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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.
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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.
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.
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.
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.
To see what’s on the checklist, download a blank copy from GOV.UK.
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:
They’ll mark each of your care needs as one of the following:
You’ll likely be eligible for NHS continuing healthcare funding if you have at least one priority need or severe needs in two or more areas.
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.
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.
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.
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.
If you aren’t eligible for NHS continuing healthcare funding but are assessed as requiring nursing care in a nursing care 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.
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.
Lottie matches care seekers with the best care homes for their needs. You can request a free care home shortlist from our care experts, who will share homes matching your budget, location and type of care needed. You can also search for a care home through our easy-to-use directory.
Your Integrated Care Board can discuss ways to ensure you have as much choice and control over your care as possible. For example, you could include the use of a personal health budget, which you can use to directly pay for healthcare.
Your care home fees being too high for NHS continuing healthcare can be resolved by you or your loved one moving to a different care home.
However, you may first want to discuss this potential move with your local Integrated Care Board. They can help you figure out the most appropriate arrangements. They can also provide a list of suitable homes to choose from.
You can choose whether to have an NHS continuing healthcare assessment. It won’t be carried out without your consent. However, if you refuse an NHS continuing healthcare assessment, you may still be eligible for an assessment by the local authority, but there’s no guarantee that they’ll provide you with services.
Written by our team of experts and designed to help families fund later life care in England.