What is NHS Continuing Healthcare?

NHS Continuing Healthcare is the name given to a package of care which is arranged and funded by the NHS for individuals outside of hospital who have ongoing healthcare needs.

You can receive NHS Continuing Healthcare wherever you live, including your own home or a care home. A personal contribution to NHS Continuing Healthcare is not necessary, unlike assistance from social services for which a financial charge may be made depending on your personal financial circumstances.

If you live in your own home, the NHS will pay for your healthcare and any necessary personal care (e.g. help with washing and dressing). If you live in a care home, NHS Continuing Healthcare pays for your care home fees, including board and accommodation, but does not contribute to sundry care such as hairdressing or chiropody.

Who is eligible?

To be eligible for NHS Continuing Healthcare funding you or your relative will need to satisfy the eligibility criteria as set out by the Department of Health. It is important to note that eligibility is not dependent on a particular disease, diagnosis or health condition, nor on who provides the care or where that care is provided. The criterion is based on the level of health need an individual is assessed as demonstrating at a given point in time. There is no limit on the number of times an individual can be assessed for eligibility.

If the assessment demonstrates that you or your relative has health needs that satisfy the Department of Health’s eligibility criteria, you or your relative should be eligible for full NHS Continuing Healthcare funding. Once eligibility has been established, you or your relative's care will be funded by the NHS but this is subject to regular review. Should you or your relative's care needs change at any time the funding arrangements may also change.

How do I apply for funding?

The application process is separated into two parts. The first part is what is known as the ‘Checklist’ process. The Checklist is designed to identify those people who may be eligible for a full NHS Continuing Care assessment. You should be aware that being eligible for a full assessment does not necessarily mean that you or your relative will be fully funded by the NHS. If the Checklist process indicates that you or your relative have needs that may make you eligible for full NHS funding you or your relative will be invited to take part in a full health needs assessment. Where an individual is not able to take part in this assessment themselves their next of kin or representative should be invited to participate in the process instead.

A multi-disciplinary team of people already involved in you or your relative's care will share the information they hold about you or your relative's care needs and jointly complete the Department of Health’s Decision Support Tool (DST). The object of this process is to determine whether or not you or your relatives care needs amount to what the Department of Health describes as a ‘primary health need’. A primary health need is a very subjective term, and is therefore difficult to adequately explain in only a few words here.

In short, the multidisciplinary team who collectively undertake the assessment must consider each of you or your relative's health and social care needs and then determine whether or not the totality of those needs are great enough that you or your relative's care should become the sole responsibility of the Health Service. This recommendation is put forward to your local Primary Care Trust (PCT) whose Panel of health and social care professionals and managers ultimately decides whether or not you or your relative is eligible for funding. In many cases individual members of the MDT are quite limited in their knowledge and experience of the CHC assessment process, which may result in an inadequate representation of you or your relative's care needs. This in turn may affect the outcome of the decision-making process.

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