Navigating the complexities of long-term healthcare can be daunting, especially when it comes to understanding NHS Continuing Healthcare. This vital provision ensures that individuals with significant, ongoing health needs receive the necessary care arranged and funded entirely by the NHS, outside of hospital settings. A crucial element in this process is understanding how needs are assessed and how eligibility is determined. This is where a Continuing Care Support Tool becomes invaluable.
Understanding NHS Continuing Healthcare and Where It’s Provided
NHS Continuing Healthcare isn’t confined to hospital walls. It’s designed to support individuals in various environments, ensuring they receive appropriate care whether they are in the comfort of their own home or within a care home facility. This flexibility is paramount to providing patient-centered care that adapts to individual circumstances and preferences.
Eligibility for NHS Continuing Healthcare: Who Qualifies?
This healthcare provision is primarily for adults with complex, long-term health needs. While children and young people have separate “continuing care packages” tailored to needs arising from disability, accidents, or illnesses, the fundamental principle remains the same: to address needs that go beyond standard services.
Download the Decision Support Tool for NHS Continuing Healthcare from GOV.UK (PDF, 194KB)
Eligibility isn’t based on specific diagnoses but on a comprehensive evaluation of your care requirements. A multidisciplinary team of healthcare professionals conducts this assessment, focusing on:
- The type of help you require
- The complexity of your needs
- The intensity of your needs
- The unpredictability of your needs and associated health risks if care is not timely and appropriate
Changes in your needs can impact your eligibility, highlighting the dynamic nature of this support. Throughout the assessment, your input is crucial. Your views, along with those of carers and family members when appropriate, are integral to understanding your needs and formulating a suitable support plan. The aim is to make an eligibility decision for a full assessment within 28 days of the initial assessment or request. If NHS Continuing Healthcare isn’t the right path, referral to your local council for potential support is the next step. In situations where health needs are partially met by the NHS alongside council support, a “joint package” of care may be established.
Accessing Information and Advice: Navigating the Process with Confidence
The NHS Continuing Healthcare assessment process can feel intricate. Organizations like Beacon offer invaluable free, independent advice to help navigate this system. Utilizing resources like the Beacon website or their helpline (0345 548 0300) can provide clarity and support throughout your journey.
The NHS Continuing Healthcare Assessment Journey: Initial Steps and Full Evaluation
Integrated Care Boards (ICBs), the bodies commissioning local health services, are responsible for initiating NHS Continuing Healthcare assessments when needs suggest eligibility. Typically, an initial checklist assessment precedes a full assessment to determine necessity. However, urgent situations, such as terminal illness, may warrant a fast-tracked assessment.
Initial Checklist Assessment: The First Step in Determining Need
A nurse, doctor, social worker, or other healthcare professional can conduct the initial checklist assessment. Transparency is key; you should be informed about the assessment and its purpose. The checklist outcome dictates the next steps: either ineligibility for a full assessment or referral for a comprehensive evaluation. Referral for a full assessment doesn’t guarantee eligibility but opens the door for thorough consideration. Crucially, the professional completing the checklist must document the decision rationale in writing, including their signature and date, and provide you with a copy.
You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK (PDF, 122KB)
Full Assessment by a Multidisciplinary Team: A Comprehensive Evaluation
A full NHS Continuing Healthcare assessment is carried out by a multidisciplinary team (MDT) comprising at least two professionals from different healthcare disciplines. Ideally, this team includes health and social care professionals already involved in your care, ensuring a holistic understanding of your situation. You should be informed about who is coordinating your assessment.
The MDT’s evaluation comprehensively addresses needs across twelve key domains:
- Breathing
- Nutrition (food and drink)
- Continence
- Skin (including wounds and ulcers)
- Mobility
- Communication
- Psychological and emotional needs
- Cognition (understanding)
- Behaviour
- Drug therapies and medicine
- Altered states of consciousness
- Other significant care needs
Each need is assigned a weighting: “priority,” “severe,” “high,” “moderate,” “low,” or “no needs.” Generally, having at least one “priority” need or “severe” needs in at least two areas indicates likely eligibility for NHS Continuing Healthcare. Eligibility can also arise from a combination of needs, such as one “severe” need plus other needs, or multiple “high” or “moderate” needs, depending on their nature, intensity, complexity, and unpredictability. The overarching assessment considers the totality of your needs, their interactions, and evidence from risk assessments to determine if NHS Continuing Healthcare is appropriate. Your perspectives and those of your carers are vital components of this assessment. You are entitled to receive copies of decision documents and clear explanations for the outcome.
