Are you eligible for NHS Continuing Care funding?

If you have a disability or complex medical problem, you might qualify for free NHS Continuing Care. You’re more likely to qualify if you have mostly health-care needs rather than social-care needs, in other words, you need a nurse rather than a carer. It’s not widely publicised, so find out if you’re eligible and get an assessment.

What is NHS Continuing Care?

If you need a lot of nursing support, NHS Continuing Care can arrange and fund your care for you. It’s designed to help you with health-care needs that result from disability, accident or illness. If you qualify, it should meet the full cost of your care including the full fees of a nursing home or hospice, although the care can also be provided at home.

Who is eligible for free NHS Continuing Care?

Top tip

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

Most people with long-term-care needs don’t qualify for NHS Continuing Care. There’s no clear-cut list of health conditions or illnesses that qualify for funding and not everyone with ongoing health needs will be eligible. The assessment is quite strict, and being frail isn’t enough. But don’t let that put you off. Free healthcare could be worth thousands each year, so it’s important to find out where you stand.

As a guide, ‘eligible’ health needs may include (but are not limited to):

  • Complex medical conditions that need additional care and support
  • Long-term medical conditions
  • Physical or mental disabilities
  • Terminal illnesses
  • Rapidly deteriorating health
  • Mobility problems
  • Behavioural or cognitive disorders

There are plenty of grey areas and whether or not you qualify often depends on where you live, since all local authorities have different budgets and different eligibility criteria.

Even if you know people in similar circumstances who’ve been turned down, the only sure way to know if you’re eligible for free NHS Continuing Care is to ask your GP or social worker to arrange an assessment.

What costs are covered?

NHS funding covers personal care and healthcare costs, such as paying for specialist therapy or help with bathing or dressing. It may also include accommodation if the care is provided in a care home, or support for carers if you’re being looked after at home.

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

What happens during the assessment process?

Step 1 – The initial screening

First of all, you’ll get 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 that will cover:

  • Behaviour
  • Cognition (understanding)
  • Communication
  • Psychological and emotional needs
  • Mobility
  • Nutrition (food and drink)
  • Continence
  • Skin (including wounds and ulcers)
  • Breathing
  • Symptom control through drug therapies and medication
  • Altered states of consciousness
  • Other significant care needs

If your health, or that of a loved one, is deteriorating rapidly, 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 may be eligible for free NHS Continuing Care, you’ll need to have a more thorough assessment. It will be carried by a multidisciplinary team of two or more health- and social-care professionals who are involved in your care.

The team will use the same headings from the checklist above but will go into a lot more detail, marking your care needs as ‘priority’, ‘severe’, ‘high’, ‘moderate’ or ‘low’.

If you have at least one priority need or two severe needs, you should qualify for funding. If you have one severe need and a number of other high or moderate needs, you may also be eligible.

What to do if you don’t agree with the assessment

Ask your local Health Board, Clinical Commissioning Group, or Health and Social Care Trust for a review of their decision. If their decision was based on an initial screening only, request a full assessment. You should be given an opportunity to contribute to the review, and to see all the evidence that was taken into account.

You may also be able to appeal if you’ve already been paying for care-home fees and think you should have received NHS funding. To do this, speak to your social worker or health practitioner, and ask for a retrospective assessment.

What if you don’t qualify for NHS Continuing Care funding?

Top tip

Circumstances change, so even if you were turned down for funding at first, you should make sure you have your situation regularly reviewed. Your GP or social worker can help get the ball rolling.

Even if you don’t qualify for NHS support, you may still be eligible for local authority funding to meet some of your care needs.

Need more information?