NHS continuing healthcare

NHS continuing healthcare, also known as "fully funded NHS care", is free care outside of hospital that is arranged and funded by the NHS. This means that you will receive care and support to meet your assessed needs at no cost to you.

Where can NHS continuing healthcare be provided?

NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your home or in a registered care home.

Eligibility for NHS continuing healthcare

NHS continuing healthcare is for adults. Children and young people may receive a "continuing care package" if they have needs arising from disability, accident or illness that can't be met by existing universal or specialist services alone. Find out more about the children and young people's continuing care national framework.

To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a "multidisciplinary team") as having a "primary health need". Whether or not someone has a primary health need is assessed by looking at all their care needs and relating them to:

what help is needed
how complex these needs are
how intense or severe these needs can be
how unpredictable they are, including any risks to the person's health if the right care isn't provided at the right time

Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.

You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.

A decision about eligibility should usually be made within 28 days of it being decided that the person needs a full assessment for NHS continuing healthcare.

If you aren't eligible for NHS continuing healthcare, you can be referred to your local authority who can discuss with you whether you may be eligible for support from them. If you still have some health needs then the NHS may still pay for part of the package of support. This is sometimes known as a "joint package" of care.

NHS continuing healthcare assessments

Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.

For most people, there is an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently - for example, if you're terminally ill - your assessment may be fast-tracked.

Initial assessment for NHS continuing healthcare

The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you're being assessed, and be asked for your consent.

Depending on the outcome of the checklist, you will either be told that you don't meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you will be referred for a full assessment of eligibility.

Being referred for a full assessment doesn't necessarily mean that you will be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.

The professional(s) completing the checklist should record written reasons for their decision, and sign and date the checklist. You should be given a copy of the completed checklist. You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK.

Full assessments for NHS continuing healthcare are undertaken by a "multidisciplinary team" made up of a minimum of two health or care professionals who are already involved in your care. You should be informed who is co-ordinating the NHS continuing healthcare assessment.

The team's assessment will consider your needs under the following headings:

behaviour
cognition (understanding)
communication
psychological/emotional needs
mobility
nutrition (food and drink)
continence
skin (including wounds and ulcers)
breathing
symptom control through drug therapies and medication
altered states of consciousness
other significant needs

These needs are then given a weighting marked "priority", "severe", "high", "moderate", "low" or "no needs".

The multidisciplinary team will consider:

what help is needed
how complex these needs are
how intense or severe these needs can be
how unpredictable they are, including any risks to the person's health if the right care isn't provided at the right time

If you have at least one priority need, or severe needs in at least two areas, you should be eligible for NHS continuing healthcare. You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.

In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.

The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.

You can download a blank copy of the NHS continuing healthcare decision support tool.

Fast-track assessment for NHS continuing healthcare

If someone's condition is deteriorating quickly and they are nearing the end of their life, they should be considered for the NHS continuing healthcare fast track pathway, so that an appropriate care and support package can be put in place as soon as possible - usually within 48 hours.

Care and support planning

If you are eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.

Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget. If it is agreed that a care home is the best option for you, there could be more than one local care home that is suitable.

Your CCG should work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.

NHS continuing healthcare reviews

If you are eligible for NHS continuing healthcare, your needs and support package should normally be reviewed within three months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you are still eligible for NHS continuing healthcare.

Refunds for delays in NHS continuing healthcare funding

CCGs should normally make a decision about eligibility for NHS continuing healthcare within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.

If the CCG decides that you are eligible, but takes longer than 28 days to decide this and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.

If your CCG decided that you weren't eligible for NHS continuing healthcare, but then revised this decision after a dispute, it should refund your care costs for the period between their original decision and their revised decision.

If you are not eligible for NHS continuing healthcare

If you are not eligible for NHS continuing healthcare, but you are assessed as requiring nursing care in a care home (in other words, a care home that is registered to provide nursing care) you will be eligible for NHS-funded nursing care. This means that the NHS will pay a contribution towards the cost of your registered nursing care. This is known as NHS-funding nursing care and is available irrespective of who is funding the rest of the care home fees.

NHS England has issued guidance on how people can be compensated following eligibility disputes and delays in receiving NHS continuing healthcare (PDF, 496kb).

Frequently asked questions about NHS continuing healthcare

I have a local authority support package that works well. I am now eligible for NHS continuing healthcare - will my support package change?

If you are concerned about changes to your care package because of a move to NHS continuing healthcare, your CCG should talk to you about ways that it can give you as much choice and control as possible. This could include the use of a personal health budget, with one option being a "direct payment for healthcare".

Find out about choice in the NHS and personal health budgets.

If you're still not satisfied, you may want to complain.

Can someone refuse an assessment for NHS continuing healthcare? If they do refuse, will they be able to get services from their local authority?

An assessment for NHS continuing healthcare can't be carried out without someone's consent, so it is possible to refuse. However, if they do refuse, although they will still be entitled to an assessment by the local authority there is no guarantee that they will be provided with services. This is because there is a legal limit on the type of services that a local authority can provide.

If you refuse to be assessed for NHS continuing healthcare, the CCG should explore your reasons for refusing, and try to address your concerns. If someone lacks the mental capacity to consent to or refuse an assessment, the principles of the Mental Capacity Act will apply and in most circumstances an assessment will be provided in the person's best interest.

My relative is in a care home and has become eligible for NHS continuing healthcare. The CCG says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different care home. I think a move will have a negative effect on my relative. What can we do?

If there is evidence that a move is likely to have a significantly detrimental effect on your relative's health or wellbeing, you should discuss this with the CCG who will take your concerns into account when considering the most appropriate arrangements.

If the CCG decides to arrange an alternative placement, they should make efforts to provide a reasonable choice of homes.

Is it possible to pay top-up fees for NHS continuing healthcare?

No, it is not possible to top up NHS continuing healthcare packages, like you can with local authority care packages.

The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you get from the NHS. These private services should be provided by different staff and preferably in a different setting.

Article provided by NHS Choices

See original on NHS Choices

Additional Information

Last updated: 16/07/2017

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