NHS Continuing Healthcare: Free Care Support

If you qualify for NHS continuing healthcare, the care and support you need will be arranged and funded entirely by the NHS, including care within a care home.

In this article, we’ve explained what NHS continuing healthcare is, whether you’re eligible - this will depend on your care needs - and how the assessment process works.

In this article:

1. What is NHS continuing healthcare?
2. Are you eligible for NHS continuing healthcare?
3. How does NHS funding differ from local authority funding?
4. NHS continuing healthcare assessments
5. If you’re eligible
6. If you aren’t eligible

What is NHS Continuing Healthcare?

NHS continuing healthcare is a package of care provided to people aged 18 or over who have been assessed as having a ‘primary health need’. This care is entirely arranged and funded by the NHS. However, the person receiving care and their family can still offer input and go beyond the list of care options provided by the hospital or discharge team.

To be eligible for NHS funding support, you’ll need to be assessed by an Integrated Care Board. This assessment will determine whether or not you have a ‘primary health need’.

A ‘primary health need’ is when you require care greater than a local authority can legally provide, meaning additional care and support is needed. You may have intense, complex and unpredictable care needs.

Are You Eligible For NHS Continuing Healthcare?

Your eligibility for NHS continuing healthcare will be determined through an assessment by a team of healthcare professionals. They’ll consider all your care needs and find out what help you require, and how complex and unpredictable your needs are.

Your eligibility for NHS continuing healthcare isn’t dependent on any particular diagnosis or condition you’re living with. Instead, eligibility is based on your assessed needs.

People living with a form of dementia such as Alzheimer’s are often eligible for NHS continuing healthcare as well.

As eligibility depends on the complexity, intensity and unpredictability of your needs, here’s what each of these means:

• Complexity- This measures how your needs affect each other. For example, having difficulty remembering things could impact your ability to take medication.

• Intensity - This describes how much care your needs require and whether this care is required all day long.

• Unpredictability - This is how often and how much your needs change, and how those caring for you need to react.

How Does NHS Funding Differ From Local Authority Funding?

If you’re eligible for continuing healthcare, the NHS will fully fund your care, regardless of how much money and assets you have. Your local authority will only fund some or all of your care if your capital is below a certain threshold. In England, the upper threshold is £23,250, while the lower threshold is £14,250. If the total value of your savings and income (and assets such as your home if you need care in a care home) is above £23,250, you’ll pay for your own care. If they’re below £14,250, your local authority will provide the maximum funding amount. If they’re between £23,250 and £14,250, they’ll provide partial funding.

If you need care in a care home and own a property, you’ll almost definitely be above the upper threshold, so will have to pay for your own care, until the total value of your savings and assets dips below £23,250.

Continuing healthcare funding includes the cost of the care you’re given, any additional social care and accommodation (if this is considered part of your overall need), such as living in a nursing home, so you'll be fully covered if eligible.

NHS Continuing Healthcare Assessments

If you may need NHS continuing healthcare, your local Integrated Care Board (ICB) will assess you. These are the NHS organisations that commission local healthcare services. They replaced Clinical Commissions Groups (CCGs) in 2022.

You’ll first have an initial assessment, determining whether you require a full assessment, to find out if you’re eligible for NHS Continuing Healthcare support.

Initial assessment

The initial checklist assessment will be carried out by a nurse, doctor, social worker or a different healthcare professional.

Based on what’s found during the initial checklist assessment, you’ll either be told that you aren’t eligible and don’t meet the criteria to move on to a full assessment for NHS continuing healthcare, or you’ll be referred for the full assessment.

Within 28 days of the initial assessment, a decision regarding eligibility for a full assessment will usually be made.

Following the outcome, you’ll receive a copy of the completed checklist, and the healthcare professional who carried out the assessment will record in writing the reasons for their decision.

Full assessment

If you’re referred for a full assessment after your initial screening, this will be done by a team or two or more health and social care professionals who understand your individual care needs.

The Decision Support Tool is a more detailed version of the checklist above. This will help the healthcare professionals assess your potential eligibility.

This assessment will consider your needs under the following categories:

• Altered states of consciousness
• Behaviour
• Breathing
• Cognition (understanding)
• Communication
• Continence
• Drug therapies and medicine
• Mobility
• Nutrition (food and drink)
• Other significant care needs
• Psychological and emotional needs
• Skin (including wounds and ulcers)

Source: NHS.UK

They’ll mark each of your care needs as one of the following:

• No need
• Low
• Moderate
• High
• Severe
• Priority

Your own views and your carer’s views should be taken into consideration during this assessment, and you should be provided with a copy of the decision documents, as well as clear reasons explaining the outcome.

Fast-track assessment

There’s also an NHS continuing healthcare fast-track pathway. This is for people who may need care more urgently, or are nearing the end of their lives and require palliative care.

Through a fast-track assessment, care and support are organised as soon as possible - usually within two days.

What To Do If You’re Eligible

If you’re eligible for NHS continuing healthcare, a care plan that meets your assessed needs will need to be created.

There are numerous potential options depending on the outcome of this assessment, including support in the comfort of your own home and the option of a personal health budget.

If it’s decided that moving into a care home is the best possible option for you, you may be provided with a list of suitable care homes in your local area. Your Integrated Care Board (ICB) will work with you to agree on the best care and support package for your needs.

You can apply for a care needs assessment by social services through GOV.UK.

Personal health budget

A personal health budget is money used to support your health and wellbeing. Your budget will be discussed and agreed upon by you or your representative and local NHS staff.

This budget allows you to manage healthcare expenses such as any treatment or equipment needed. It will also set out what your health and wellbeing needs are, what you wish to achieve regarding your health, how much money is in the budget and where this money will be spent.

If you receive NHS continuing healthcare, you’ll be eligible for a personal health budget. If you aren’t eligible this way but would still like one, you can speak to your local Integrated Care Board (ICB) to potentially arrange one.

Alternative Options If You Aren’t Eligible

If you aren’t eligible for NHS continuing healthcare funding but are assessed as requiring nursing care in a nursing home, you may instead be eligible for NHS funded nursing care. This means that the NHS will contribute toward the cost of your nursing care.

If you disagree with the decision made about your eligibility for NHS continuing healthcare, you can appeal the decision by asking your local Integrated Care Board (ICB) to reconsider your case. You can also ask for an independent review of your case.

Finally, you can ask to be referred to your local council. They’ll decide whether you’re eligible for care and support via a care needs assessment.

Getting Free and Independent Advice

If you think you might be eligible for NHS continuing healthcare, the first step is to speak with your doctor or a social worker.

They can then refer you to your local Integrated Care Board (these replaced Clinical Commissioning Groups in July 2022). You can discuss why you think you’re eligible with your local Integrated Care Board.