Am I eligible for NHS continuing healthcare funding?

In England, Wales and Northern Ireland, if you have a disability or complex medical problem, you might qualify for free NHS continuing healthcare.

What is NHS continuing healthcare?

If your primary need is a ‘health need’, the NHS is responsible for providing for and funding all your needs, even if you’re not in hospital. For example, you could be in:

  • a hospice,
  • a care home, or
  • your own home.

Not many people know about NHS continuing care (sometimes called NHS continuing care). So it’s important to find out if you’re eligible and get an assessment.

Who is eligible?

Top tip

The only sure way to know if you’re eligible is to ask your GP or social worker to arrange an assessment.

There’s no clear-cut list of health conditions or illnesses that qualify for funding.

The assessment is made on whether your health needs are intense, complicated or unpredictable.

For example, if you have difficulty with things like breathing, eating & drinking, taking medicines, moving about, memory and thinking, for example, you may be eligible for continuing healthcare.

Intensity – this describes how much (for example, how often) and how severe your needs are. It also describes the support needed to help you, including the need for ongoing care.

Complexity – this is about how your needs affect each other. It also describes the level of skill needed to check your symptoms, treat the condition and/or manage your care.

Unpredictability – this is about how much and how often your needs can change and what the challenges are for the people who give you care and support. It should also explain the risk to your health if the right care isn’t given at the right time. Someone with an unpredictable health need is likely to have an unstable and changeable health condition.

Most people with long-term care needs don’t qualify for NHS continuing healthcare. This is because the assessment is quite strict.

It’s definitely worth being assessed though as having your full care package funded by the NHS could be worth thousands of pounds each year. So it’s worth finding out.

For more details whether your health problems mean you may qualify, take a look at the video on the NHS website.

What costs are covered?

Normal NHS healthcare (for example, from your GP, health visitor or in hospital) is free. But NHS continuing healthcare covers extra costs, such as help with washing or dressing, or paying for specialist therapy.

It might also include accommodation if your care is provided in a care home, or support for carers if you’re being looked after at home.

If you don’t qualify for NHS continuing care and you need care in a nursing home, you might get NHS-funded nursing care. This is a non means-tested contribution towards your nursing costs.

Funding varies by region. So you’ll need to check with your local Clinical Commissioning Group, Health Board or Health and Social Care Trust to see what’s covered:

Find out more in our guide to NHS-funded nursing care.

How do I apply for NHS continuing healthcare

To apply, ask your GP or social worker to arrange an NHS continuing healthcare assessment.

What happens during the assessment process?

Step 1 – The initial screening

First , you’ll have an initial screening to see if you’re eligible for funding.

It’s usually carried out in hospital or at home by a nurse, doctor, social worker or other healthcare professional.

They’ll assess your general health and care needs with a simple checklist. It will cover:

  • 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 your health, or the health of someone you care for, is getting worse quickly, ask about a fast track assessment to bypass the initial screening.

Step 2 – The assessment

Don’t be put off

Even though the assessment process can be complex, most people and families who’ve been through it say the benefits are worth it.

If the initial screening shows that you might be able to get free NHS continuing healthcare, you’ll need to have another assessment.

It will be carried by a team of two or more health and social-care professionals who are involved in your care.

The team will use the same checklist above, but they’ll go into a lot more detail.

They will mark each of your care needs as no need, low, moderate, high, severe or priority.

Find out more about the assessment process in the Department of Health leaflet ‘NHS continuing healthcare and NHS-funded nursing care’ (PDF).

I’m eligible for NHS continuing healthcare – what happens next?

If you’re eligible, the next stage is to arrange a care and support package that meets your assessed needs. Your local NHS authority (a Clinical Commissioning Group or Local Health Board) will organise this. They may work with your local council to arrange it.

Depending on your situation, different options could be suitable. This could include support in your own home and the option of a personal health budget.

What is a personal health budget?

In England, the NHS can arrange care for you, or you can choose to receive funding for your care as direct payments. This is known as a personal health budget.

A personal health budget gives you more choice and control over how to plan and pay for your healthcare and wellbeing needs.

Find out more about personal health budgets on the NHS website.

Personal health budgets aren’t currently available in Wales or Northern Ireland.

In Scotland, there are different arrangements called Hospital Based Complex Clinical Care.

Find out more on the Care Information Scotland website.

There’s also useful information on the Scottish Government website.

What if I don’t agree with the assessment?

Top tip

Circumstances change. So even if you’ve been turned down for funding, make sure your situation is regularly reviewed, especially if your health deteriorates. Your GP or social worker can help you.

If you don’t agree with the result of the assessment, ask your local Clinical Commissioning Group, Health Board or Health and Social Care Trust for a review of their decision.

You must ask for this in writing within six months of being told you weren’t eligible.

If their decision was only based on an initial screening, ask for a full assessment.

You should have an opportunity to contribute to the review and to see all the evidence that is taken into account.

If you’ve already been paying for care home fees and think you should have received NHS funding, you might be able to appeal.

To do this, speak to your social worker or health practitioner, and ask for a retrospective assessment.

If this doesn’t resolve the issue for you, you can ask for an independent review panel to consider your situation within six months. As a last resort, you can ask for your complaint to be determined by the Parliamentary Health Service Ombudsman.

What if I don’t qualify?

Even if you don’t qualify for NHS continuing healthcare, you might still be eligible for other NHS services to support you. This might include:

  • palliative care;
  • carer’s breaks and respite health care;
  • rehabilitation and recovery; and
  • community health services specialist support for healthcare needs.

Or, there might be local authority funding to meet some of your care needs.

Find out more in our Local authority funding for care costs – do you qualify? {:target=”_blank”}guide.

Detained under Mental Health Act

By law, the NHS and your local authority must jointly provide aftercare services if you’ve been detained under some provisions of the Mental Health Act for assessment and treatment.

All services provided under this section should be free.

Hospital Based Complex Clinical Care in Scotland

NHS continuing healthcare in Scotland was replaced in 2015 by a scheme called Hospital Based Complex Clinical Care.

If you need long-term complex clinical care, your needs will be assessed based on one question – can your care needs be properly met in a setting other than hospital?

If the answer is no, the NHS will fully fund your care but only in a hospital. If the answer is yes, the NHS won’t fund the non-healthcare aspects of your care. But you might be eligible for help from your local authority instead.

Find out more in our Local authority funding for care costs – do you qualify? guide.

If it’s possible to provide you with care outside hospital, you’ll get it in the place that’s best for you. This could be your home, a care home or supported accommodation.

If you’ve been getting NHS continuing healthcare under the old scheme since before June 2015, you’ll continue to receive it for as long as you’re eligible.

Find out more about Hospital Based Complex Clinical Care and how to get other care services in Scotland on the Care Information Scotland website.

For more about the changes – and what to do if you don’t agree with a care assessment – see Age Scotland’s factsheet Hospital Based Complex Clinical Care.

More information

For more free independent help, can contact FirstStop Advice using its online enquiry formopens in new window.

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