What is NHS Continuing Healthcare?
‘Continuing care’ means care provided over an extended period, to a person aged 18 or over, to meet physical or mental health needs that have arisen as a result of disability, accident or illness. ‘NHS continuing healthcare’ means a package of continuing care that is arranged and funded solely by the NHS.
Who can get it?
Eligibility for NHS Continuing Healthcare is not dependent on diagnosis or medical condition. Eligibility is assessed through a process as defined in the Department of Health National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
For the majority of cases the first step in the process will be a screening process, using the NHS continuing healthcare Checklist. This will be completed by a social worker or health professional, usually involving you or, if you choose, your family, carers or representative. Where the Checklist indicates that you may have needs that would make you eligible for continuing healthcare, a referral to the Integrated Continuing Care team for full assessment of eligibility will take place.
How will I be assessed for eligibility?
A Continuing Healthcare Co-ordinator will be allocated your case and their role is to co-ordinate the whole process until the decision on eligibility has been made. The Co-ordinator does not make the decision about eligibility. A team of health and social care professionals will carry out an assessment of your healthcare needs, from this a recommendation will be made. This assessment will help complete the Department of Health’s Decision Support Tool. The Decision Support Tool is not an assessment in itself but helps bring together information in a single format to facilitate decision making regarding NHS continuing healthcare eligibility.
Eligibility is determined by a detailed assessment which looks at all of aspects of health and social care needs and considers the four key indicators as follows:
- Nature – the type of condition or treatment required
- Complexity – symptoms that interact and are therefore difficult to manage or control
- Intensity – one or more health needs which are so severe that they require regular intervention
- Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to yourself or others
Following your assessment the health and social care professionals will make a recommendation to the CCG about your eligibility for NHS Continuing Healthcare. The CCG will then write to you advising whether you are eligible, giving reasons for their decisions. In most cases decisions are made within 28 days of the CCG receiving the completed checklist, this may be extended in complex cases.
What happens if I am assessed and deemed not eligible for NHS Continuing healthcare?
If you are unhappy with the outcome, in the first instance you should speak to the Continuing Healthcare Co-ordinator handling your case and ask for an informal meeting. This will allow you to discuss any concerns and obtain clarification where needed. If you are still unhappy, Sandwell & West Birmingham CCG has a review process which the Co-ordinator will explain to you.
Where is NHS continuing healthcare provided?
NHS continuing healthcare can be provided by the NHS in any setting, including a care home or at home. If NHS continuing healthcare is provided in a care home, it will cover the care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS continuing care is provided in the home of the person, it will cover personal care and healthcare costs. Those in receipt of NHS continuing healthcare continue to be entitled to access to the full range of health services, eg. GP, Hospital, out-patients, District nursing.
What if my care needs change?
Continuing Healthcare is episodic, if you are assessed as eligible for NHS continuing healthcare, please be aware that it is subject to review and should your care needs change the funding arrangements may also change. Your eligibility for NHS continuing healthcare will be reviewed regularly. If you are not eligible at this assessment, you may be eligible should your needs change over time. You can ask for a reassessment or ask your social worker, health worker or nursing home to refer you.
What is the Fast-Track tool?
This is used when a person has a primary health need arising from a rapidly deteriorating condition. This may be entering a terminal phase, with an increasing level of dependency and so should be fast tracked for NHS continuing healthcare. The patient may need NHS continuing healthcare funding to enable their needs to be urgently met (e.g. to allow them to go home to die or to allow appropriate end of life support to be put in place).
What are Personal Health Budgets?
Personal Health Budgets have been introduced into healthcare to offer patients greater control and a wider choice in their care options. Everyone who receives NHS Continuing Healthcare funding is eligible to request a Personal Health Budget
A Personal Health Budget is an amount of money to support a person’s identified health need, planned and agreed between the patient and the CCG.
An assessment is undertaken to develop a detailed care plan. This assessment is used to calculate the Personal Health Budget taking into account how much money is needed to support health and wellbeing needs. A Support Worker will be allocated to the patient to ensure the budget is used for maximum benefit and a support plan developed. Following agreement of the support plan by the patient and the CCG, the Personal Health Budget will be confirmed and the plan implemented.
There are a number of ways to receive a Personal Health Budget, the options will be explained during the initial meeting with the allocated Case Manager.
Should you wish to be considered for a Personal Health Budget please contact your Continuing Healthcare Case Manager in the first instance.
Does Continuing Healthcare apply to people under 18?
There is a separate framework for Children and Young People’s Continuing Care. It describes the process, led by CCGs, that organisations should go through in assessing needs and putting in place bespoke packages of Continuing Care for those children and young people who require it because their needs cannot be met by existing universal or specialist services alone. We are currently working in collaboration with neighbouring CCG’s to develop processes related to children’s Continuing Care to ensure cross-boundary regulation.
What is NHS-funded nursing care?
If you are not eligible for NHS continuing healthcare, but are in a nursing home (a care home that is registered to provide nursing care), you may be eligible for NHS-funded nursing care. This means that the NHS will pay a contribution towards the nursing home fees. By law, local authorities cannot provide clinical services because the NHS is responsible for any care that must be provided by a registered nurse. For people in care homes, registered nurses are usually employed by the care home itself and, in order to fund this nursing care, the NHS makes a payment directly to the care home to cover the cost of providing the care for those who are eligible.
NHS-funded nursing care is only used to pay for the costs of nursing care. People who get it will still need to pay for their accommodation, board and personal care, or have a community care assessment to see if they can get help with these fees from their local authority.
The assessment for NHS-funded nursing care should be done automatically when you move into a nursing home. Eligibility depends on whether you are assessed as having needs that require a nursing care environment.
Who is eligible for NHS-funded nursing care?
A person should receive NHS-funded nursing care if:
- they have been assessed as requiring the services of a registered nurse for physical or mental health needs
- they do not qualify for NHS continuing healthcare (i.e. nursing and accommodation costs) but have been assessed as requiring the services of a registered nurse
- they are not receiving registered nursing care in any other way
Local Authority Responsibility
If NHS continuing healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive an ‘integrated’ package of care, where some services come from the NHS and some from social services.
Where local social services provide your care, they will usually undertake a financial assessment to decide whether you must make any financial contribution.
Sandwell & West Birmingham CCG work in close partnership with Local Authorities.
Where can I get further information?
Sandwell & West Birmingham CCG’s Continuing Healthcare team can be contacted on the below telephone number:
Tel: 0121 612 1748
During busy times a message can be left on the answerphone, messages are regularly retrieved.
Postal correspondence should be addressed to:
4th Floor Rear
438 High Street
For written information, please click to view related documents and forms below:
All information relating to Department of Health National Framework for NHS Continuing Healthcare/Funded Nursing Care and relevant forms can be found on: