What is it?

NHS continuing healthcare or fully funded NHS care is when a package of care is provided solely by the NHS which can be provided in hospital, care home or in an individual’s own home.

Regardless of a person's financial circumstances, it is the responsibility of the NHS to arrange and fund services to meet all the needs in any setting, of people whose health needs have been assessed under the national guidelines as critical, unstable and unpredictable and where their primary need is a health need. Primarily, people who need a high level of supervision and equipment to preserve their life on an ongoing basis are likely to fall into this category.

When someone is admitted to hospital, they receive emergency care. Once their condition has been treated and they are stable their eligibility to NHS continuing healthcare is assessed in 2 stages. The first one is by using a simple checklist. If this checklist produces a positive result, then the person is put forward for further assessment by a multidisciplinary team (MDT). This is a much more comprehensive assessment and includes examinations, assessments, review of evidence of a person’s medical records and all the findings are collated into a Decision Support Tool (DST) which helps the team to make their decision on whether or not the person is eligible for NHS Continuing Care (NHSCHC).

The MDT has a duty to assess the person and their care needs fully and to fund their care if they are found to be eligible for NHS Continuing Care.

It is vitally important to ensure that this assessment has taken place before any mention of Local Authority provision because this is the point where a person moves from having their care fully funded by the NHS to having to pay for their care either with help from the Local Authority or from private means.

A review of eligibility for Continuing Care should be taken at 3 months and then annually to ensure that a person continues to qualify for fully funded care.

If, following this assessment, you disagree with the outcome and feel that care should remain fully funded, you should refer to the Health Authority review procedure. The nursing home co-ordinator who may be employed by either the Primary Care Trust, Local Authority or Health Authority, is responsible for ensuring that a person's nursing care needs are met in full and this is the person you should contact and inform of your concerns. The involvement of the nursing home co-ordinator may lead to the Health Authority's continuing care panel reviewing their decision.

There is no cost to you if you qualify for NHSCHC.

How do I qualify for it?

Applying for NHS Continuity Healthcare is a very grey area and it is not an easy process to go through or understand as it is a two stage assessment process and it is awarded depending upon whether a person’s primary need is a health one and its severity.

If your overall care needs show that your primary need is a health one you should qualify for continuing healthcare. This will be assessed by 4 key indicators:

• nature – the type of condition or treatment required including quality and quantity
• intensity – one or more needs which are so severe that they require regular interventions
• unpredictability – unexpected changes in your condition that are difficult to manage and present a risk to you or to others
• complexity – symptoms that interact, making them difficult to manage or control

People are eligible for NHS continuing healthcare where it can be said that their ‘primary need is a health need’. The decision as to whether a person has a primary health need takes into account the legal limits of Local Authority provision. In order to arrive at the correct decision, use is made of a 'Decision Support Tool' which should support the application of the National Framework.

Using the Decision Support Tool correctly should ensure that all needs and circumstances that might affect an individual’s eligibility are taken into account in making this decision. Further information is available from NHS Continuing Healthcare

What if I still have health needs?

If you’re not eligible for NHS continuing healthcare but you have health needs, the NHS may still pay for part of your care. This is sometimes known as a joint package of care.

One way in which this happens is through NHS-funded nursing care. For more information, see What is NHS-funded nursing care?

Another way is for the NHS to provide other funding or services as part of your care plan. Whether you’re eligible for NHS continuing healthcare or not, you can still use all the NHS services in your area, in the same way as any other NHS patient.

Will there be a charge?

There is no charge for the NHS part of a joint package of care.

Local authorities are allowed to charge for the services they provide, and most of them do so. If your local authority is part-funding your care package, you may have to pay towards the cost of their part of the care, depending on your income and savings. Some authorities have set maximum amounts that you can be charged, which varies from area to area.

Who Provides NHS Continuing Health Care Services?

NHSCHC services can be provided by any number of health professionals including physiotherapists, occupational therapists, speech therapists and domiciliary carers. When you are assessed as being eligible for NHSCHC, you will be allocated a personal health budget. This is an amount of money that is used to support the needs that you have. It is similar to the personal budgets allocated by social services to support social care needs.

Just as with a social care personal budget, you can ask for your personal health budget to be paid to you in the form of a direct payment. A direct payment puts you in control of choosing who supplies your services. You don’t have to do this. You may, however, enjoy the freedom and choice that direct payments give you. You can find out more about personal health budgets and direct payments on this page.

For further help and information, the Department of Health and Social Security has produced a very useful and comprehensive public information leaflet entitled NHS continuing healthcare and NHS-funded nursing care, which explains the process in detail.