NHS Continuing Healthcare

Most people have to pay something for the care they receive. But some people with ongoing, significant health needs can get their care paid for through NHS Continuing Healthcare.

What is NHS Continuing Healthcare?

NHS continuing healthcare is a package of care for people who are assessed as having a 'primary health need'. It's arranged and funded by the NHS.

If you receive care in your own home: The NHS covers the cost of the care and support you need to meet your assessed health and associated care needs, which includes personal care such as help with washing and getting dressed.
If you receive NHS continuing healthcare in a care home: The NHS pays your care home fees.

Am I eligible for NHS Continuing Healthcare?

NHS continuing healthcare is for adults. Children and young people may receive a "continuing care package" if they have needs arising from disability, accident, or illness that cannot be met by existing universal or specialist services alone.

To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). 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 is not provided at the right time

Your eligibility for NHS continuing healthcare depends on your assessed needs, not on any particular diagnosis or condition. If your needs change, then your eligibility for NHS continuing healthcare may change.

You should be fully involved in the assessment process, 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 are not eligible for NHS continuing healthcare, you can be referred to the council, 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.

Information and advice

The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free, independent advice on NHS continuing healthcare.

Visit the Beacon website or call the free helpline on 0345 548 0300.

NHS Continuing Healthcare assessments

Integrated care boards, known as ICBs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.

For most people, there's an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently - for example, if you're terminally ill - your assessment may be fast-tracked.

Initial assessment for NHS Continuing Healthcare

The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional, or social worker. You should be told that you're being assessed and what the assessment involves.

Depending on the outcome of the checklist, you'll either be told that you do not 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 does not 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. You should be given a copy of the completed checklist.

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 both health and social care professionals who are already involved in your care.

You should be informed of who is coordinating the NHS continuing healthcare assessment.

The team's assessment will consider your needs under the following headings:

breathing
nutrition (food and drink)
continence
skin (including wounds and ulcers)
mobility
communication
psychological and emotional needs
cognition (understanding)
behaviour
drug therapies and medicine
altered states of consciousness
other significant care needs

These needs are given a weighting marked "priority", "severe", "high", "moderate", "low" or "no needs".

If you have at least 1 priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare.

You may also be eligible if you have a severe need in 1 area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity, or unpredictability.

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. You should be given a copy of the decision documents, along with clear reasons for the decision.

Fast-track assessment for NHS Continuing Healthcare

If your health is deteriorating quickly and you're nearing the end of your life, you should be considered for the NHS's 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.

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.

If it's agreed that a care home is the best option for you, there could be more than 1 local care home that's suitable.

Your ICB should work collaboratively with you and consider your views when agreeing on your care and support package and the setting in which 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'll be eligible for NHS-funded nursing care.

This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees.