What Is NHS Continuing Healthcare?
NHS Continuing Healthcare is free, non means tested care arranged and paid for by the NHS.
It is provided to meet physical and/or mental health needs that have arisen because of disability accident or illness.
Providing you live in England or Wales it can be provided in any setting – your own home, hospice, or care home.
If you live in Scotland it is called “Hospital Based Complex Clinical Care” and is only awarded and continues if your care needs can only be delivered in a hospital or NHS hospice. Once you are discharged it will cease and apart from receiving Scotland’s Personal Care Contribution (and if necessary, Nursing Care contributions) you will be financially means tested to see if you need to pay for your accommodation costs.
Who Is Eligible For NHS Continuing Healthcare?
To be eligible for NHS Continuing Healthcare your need for care must be primarily a health need and not just a social care need.
To objectively determine whether you might qualify, you should have your care needs assessed by a GP, nurse or even social worker using an initial NHS Continuing Healthcare checklist that looks at 12 different needs or “domains”
- Behaviour
- Cognition
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition – food and drink
- Continence
- Skin and tissue viability
- Breathing
- Drug therapies and medication: symptom control
- Altered states of consciousness
- Other Significant Care Needs
To potentially qualify:
- 2 or more of these categories need to be assessed as “exceeding the standard” (or just one if it is a need which carries a priority rating),
or
- You meet the standard in 5 or more categories
If this is the case a further, more in depth assessment is carried out by at least 2 people from different medical disciplines.
If this further assessment concludes you meet the criteria, a recommendation is then made to your Local Clinical Commission Group and you will only be awarded it if they agree.
What Care Is Provided
Should you be fortunate enough to qualify, the type of care you receive will depend on the location of where you receive care:-
If you live in your own home (England and Wales only) – You could receive free nursing services from the community nurse or help with personal care, such as bathing.
If you need full time care in a care home (England and Wales only) – the NHS will pay all your care home fees including board and accommodation.
How Long Will They Pay?
Despite its name, Continuing Healthcare may not continue indefinitely. You will be re-assessed at frequent periods (at least annually) and should your health improve sufficiently, or more stable and more manageable, it can be stopped.
What Happens If You Do Not Qualify?
First if you live in England you can ask your local Integrated Care Board to review it.
If you are still unhappy and feel the criteria has been wrongly applied or the process flawed, you can ask your CCG to get in touch with the NHS National Commissioning Board or you can contact them directly.
Thereafter appeal to Director of the relevant NHS Board (within 14 days) and they should appoint another competent professional to review the case.
If any appeal proves unsuccessful you will be deemed as needing social care and depending on how much money you have, your local authority may expect you pay for your own care. If this is the case, you may also like to read …