This page is a guide for anyone who may need ongoing care and support from health and social care professionals due to disability, accident or illness. Below we explain how we decide whether someone is eligible for care funded entirely by the NHS (known as continuing healthcare or CHC).
What is NHS continuing healthcare?
NHS continuing healthcare is a package of care that’s arranged and funded solely by the NHS. It’s designed to support people aged 18 or over who have ongoing healthcare needs, but are outside of hospital care. This might be the result of disability, an accident or illness.
NHS continuing healthcare is free, unlike support provided by local authorities, which may involve you making a financial contribution, depending on your income and savings.
You can receive NHS continuing healthcare in any setting – including your own home or a care home.
The Clinical Commissioning Group (CCG) is responsible for deciding the appropriate package of support for someone who is eligible for NHS continuing healthcare.
Decisions about who is eligible for continuing healthcare are guided by the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care. This is designed to ensure that everyone assessing or delivering continuing healthcare does so in the same way.
You may find the Department for Health and Social Care’s leaflet, ‘NHS continuing healthcare and NHS-funded nursing care’ helpful.
Who is eligible for NHS continuing healthcare?
Anyone over 18 years old, who is assessed as having a certain level of clinical need, may receive continuing healthcare. It is not dependent on a particular disease, diagnosis or condition, who provides the care or where that care is provided.
If your eligibility assessment determines that you have a ‘primary health care need’, you should be able to receive NHS continuing healthcare funding. This would be reviewed regularly, and your care package may change if your clinical needs change.
The first step for most people is for a health or social care professional to complete the NHS continuing healthcare checklist tool. This helps health and social care professionals to see whether your clinical needs are at a level that should be considered for a full assessment.
The result of this checklist tool will then be passed to us at the CCG, whether it is positive or not.
If the checklist process does not suggest that you should be considered for continuing healthcare at this stage, it is still possible for this to be reviewed again in future if your health needs change.
How the assessment works
If the checklist tool gives a positive result, the next step is taken by a multidisciplinary team (sometimes called an MDT). This includes two or more health and social care professionals, who will carry out the assessment. You will be able to take part in this assessment.
The multidisciplinary team will complete a ‘decision support tool’ (also called a DST). This involves gathering information about your health needs, from yourself and those who are involved in your care.
Fast track referrals
If you need an urgent package of care due to a rapidly deteriorating condition, then a fast track referral may be needed. This is to ensure that you receive the care you need, with NHS funding.
In this situation, a doctor or health professional will complete the ‘continuing healthcare fast track tool’ for you. Any services provided under this process will be subject to review as required, and may be amended in response to your changing health needs. Eligibility for fast track funding is subject to review.
If you are not eligible
If you are not eligible for NHS continuing healthcare, your local council will discuss with you whether you can receive support from them instead. The letter telling you about the decision would include details of how to appeal. The Department of Health and Social Care website provides more information about what to do if you’re not happy with a decision.
If you live in Gateshead or Newcastle, our continuing healthcare team are here to support you through the process. The team is made up of nurses who work with other health and social care professionals to get a full understanding of your individual needs.
You can contact the team:
- By phone on 0191 223 6503
- By emailing email@example.com
NHS England continuing healthcare film
This public information film is a guide to NHS continuing healthcare and what to expect through the complex assessment process. Further information is available on the NHS England website.