Fast-Track Assessment: Expedited Support for Urgent Situations
For individuals experiencing rapid health deterioration and nearing the end of life, the NHS Continuing Healthcare fast-track pathway ensures swift action. This expedited process aims to establish a suitable care and support package, typically within 48 hours, to provide immediate and necessary support during critical times.
Care and Support Planning: Tailoring Support to Your Needs
Upon confirmation of NHS Continuing Healthcare eligibility, the subsequent step involves creating a personalized care and support package. This package is designed to precisely meet your assessed needs and can encompass various options, including in-home support and personal health budgets. If a care home is deemed most suitable, you should have options within your local area. ICBs collaborate with you, considering your preferences when deciding on your care package and setting. However, they also consider factors like cost-effectiveness when making final arrangements.
Regular Reviews: Ensuring Ongoing Appropriateness of Care
If you are receiving NHS Continuing Healthcare, your care and support package undergoes regular reviews, typically within three months initially and at least annually thereafter. These reviews assess whether your current support adequately addresses your needs. Significant changes in your needs may also prompt a re-evaluation of your ongoing eligibility for NHS Continuing Healthcare.
Refunds for Funding Delays: Addressing Unjustifiable Delays
ICBs are expected to make NHS Continuing Healthcare eligibility decisions within 28 days of receiving a completed checklist or full assessment request, barring exceptional circumstances. If eligibility is confirmed but the decision process exceeds 28 days without justifiable reasons, the ICB should reimburse care costs incurred from the 29th day until the decision date.
Alternatives if Ineligible: NHS-Funded Nursing Care
Even if you are not eligible for full NHS Continuing Healthcare, but require nursing care in a registered care home, you may qualify for NHS-funded nursing care. This provides an NHS contribution towards the cost of your registered nursing care, regardless of who funds the remaining care home fees. NHS England provides further information on NHS Continuing Healthcare and NHS-funded healthcare.
Find out more about NHS continuing healthcare and NHS-funded healthcare from NHS England
Frequently Asked Questions: Addressing Common Concerns
Will My Existing Local Authority Support Package Change If I Become Eligible for NHS Continuing Healthcare?
If you are concerned about potential disruptions to your current care arrangements when transitioning to NHS Continuing Healthcare, your ICB should discuss options to maximize your choice and control. Personal health budgets, including direct payments for healthcare, can be explored to maintain continuity and align with your preferences.
Can I Decline an NHS Continuing Healthcare Assessment? Will This Affect Local Authority Services?
Consent is not mandatory for assessments like CHC Checklists, Decision Support Tools, and Fast Tracks, or for sharing information within care teams and health/social care staff. However, consent is required to share personal information with third parties (family, friends, representatives) at the outset. Local Authorities have service limitations. If you have reservations about an NHS Continuing Healthcare assessment, discuss your concerns with the ICB to find resolutions. For individuals lacking mental capacity to consent to information sharing with third parties (excluding care teams/staff), the Mental Capacity Act principles apply, potentially requiring a best interests decision.
What Happens if My Relative Is in a Care Home, Becomes Eligible, but the ICB Proposes a Move Due to Cost?
If relocating your relative is deemed detrimental to their health or wellbeing, present this evidence to the ICB. They are obligated to consider these concerns when making placement decisions. If an alternative placement is pursued, the ICB should offer a reasonable selection of care homes.
Is it Possible to Pay Top-Up Fees for NHS Continuing Healthcare?
No, “top-up fees” as used with local authority care packages are not applicable to NHS Continuing Healthcare. Private top-ups are only permissible for additional, private services beyond those NHS-assessed needs, ideally provided by different staff and in separate settings.
Can I Request an Assessment for Past Unassessed Care Periods?
You can request a Previously Unassessed Period of Care (PUPoC) assessment if you believe you should have been considered for NHS CHC previously but were not, and you have funded your care (fully or partially). These requests typically cover care periods after April 2012. Further guidance on PUPoC assessment requests is available on GOV.UK.
Read more information and guidance on how to make a request for a PUPoC assessment on GOV.UK
Video Resource: Understanding Care Plans for Long-Term Conditions
Video: Coping with a long-term condition – the care plan
Note: Replace “your-video-link-here” with the actual video link if available from the original source.
This video explores the empowering role of care plans in enabling patients to manage long-term conditions by setting personalized goals and actively participating in their care.
Media last reviewed: January 12, 2024
Media review due: January 12, 2027
