Some people with long-term complex health needs qualify for care and support funded solely by the NHS. This is known as NHS Continuing Healthcare.
NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
Introduction to CHC:
Am I eligible for NHS continuing healthcare?
NHS Continuing Healthcare is for adults. Children and young people may receive a “continuing care package”. For more information please visit our Children and Young People’s Continuing Care page.
To be eligible for NHS Continuing Healthcare, you must be assessed by a team of healthcare professionals called a multidisciplinary team (MDT). The team will look at all your care needs and relate them to:
- what help you need
- how complex your needs are
- how intense your needs can be
- how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time
Your eligibility for NHS Continuing Healthcare depends on your assessed needs, and not on any particular diagnosis or condition. NHS Continuing Healthcare is subject to regular review and If your needs change then your eligibility for NHS Continuing Healthcare may change.
You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.
A decision about eligibility for a full assessment for NHS Continuing Healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
If you aren’t eligible for NHS Continuing Healthcare, you can be referred to your local authority who can discuss with you whether you may be eligible for support from them.
If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
Important facts about CHC and a primary health need:
Initial assessment for NHS Continuing Healthcare
Before a checklist is completed the process should be discussed with you and you will be asked for your consent.
Requirements before CHC can commence e.g. consent
Depending on the outcome of the checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS Continuing Healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.
Being referred for a full assessment doesn’t necessarily mean you’ll be eligible for NHS Continuing Healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. A copy of the completed checklist is available to you at your request.
It is possible for the relevant health professionals to determine that a checklist would not be appropriate at any given time. This could be a professional decision based on the health and care information available or if your needs have not changed from a previous NHS Continuing Healthcare assessment.
A blank copy of the NHS Continuing Healthcare Checklist can be found on our professionals page.
The CHC checklist and the domains
Full assessment for NHS Continuing Healthcare
Full assessments for NHS Continuing Healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include professionals already involved in your care.
The NHS Continuing Healthcare assessment will be arranged by the CHC team and will include you and / or your representative.
The team’s assessment will consider your needs under the following headings (or “domains”):
- nutrition (food and drink)
- skin (including wounds and ulcers)
- psychological and emotional needs
- cognition (understanding)
- drug therapies and medication
- altered states of consciousness
- other significant care needs.
The ‘levels of need’ considered in these domains range between “priority”, “severe”, “high”, “moderate”, “low” or “no needs”.
In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS Continuing Healthcare should be provided.
The assessment should take into account your views and the views of any carers you have. A copy of the decision documents are available on request, which include clear reasons for the decision.
A blank copy of the NHS Continuing Healthcare Decision Support Tool (DST), and guidance notes can be found on our professional’s page.
The full assessment:
Fast-track assessment for NHS continuing healthcare
If your health is rapidly deteriorating and you may be entering a terminal phase, you should be considered for the NHS Continuing Healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
A blank copy of the NHS Continuing Healthcare Fast Track Tool is available.
CHC fast-track pathway:
Care and support planning
If you’re eligible for NHS Continuing Healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget (PHB). For more information please visit our PHB page.
If it’s agreed that a care home is the best option for you, there could be more than one local care home that’s suitable.
All organisations will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.
NHS Continuing Healthcare reviews
If you’re eligible for NHS Continuing Healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS Continuing Healthcare.
If you’re not eligible for NHS Continuing Healthcare
If you’re not eligible for NHS Continuing Healthcare, but you’re assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you may be eligible for NHS-funded Nursing Care (FNC).
This means that the NHS will pay a contribution towards the cost of your registered nursing care which is paid directly to the care home. NHS-funded Nursing Care is available irrespective of who is funding the rest of the care home fees.
Following a full assessment you have the right to appeal a decision that you are not eligible for NHS Continuing Healthcare. More information about local resolution is available.