NHS continuing healthcare (NHS CHC) is a package of care arranged and funded solely by the health service for a person aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident or illness.
Eligibility places no limits on the settings in which the package of support can be delivered or the type of service delivery. If you are to receive care in your own home, the NHS funds an appropriate care package to meet your assessed health and personal care needs. If you are to live in a care home, the NHS contracts with the home and pays for accommodation, board and to meet your assessed health and personal care needs.
Who is eligible for NHS continuing healthcare?
The diagnosis of a particular disease or condition does not determine eligibility. People with the same diagnosis or health condition can have very different needs. Eligibility decisions for NHS CHC are ‘needs based’ and rest on whether your need for care is primarily due to your health needs. This is referred to as having a ‘primary health need’.
Certain characteristics of your needs, in combination or alone, may demonstrate a ‘primary health need’ because of the quantity and/or quality of care needed to manage them. So when assessing your needs, consideration should be given to the nature, complexity and unpredictability of your particular needs.
When should eligibility be considered?
In Northern Ireland Circular HSC (ECCU) 1/2010 Care Management, Provision of Services and Charging Guidance states;
‘The distinction between health and social care needs is complex and requires a careful appraisal of each individual’s needs. In this context, it is for clinicians, together with other health and social care professional colleagues and in consultation with the service user, his/her family and carers, to determine through a comprehensive assessment of need whether an individual’s primary need is for healthcare or for personal social services.’
There are times when it would be appropriate to consider whether you may have a need for such care and the above guidance clearly outlines that
‘HSC Trusts should contract for the full cost of the placement, and, where there has NOT (our capitals) been a determination of continuing healthcare need, seek reimbursement under the 1993 Regulations’.
In Northern Ireland NHS CHC is not straightforward and is currently difficult to access. If you think you or someone you know might be eligible for continuing healthcare and need support, contact Age NI Advice Line on 0808 808 7575.