For individuals in the UK with long-term, complex health needs, NHS Continuing Healthcare (NHS CHC) can provide fully funded health and social care outside of a hospital setting. This crucial support system ensures that those with significant care needs receive the necessary assistance either in their own homes or in a care home. Understanding the process, especially the Fast Track Tool For Continuing Care, is vital for timely access to this support.
Where NHS Continuing Healthcare is Provided
NHS Continuing Healthcare isn’t confined to hospital walls. It’s designed to support individuals in more comfortable and appropriate environments, such as:
- Your Own Home: Allowing individuals to remain in familiar surroundings while receiving necessary care.
- Care Homes: Providing specialized care within a residential setting when home care is not sufficient.
This flexibility ensures that care is tailored to the individual’s needs and preferences, promoting a better quality of life outside of the clinical atmosphere of a hospital.
Eligibility for NHS Continuing Healthcare
NHS Continuing Healthcare is primarily for adults. However, children and young people with complex needs stemming from disability, accident, or illness may also be eligible for a “continuing care package.” This package addresses needs that go beyond standard universal or specialist services.
Download the Decision Support Tool for NHS Continuing Healthcare from GOV.UK (PDF, 194KB)
Eligibility is determined through a comprehensive assessment by a multidisciplinary team of healthcare professionals. This team evaluates your specific care needs, focusing on:
- Type of Help Required: Identifying the practical assistance needed.
- Complexity of Needs: Assessing the intricacy of your health conditions.
- Intensity of Needs: Determining the level of care required.
- Unpredictability of Needs: Considering fluctuations in your condition and potential health risks if care is not consistently available.
Crucially, eligibility hinges on assessed needs, not on a specific diagnosis or condition. Changes in your health needs can affect your ongoing eligibility for NHS Continuing Healthcare, highlighting the dynamic nature of the support system.
Throughout the assessment, your active participation is essential. Your views on your needs and desired support are taken into account. Where appropriate, carers and family members are also consulted to provide a holistic understanding of your situation. A decision regarding a full assessment for NHS Continuing Healthcare is typically made within 28 days of the initial assessment or request. If you are deemed ineligible for NHS Continuing Healthcare, referral to your local council for potential support options is the next step. In cases where health needs are partially met, the NHS may contribute to a “joint package” of care, sharing responsibility with other funding sources.
Accessing Information and Advice
Navigating the NHS Continuing Healthcare assessment process can be intricate. Beacon, an independent organization, offers free advice and support. They can be reached through their website or their free helpline at 0345 548 0300. These resources are invaluable for understanding your rights and navigating the system effectively.
Navigating NHS Continuing Healthcare Assessments
Integrated Care Boards (ICBs), the NHS bodies responsible for local health services, are tasked with conducting NHS Continuing Healthcare assessments when needs suggest eligibility. The assessment pathway usually begins with an initial checklist to determine the necessity of a full assessment. However, for urgent cases, the fast track assessment for continuing care is employed to expedite the process.
Initial Assessment: The Gateway to Continuing Care
The initial checklist assessment is conducted by healthcare professionals, including nurses, doctors, or social workers. You should be informed about the assessment and its purpose. The checklist outcome determines whether you proceed to a full assessment or are deemed ineligible for NHS Continuing Healthcare. Being referred for a full assessment doesn’t guarantee eligibility but opens the door for a thorough evaluation. The professionals completing the checklist are required to document their decision in writing, including the rationale, and provide you with a copy.
You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK (PDF, 122KB)
Full Assessment: A Multidisciplinary Approach
A full NHS Continuing Healthcare assessment is conducted by a multidisciplinary team (MDT) comprising at least two professionals from different healthcare disciplines. Ideally, this team includes health and social care professionals already involved in your care, ensuring a cohesive and informed evaluation. You will be informed about the coordinator of your NHS Continuing Healthcare assessment.
The MDT comprehensively evaluates your needs across twelve key domains:
- Breathing
- Nutrition (food and drink)
- Continence
- Skin (including wounds and ulcers)
- Mobility
- Communication
- Psychological and Emotional Needs
- Cognition (understanding)
- Behavior
- Drug Therapies and Medicine
- Altered States of Consciousness
- Other Significant Care Needs
Each need is assigned a weighting: “priority,” “severe,” “high,” “moderate,” “low,” or “no needs.” Generally, having at least one “priority” need or “severe” needs in two or more areas indicates eligibility for NHS Continuing Healthcare. Eligibility can also arise from a “severe” need in one area combined with other needs, or multiple “high” or “moderate” needs, depending on their nature, intensity, complexity, and unpredictability. The assessment process considers the interplay of needs and evidence from risk assessments to determine if NHS Continuing Healthcare is appropriate. Your perspectives, and those of your carers, are integral to the assessment. You are entitled to receive copies of decision documents with clear explanations for the outcome.
