; help with washing, dressing, preparing meals and shopping. 
  • In a care home: care home fees, including board and accommodation.

If the person you’re looking after is eligible for Continuing Healthcare, then the NHS will take into consideration their wishes and those of other family members. However, the final decision about where and how they receive their care will be made by the NHS. The NHS has a duty to meet the needs of the individual so they should ensure that common social and psychological needs, such as finding a care home placement close to the family, are met.

Further reading

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Paying for a care home

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Last updated: 03 Oct 2018