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 package of care for people who are assessed as having significant ongoing healthcare needs. It is arranged and funded by the NHS.
- If you receive care in your own home the NHS covers 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 pays 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, and
- require care primarily because of the nature of your health needs
How does the assessment for NHS continuing healthcare work?
There is a process staff must follow to decide your eligibility for NHS continuing healthcare.
1. If you have ongoing significant health needs, there are times when NHS staff or a member of the social work team should consider whether you may be eligible for NHS continuing healthcare.
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
Important things to know about all stages of 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.
2. The assessment process starts with the completion of a checklist by a nurse or a social worker trained to complete it. The checklist identifies what your needs are and shows whether you need to have a full NHS continuing healthcare assessment.
If your condition is deteriorating quickly and you may be 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 meet to look at this evidence and make their recommendations as to whether or not you’re eligible. You and/or your representative can attend and participate at this meeting.
5. Their recommendation is given to the Clinical Commissioning Group (CCG), which is responsible for funding your care. Except in exceptional circumstances, the CCG confirms their recommendation.
6. The CCG should write to you with the decision and explain the reasons for it.
What happens if I’m eligible for NHS continuing healthcare?
If you’re found to be eligible for NHS continuing healthcare:
- The CCG will discuss with you what care and support you need - this could be at home or in a care home.
- The package of care and support that's agreed upon will be reviewed after three months and then at least every year.
- You will also have the right to ask for a Personal Health Budget, which can give you more choice over the services and care you receive. However, this can't be used to pay for care home fees.
- If your care needs change in the future, your funding arrangements may also change. You have a right to challenge this decision.
What happens if I’m not eligible for NHS continuing healthcare?
If it's decided you’re not eligible for NHS continuing healthcare, you can:
Appeal the decision
- The CCG letter explaining the decision should tell you how to appeal.
- If you're not happy with the decision after the checklist 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 the CCG to reconsider its decision. If you are still dissatisfied, you can ask for an independent review of your case.
Ask for referral to the local authority
- If you decide not to appeal or the decision isn't overturned, you can ask to be referred to your local authority. They will look at whether you’re eligible for care and support and apply a means test to see how much you should contribute to your care.
Check if you're eligible for NHS-funded nursing care
- You may be eligible if you don’t qualify for NHS continuing healthcare, but have been assessed as needing to live in a nursing home, requiring help from a registered nurse.
- You usually won’t need a separate assessment for NHS-funded nursing care if you had the assessment for NHS continuing healthcare.
- If you’re eligible for NHS-funded nursing care, payment is paid 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?
Speak to your doctor or social worker if you think you might be eligible for NHS continuing healthcare. They can make a referral the to relevant CCG.
See our factsheet NHS continuing healthcare and NHS-funded nursing care (PDF 1MB) for more information.
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