Fast-Track Pathway: Expedited Access for Urgent Needs
When an individual’s health is rapidly deteriorating and they are nearing the end of life, the fast-track pathway for continuing care becomes critical. This expedited assessment ensures that a suitable care and support package is implemented swiftly, typically within 48 hours. This rapid response system is a vital component of NHS Continuing Healthcare, providing immediate support during the most critical times.
Care and Support Planning: Tailoring Support to Your Needs
Eligibility for NHS Continuing Healthcare leads to the development of a personalized care and support package. This package is designed to meet your assessed needs and can encompass various options, including care in your own home and personal health budgets. If a care home is deemed the most suitable setting, you may have a choice among appropriate local care homes. Your ICB collaborates with you, considering your preferences when agreeing on the care package and setting. However, they also need to consider factors like cost-effectiveness and value for money when making final decisions.
Regular Reviews: Ensuring Ongoing Appropriateness
If you receive NHS Continuing Healthcare, your needs and support package are regularly reviewed, typically within three months of the initial assessment and at least annually thereafter. These reviews evaluate the ongoing suitability of your current care package and reassess your eligibility for NHS Continuing Healthcare if your needs have changed. This ensures that the support provided remains appropriate and responsive to evolving needs.
Refunds for Delays: Accountability for Timely Decisions
ICBs are expected to make eligibility decisions within 28 days of receiving a completed checklist or full assessment request, barring exceptional circumstances. If an ICB determines eligibility but exceeds the 28-day timeframe without justifiable reason, they are obligated to refund care costs incurred from the 29th day until the decision date. This measure ensures accountability and timely access to funded care.
Alternatives if Ineligible: NHS-Funded Nursing Care
If you are not eligible for NHS Continuing Healthcare but require nursing care in a registered care home, you may qualify for NHS-funded nursing care. This means the NHS contributes financially towards the cost of your registered nursing care, regardless of who funds the remaining care home fees.
Find out more about NHS continuing healthcare and NHS-funded healthcare from NHS England
Frequently Asked Questions about NHS Continuing Healthcare
Will My Current Local Authority Support Package Change if I Become Eligible for NHS Continuing Healthcare?
Concerns about changes to existing care packages when transitioning to NHS Continuing Healthcare are understandable. Your ICB should discuss options to maximize your choice and control, potentially including a personal health budget with options like direct payments for healthcare.
Can I Decline an NHS Continuing Healthcare Assessment? Will This Affect Local Authority Services?
Consent is not required for assessments like CHC Checklists, Decision Support Tools, and Fast Tracks, or for sharing information with care teams and health/social care staff. However, consent is needed to share personal information with third parties outside of these groups. Local authorities have service limitations. If you have concerns about assessment, discuss them with your ICB to find solutions. For individuals lacking mental capacity to consent to information sharing with third parties, the Mental Capacity Act principles apply, and decisions are made in their best interests.
What if My Relative is in a Care Home with Higher Fees Than the ICB Typically Pays?
If a move to a different care home is proposed due to cost considerations and you believe it will negatively impact your relative’s health or wellbeing, discuss this with the ICB. They are required to consider such concerns. If relocation is pursued, the ICB should offer a reasonable selection of alternative care homes.
Are Top-Up Fees Permitted for NHS Continuing Healthcare?
No, topping up NHS Continuing Healthcare packages with personal funds is not allowed, unlike local authority care packages. Private top-ups are only permissible for additional private services beyond those assessed as necessary and should be provided by different staff, ideally in a separate setting.
Can I Request an Assessment for Past Unassessed Care Periods?
You may request a Previously Unassessed Period of Care (PUPoC) assessment if you should have been considered for NHS CHC previously but were not, and you have funded your care (fully or partially). These requests generally apply to care periods after April 2012.
Read more information and guidance on how to make a request for a PUPoC assessment on GOV.UK
Video: Understanding Long-Term Care Plans
[Image of a video play button, suggesting a video about care plans]
Media last reviewed: 12 January 2024
Media review due: 12 January 2027
This video provides insights into how care plans empower patients with long-term conditions to actively manage their health by setting personalized goals. It’s a valuable resource for understanding the broader context of long-term care and patient empowerment.
