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NHS continuing healthcare

Most people have to pay something towards the care they receive. But some people with ongoing significant health needs can get their care paid for through a scheme called NHS continuing healthcare.

What is NHS continuing healthcare?

NHS continuing healthcare is a free package of care for people who have significant ongoing healthcare needs. It is arranged and funded by the NHS.

  • If you receive care in your own home the NHS will cover the cost of the support you need from health professionals and the cost of personal care which can include help with washing and getting dressed.
  • If you receive NHS continuing healthcare in a care home the NHS will also pay your care home fees.

Can I get NHS continuing healthcare?

Eligibility for NHS continuing healthcare isn’t based on whether you have a specific health condition.

To get NHS continuing healthcare you must:

  • have ongoing significant health needs
  • need care primarily because of those health needs.

How does the assessment for NHS continuing healthcare work?

1. If you have ongoing significant health needs, there are times when health staff (such as your GP or a member of the social work team) should consider whether you’re eligible for NHS continuing healthcare. If they don’t, make sure you ask for an assessment.

These situations include:

  • when you are ready to be discharged from hospital and your long-term needs are clear
  • once a period of rehabilitation following a hospital stay has finished and it's agreed your condition is unlikely to improve
  • whenever your health or social care needs are being reviewed as part of a community care assessment
  • if your physical or mental health deteriorates significantly and your current level of care seems inadequate
  • when your nursing needs are being reviewed; this should happen annually if you live in a nursing home
  • if you have a rapidly deteriorating condition and may be approaching the end of your life

2. The assessment process starts with you completing a checklist with your health professional, like a nurse, doctor or a social worker. The checklist will highlight what your needs are and will show whether you need to have a full assessment.

Important things to know about the assessment process:

  • You should be fully involved and your views should be considered.
  • You can ask a relative or carer to help and support you.
  • If you’re approaching the end of life, you may have a Fast Track assessment instead, which is a quicker process.

3. If you’re referred for a full assessment, evidence will be collected from all relevant health and social care professionals about your physical, mental health and social care needs.

4. A team of health and social care professionals will look at this evidence and decide whether or not you’re eligible. You and/or your representative can attend and participate at this meeting.

What happens if I’m eligible for NHS continuing healthcare?

If you’re found to be eligible for NHS continuing healthcare:

  • The assessment team will give their recommendation to the Clinical Commissioning Group (CCG) that is responsible for funding your care.
  • The CCG will discuss with you what care and support you need.
  • The package of care and support will be reviewed after three months and then at least every year.
  • You will also have the right to a Personal Health Budget to give you more choice over the services and care you receive.
  • If your care needs change in the future, your funding arrangements may also change.

What happens if I’m not eligible for NHS continuing healthcare?

If you’re not eligible for NHS continuing healthcare, there are three potential options for what can happen next.

  1. Appeal the decision
    If you’re not happy with the decision, you can try the following:
    If you weren’t given a full assessment, you can ask the CCG to reconsider your case. If you are still dissatisfied, you can use the NHS complaints system to pursue your case.
    If you’re not happy after a full assessment, you can ask for the CCG to reconsider its decision. If you are still dissatisfied, you can ask for an independent review of your case.
  2. Referral to the local authority
    You’ll be referred to your local authority who will look at whether you’re eligible for help to arrange or pay for care that you need.
  3. You may be eligible for NHS-funded nursing care
    This is for people who don’t qualify for NHS continuing healthcare, but have been assessed as needing help from a registered nurse in a nursing home.
    You usually won’t need a separate assessment for NHS-funded nursing care, as you should have had the assessment for NHS continuing healthcare.
    If you’re eligible for NHS-funded nursing care, payment will be made directly to your nursing home. Your needs will be reviewed no more than 3 months after the initial decision, and then at least once every year.

What should I do next?

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All the information and advice we provide on the website is free and completely independent, as is our National Advice Line that is open 365 days a year.

But demand is going up. We are an ageing population and more people than ever are coming to us for support, which is why we need to ask for help.

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For more information call Age UK on 0800 055 6112

Last updated: Oct 18 2017

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