Are you eligible for NHS continuing healthcare funding?

If you have a disability or complex medical problem, you might qualify for free NHS continuing healthcare (CHC) if you’re an adult, or free NHS continuing care (CC) if you’re under 18. Not many people know about it, so it’s important to find out if you’re eligible and get an assessment.

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?

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.

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.

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:

  • behaviour
  • cognition (everyday understanding of what’s going on around you)
  • 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 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:

  • priority
  • severe
  • high
  • moderate
  • 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.

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

Top tip

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.

Need more information?