What is NHS continuing healthcare?
NHS continuing healthcare is the name given to a package of care, which is arranged and funded solely by the NHS for individuals outside of hospital who have on-going health care needs. A person can receive NHS continuing healthcare in any setting, including their own home or in a care home.
NHS continuing healthcare is free, unlike support provided by local authorities for which a financial charge may be made depending on income and savings.
If found to be eligible for NHS continuing healthcare in your own home, the NHS will pay for healthcare (e.g. services from a community nurse or any specialist therapist that may be required) and associated social care needs (e.g. personal care and domestic tasks, help with bathing, dressing and food preparation) – in a care home, the NHS also pays care home fees, including board and accommodation.
Who is eligible for NHS continuing healthcare?
Anyone over 18 years of age assessed as having complex, intense or unpredictable health care needs may be entitled to NHS continuing healthcare. It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided.
If your overall assessment of care needs shows that you have a ‘primary health need’ you should be eligible for NHS continuing healthcare. Once eligible for NHS continuing healthcare, your care will be funded by the NHS – this is however, subject to regular reviews, and, should your care needs change, the funding arrangements may also change.
Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:
Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs
Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care
Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/on-going care
Unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.
Assessments for continuing healthcare are usually carried out using the decision support tool where a recommendation on eligibility is made by a multi-disciplinary team, which is coordinated by a continuing healthcare nurse assessor. Referrals for assessment can be made by any healthcare professional, care manager or social worker who has been trained using a checklist.
End of life care
Sometimes a person over 18 is in need of an urgent package of care due to a rapidly deteriorating condition, which may be entering a terminal phase. Because of that deterioration, a person may be eligible for a healthcare assessment using a Fast Track Tool instead of the usual assessment in order to speed up decision making relating to continuing health care eligibility.
More information is available in the NHS Continuing Care Public information booklet.
This Video explains the process for NHS Continuing Healthcare in more detail.
The national framework for NHS continuing healthcare and NHS funded nursing care sets out the principles and processes for determining eligibility.
The national framework, implemented from 1 October 2007, was revised and a new version published in October 2018
Download your copy of the current National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.
The framework describes the process for determining eligibility and introduces a set of national tools to support and improve consistency with regard to decision-making. It also sets one band for NHS funded nursing care.
National decision support tools
We have provided a link to the current up to date tools for clinicians that can be downloaded from the site below. These documents are in Microsoft Word format for use by those involved in the assessment process for NHS Continuing Healthcare.
What is children and young people’s continuing care?
A continuing care package will be required when a child or young person has needs arising from disability (including child and adolescent mental health, Autistic Spectrum Disorder and learning difficulties), accident or illness that cannot be met by existing universal or special services alone.
Some children and young people (up to 18-years-old), may have very complex health needs. These may be the result of congenital conditions, long-term, life-limiting, or life-threatening conditions, disability, or the after-effects of serious illness or injury.
These needs may be so complex, that they cannot be met by the services, which are routinely available from GP practices, hospitals or in the community commissioned by CCGs or NHS England. A package of additional health support may be needed. This additional package of care is known as continuing care.
Continuing care is not needed by children or young people whose needs can be met appropriately through existing universal or specialist services through a directly contracted case management approach.
Information on Children’s Continuing Care, including the National Framework and associated assessment tools can be found here.
Personal Health Budgets (PHB)
Adults who are eligible for NHS Continuing Healthcare (CHC) funding, and children in receipt of continuing care have had a legal right to have a personal health budget since October 2014. By April 2019, NHS England expects that unless there are exceptional circumstances, everyone living in their own home who is in receipt of standard CHC funding will have a personal health budget.
Please click here for further information on PHB’s
Have your say!
NHS England is gathering views on draft guidance to help CCGs when they are settling claims to do decisions about eligibility for NHS Continuing Healthcare or where an eligibility decision has been made on a period of NHS Continuing Healthcare that was previously unassessed. Please click here for more information and to have your say.
NHS England recognises that information and support are vital to all individuals involved in the CHC process and so has funded an independent information and advice service through a social enterprise called Beacon. This service is supported by a consortium of leading voluntary sector organisations including Age UK, Parkinson’s UK and the Spinal Injuries Association.
Information and advice is accessible in the form of free and comprehensive written guidance, and individuals are also able to access up to 90 minutes of free advice with a trained NHS continuing healthcare adviser 0345 548 0300.
For further information and to access this service please see the Beacon website.
If you would like to contact the Barnet Continuing Healthcare Team then please:
Contact the Barnet Continuing Healthcare Team: Tel: 020 3688 1826 or email firstname.lastname@example.org
If you would like to contact NHS England, their contact details can be found here.