Continuing healthcare funding offers care, arranged and funded by the NHS, for individuals who have a need for ongoing health care outside of hospital.
It is most often awarded to people in care homes who have the most complex or unpredictable medical care needs due to disability, accident or illness, and means that the full cost of the care home fees are covered, including room and board. In some cases it can also be awarded for care in the home.
On this page we tell you about:
1. Who can get NHS continuing healthcare
2. How your relative is assessed
3. Making the decision
4. The Fast Track Tool
5. What your relative will get if deemed eligible
Who can get NHS continuing healthcare
NHS continuing healthcare is available to anyone over 18 who is assessed by the NHS as having ‘a primary health need’. A ‘primary health need’ is where care is an integral part of that person’s health and wellbeing.
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It can be considered:
- at the end of a period of NHS intermediate care
- as part of a needs assessment, which is frequently done as part of discharge from hospital or can be arranged at home
- if your relative has a rapidly deteriorating condition.
Health and social care professionals involved in your relative’s care will normally discuss whether to consider them for additional NHS funding at home or in a care home. If they decide that your relative may be eligible for this funding, he or she would then be assessed automatically.
The NHS criteria for continuing healthcare are very complex and can be difficult to access, but nevertheless it is worth pursuing if you think your relative may qualify and your relative’s social worker isn’t following it on their behalf
How your relative is assessed
Although there appears to be elements of a ‘postcode lottery’ in qualifying for continuing healthcare payments, all assessments should be completed in line with the National Framework, which sets out the criteria that all local NHS Commissioning Groups should be making their decision on.
Judgements are based on four elements:
To see if your relative is eligible for NHS continuing healthcare, he or she will be assessed as follows:
1. A member of the NHS or social services staff will carry out a brief assessment to see if it would be appropriate to undertake a full eligibility assessment of your relative (known as the Checklist Tool).
2. If they decide it is appropriate, a full assessment is carried out by a multi-disciplinary team (MDT) of two or more health/social care professionals. With your relative’s permission, they might interview other professionals involved in your relative’s care to build up a full picture of their needs. Sometimes, the multi-disciplinary team will ask for more detailed specialist assessments from these professionals.
3. The multi-disciplinary team will then use the information from the assessment to complete a Decision Support Tool. This looks at 12 different types of need (for example, mobility, nutrition and behaviour; the twelfth need is 'Other') to help decide on the nature, complexity, intensity and unpredictability of your relative’s needs. For a detailed breakdown of the 12 areas of need and to understand how the Decision Support Tool is applied, you may wish to view this policy document from the Department of Health.
4. Using the information from the assessment and the Decision Support Tool, the team will decide if your relative has a primary health need. They will then make a recommendation to their Clinical Commissioning Group (CCG, led by GPs and other health professionals, responsible for buying and arranging care packages for patients) as to whether your relative is eligible for care or not.
Try to be there with your relative
Your relative is allowed to have someone with them during their assessment. It can be very helpful to have a friend or relative present to help them to communicate their needs and to take notes.
In Wales, the Decision Support Tool consists of 12 'domains' to help decide on the nature, complexity, intensity and unpredictability of your relative's needs.
From the assessment the recommendation is considered by the Local Health Board but each individual is allocated a specific 'care coordinator' who will be their liaison point and keep them informed. (For more information, see this NHS Wales public information leaflet)
In Scotland, the recommendation is also considered by the Local Health Board.
NHS continuing healthcare is limited to hospital patients in Scotland. This means that anyone getting an assessment who lives in a care home or hospice (that is not run by the NHS) doesn't qualify. Those with complex needs have to pay accommodation fees and (depending on individual circumstances) contribute either fully or partly towards the cost of their care. People who receive treatment at home also have to pay care costs.
Making the decision
The NHS should make a decision within 28 days of it being decided that the person needs a full assessment for continuing healthcare. If it takes longer than this and the person needing care is deemed eligible for this support, then the NHS should pay retrospectively to the due date of completion.
Challenging the decision
Many people that are turned down for continuing healthcare go on to successfully challenge the decision for their relative. If your relative is refused NHS-funding, then information should be given on how to challenge the decision. We also cover this in How to complain about an NHS decision.
Fast Track Tool
If your relative’s needs are urgent – because their condition is deteriorating rapidly due to a terminal illness, for example – a Fast Track Tool (in Wales, this is known as the Fast Track Assessment) is used instead of the Decision Support Tool to confirm eligibility. If your relative is found to be eligible, their funding from the NHS should be provided as quickly as possible.
Your relative’s needs may subsequently be reviewed using the Decision Support Tool, following the fast track decision. It is possible that this could result in a different decision and the NHS continuing healthcare could be withdrawn.
What your relative will get if deemed eligible
Following any assessment, your relative should get a statement of the decision outcome and why it was made.
If your relative is found to be eligible for NHS continuing healthcare at home, the NHS will pay for:
- At home: healthcare, such as services from a community nurse or specialist therapist, and associated social care needs, such as personal care and domestic tasks, help with washing, dressing, preparing meals and shopping.
- In a care home: care home fees, including board and accommodation.
If your relative is eligible for continuing healthcare then the NHS will take into consideration their wishes and those of other family members, although ultimately the final decision about where and how your relative receives their care will be made by the NHS. However, the NHS has a duty to meet the needs of the individual so they should ensure that common social and psychological needs, such as finding a care home placement close to the family, are met.
- NHS-funded nursing care: further free funding if the NHS assesses your relative as needing nursing care
- NHS intermediate care: NHS support for up to six weeks in a care home or at home for an older person in need of temporary care
- The procedure for discharge from hospital: find out when your relative should be discharged and who will manage it.
Page last updated: April 2018