NHS Continuing Healthcare

Some people, with a disability or long-term complex health needs, qualify for free social care arranged and funded by the NHS. This is called NHS Continuing Healthcare. If someone qualifies, all their care will be paid for, including their care home fees. 

It could be worth thousands of pounds a year, so it’s worth finding out if the person you care for could be eligible. 

There’s no list of health conditions or illnesses covered by NHS Continuing Healthcare. It’s awarded to adults who are assessed as having a primary health need. This means that dealing with health issues is the most important part of their care needs, over their need for social care. It isn’t means-tested, so it doesn’t matter how much money the person has. 

The eligibility criteria are strict

There is an assessment to review what help someone requires and how complex, intense and unpredictable their needs are.

It’s most often awarded to people in care homes, but can also be given for care at home. In England, the NHS can arrange care or the person can receive funding for their care as a personal health budget.

NHS Continuing Healthcare is available in England, Wales and Northern Ireland. In Scotland, there is a different system – see 'NHS Continuing Healthcare in Scotland'.

If you think the person you care for may qualify for NHS Continuing Healthcare, you could suggest they ask their GP or social worker to arrange an assessment or ask on their behalf. 

Someone from the NHS or social services will do a brief assessment of the person’s health needs to see if they might be eligible for NHS Continuing Healthcare. This is known as the Checklist Tool. 

It looks at the person’s: 

• mobility 
• breathing 
• continence 
• communication 
• nutrition (food and drink) 
• skin (including wounds and ulcers) 
• psychological and emotional needs 
• altered states of consciousness 
• symptom control through drug therapies and medication 
• cognition (everyday understanding of what’s going on around you) 
• other significant care needs. 

If this initial screening shows the person might be eligible for NHS Continuing Healthcare, they will have another assessment. This uses the same checklist but goes into a lot more detail. It’s carried out by two or more health and social care professionals who are involved in the person’s care. In Wales, a representative from the local council is also present. 

A decision about whether the person is eligible for NHS Continuing Healthcare should be made within 28 days of the assessment. 

The next step is to arrange a care and support package that meets the person’s assessed needs. This could involve support at home or a move into a care home. The person’s Clinical Commissioning Group (CCG) should work with them and consider their views while making decisions. 

This support package will be reviewed after three months, and then every year, to check it’s still suitable. 

If the person you care for is turned down for NHS Continuing Healthcare, they may still qualify for NHS-funded nursing care. This is available to people living in a nursing home who are assessed as needing nursing care. This means the NHS will pay towards the cost of their registered nursing care. 

They may also be eligible for other NHS services such as respite care, palliative care, rehabilitation and recovery, or community health services.
 

If the person you care for is terminally ill and their condition is quickly getting worse, they should be considered for a Fast Track Pathway. This is a quicker process completed by a medical professional. If it’s accepted, the person’s care package should be in place within two days. 

You can also read about the specials rules in place for benefits if someone is terminally ill here: Benefits if you are terminally ill.

In June 2015, NHS Continuing Healthcare was replaced in Scotland by a different system called Hospital Based Complex Clinical Care. It’s limited to patients who need to be in hospital for their care needs to be met. Anyone who lives at home or in a care home won’t qualify.

Find out more about the assessment process at Care Information Scotland.

The process involved in NHS Continuing Healthcare assessments can be complex. An organisation called Beacon offers up to 90 minutes of free advice, and also has paid services. Visit the Beacon website: www.beaconchc.co.uk or call the helpline on 0345 548 0300. 

You could also contact your local Healthwatch for details of your local NHS independent advocacy service (visit healthwatch.co.uk or call 03000 683 000).

Or email our Helpline Team to get in touch with an adviser if you have any specific queries: advice@carersuk.org