Continuing healthcare funding offers care, arranged and funded by the NHS, for individuals who have a need for ongoing health care outside of a hospital.
Who can get NHS continuing healthcare
NHS continuing healthcare is available to anyone over 18 who is assessed by the NHS as having ‘a primary health need’.which is where care is an essential part of the person’s health and wellbeing.
It is considered after a period of NHS intermediate care, where someone still requires substantial help and care but no longer needs acute medical care. It may also be as part of a needs assessment which is done ( hopefully ) as part of the hospital discharge plan. It may also be provided if your relative has a rapidly deteriorating condition.
The health and social care professionals involved in your relative’s care should discuss whether to consider them for additional NHS funding at home or in a care home. If they decide that your relative could be eligible fthen they would then be assessed automatically.
The criteria for continuing healthcare are very complex and can be very difficult to access. It is, however, worth pursuing if you think your relative may qualify and your relative’s social worker isn’t working to get it on their behalf.
NHS Continuing Care Assssment
There has been much about this in the media and there appears to be a ‘postcode lottery’ in qualifying for continuing healthcare payments, all assessments should be completed in line with the National Framework.This sets out the criteria that all local NHS Commissioning Groups should be making their decision on.
Judgements are based on their nature, complexity, unpredictability and intensity. To see if your relative is eligible for NHS continuing healthcare, he or she will be assessed using an initial checklist tool.
Then if appropriate, a full assessment is carried out by a multi-disciplinary team (MDT) of two or more health/social care professionals. With your relative’s permission, they might interview other professionals involved their care to build up a full picture of needs. Sometimes,they will ask for more detailed, specialist assessments from these professionals.
The team will then use the information from the assessment to complete a Decision Support Tool.
This looks at 12 different types of need such as mobility, nutrition and behaviour; the twelfth need is ‘Other’ to help decide on the nature, complexity, intensity and unpredictability of needs.
For a detailed breakdown of the 12 areas of need and to understand how the Decision Support Tool is applied. The Department of Health have a document explaining how the tool works. A document to explain a tool!
Using the information from the assessment and the Decision Support Tool, the team will decide if your relative has a primary health need. They will then make a recommendation to their Clinical Commissioning Group (CCG, led by GPs and other health professionals, responsible for buying and arranging care packages for patients) as to whether your relative is eligible for care or not.This refers to England only, the rules governing this are slightly different in Wales.
Attend this meeting.
You can attend this meeting, your relative is allowed to have someone with them during the assessment. It can be very helpful to have someone there to help them to communicate their needs and to take notes.
The NHS should make a decision within 28 days of it being decided that the person needs a full assessment for continuing healthcare. If it takes longer than this and the person needing care is deemed eligible for this support the NHS should pay retrospectively to the due date of completion.
Challenging a “No” decision
Many people that are turned down for continuing healthcare go on to successfully challenge the decision for their relative. If your relative is refused NHS-funding, then information should be given on how to challenge the decision.
If your relative’s needs are urgent – because their condition is deteriorating rapidly due to a terminal illness, a Fast Track Tool is used instead of the Decision Support Tool to confirm eligibility. If your relative is found to be eligible, their funding from the NHS should be provided as quickly as possible.
If your relative is found to be eligible for NHS continuing healthcare at home, the NHS will pay for:
- At home: healthcare, such as services from a community nurse or specialist therapist, and associated social care needs, such as personal care and domestic tasks, help with washing, dressing, preparing meals and shopping.
- In a care home: care home fees, including board and accommodation.
- support for up to six weeks in a care home or at home for an older person in need of temporary care
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