Are you 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 (CHC). Not many people know about it, so it’s important to find out if you’re eligible and get an assessment.
In Scotland there are different care arrangements called Hospital Based Complex Clinical Care.
- What is NHS continuing healthcare or NHS continuing care?
- Who is eligible?
- What costs are covered?
- What happens during the assessment process?
- What to do if you don’t agree with the assessment
- What if you don’t qualify?
- Hospital Based Complex Clinical Care in Scotland
What is NHS continuing healthcare or NHS continuing care?
If you need a lot of nursing support, the NHS can fund your care for you.
NHS continuing healthcare (adults) or NHS continuing care (children) helps you with healthcare needs resulting from disability, accident or illness.
If you qualify, it should meet the full cost of your care including care at home, in a nursing home or hospice.
In England, the NHS can arrange care for you or you can choose to receive funding for your care as a direct payment, known as a personal health budget. A personal health budget gives you more choice and control over how you plan and pay for your healthcare and wellbeing needs.
Personal health budgets are not currently available in Wales, Scotland or Northern Ireland.
Who is eligible?
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.
Most people with long-term care needs don’t qualify for NHS continuing healthcare or NHS continuing care because the assessment is quite strict. Being frail, for example, isn’t enough.
But don’t let that put you off.
Free healthcare could be worth thousands of pounds each year, so it’s important to find out where you stand.
What are eligible health needs?
As a guide, ‘eligible’ health needs may include:
- 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 you may have other conditions that mean you qualify.
You may know people in similar circumstances who’ve been turned down. But the only sure way to know if you’re eligible is to ask your GP or social worker to arrange an assessment.
What costs are covered?
NHS continuing healthcare or continuing care covers personal care and healthcare costs, such as paying for specialist therapy or help with bathing or dressing.
It may 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 need nursing care as an adult, you might get NHS funded nursing care. You might get this even if you don’t qualify for NHS continuing healthcare or NHS continuing care.
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.
- In England, find your local Clinical Commissioning Group
- In Scotland, find your local Health Board
- In Wales, find your local Health Board
- In Northern Ireland, find your local Health and Social Care Trust
What happens during the assessment process?
Step 1 – The initial screening
First of all, 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 that will cover:
- cognition (everyday understanding of what’s going on around you)
- psychological and emotional needs
- nutrition (food and drink)
- skin (including wounds and ulcers)
- symptom control through drug therapies and medication
- altered states of consciousness
- other significant care needs
If your health, or the health of someone you care for, is getting worse 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 able to get free NHS Continuing Care, 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 will go into a lot more detail. They will mark each of your care needs as:
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.
Find out more about the assessment process in the Department of Health leaflet ‘NHS continuing healthcare and NHS-funded nursing care’ (PDF).
Find out more about the assessment for NHS Continuing Healthcare in Scotland in this ‘Continuing Health Care Assessment Summary’ (PDF).
What to do if you don’t agree with the assessment
Circumstances change, so even if you were turned down for funding at first, make sure you have your situation regularly reviewed. Your GP or social worker can help you.
Ask your local Clinical Commissioning Group, Health Board or Health and Social Care Trust for a review of their decision.
If their decision was only based on an initial screening, ask for 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 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?
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.
Hospital Based Complex Clinical Care in Scotland
NHS continuing healthcare in Scotland was replaced on June 1 2015 by a scheme called Hospital Based Complex Clinical Care. This scheme is only available to people in hospital.
If you need long-term complex clinical care, your needs will be assessed based on one question asking whether your care needs can be properly met in a setting other than hospital.
If it is possible to provide care outside hospital, you will receive it in the place that’s best for you. This could be your home, a care home or supported accommodation.
If you already getting NHS continuing healthcare under the old scheme, you will continue to receive it for as long as you are eligible.
Find out more about Hospital Based Complex Clinical Care and how to get other care services in Scotland on the careinfoscotland website.
You can also read more about the changes and what to do if you don’t agree with a care assessment in the Age UK fact sheet Hospital Based Clinical Care and NHS Continuing care in Scotland.
Need more information?
- In England, get practical support on the NHS Choices website
- In Scotland, find care information for older people on the Care Information Scotland website
- In Wales, find out more about continuing NHS Healthcare on the Health in Wales website
- In Northern Ireland, contact your local Health and Social Care trust for more information