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NHS Continuing Healthcare

What is NHS Continuing Healthcare?

The national framework for NHS continuing healthcare and NHS funded nursing care sets out the principles and processes for determining eligibility. The frameworks ensure that those assessing and delivering NHS continuing healthcare do so in the same way.

All relevant and updated documents regarding NHS continuing healthcare and NHS funded healthcare is published on the Department of Health's website.

In recent years, requests for NHS continuing healthcare and NHS funded healthcare have increased dramatically, including retrospective requests.

Although Herts Valleys Clinical Commissioning Group (CCG), like other NHS organisations, is working hard to clear these requests, the process itself, together with the amount of requests received, can result in a lengthy process.

What is NHS Funded Nursing Care?

This is the name given to a contribution from the NHS to meeting the nursing element of your care if your needs are such that they have to be met in a nursing home, but to not trigger full NHS funding.‚Äč

If you do not qualify for NHS continuing healthcare and are resident in a care home with nursing, you may be eligible for NHS funded nursing care (FNC). This type of funding is available for people that have registered nursing needs and are receiving their care in a care home with nursing. Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for FNC.

If you are eligible for FNC we will pay the FNC contribution to the care home directly to fund your care. This means care provided, supervised or planned by registered nurses that are employed by the care home. If you are self-funding your care at the care home with nursing, these funds should be reflected in your care home fees. Please talk to the manager of the home to discuss how FNC affects your fees. If your placement is funded by Social Services, the FNC payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

How is eligibility for NHS Continuing Healthcare or Funded Nursing Care decided?

You will be assessed to identify whether you have a "primary health need". This is likely to be a complex medical condition that requires substantial on-going healthcare. Eligibility is not dependent on a particular diagnosis, disease or determined by the location of where your care is provided. If your assessment does not identify a primary health need, you will not be eligible for NHS continuing healthcare.

We follow national guidance and criteria in assessing your care needs and eligibility. You will be fully informed and involved throughout this process. If you wish, you can ask a member of your family, a friend, carer or perhaps another representative to support you during this assessment process. We encourage you do this.

A "checklist" screening tool assessment may be completed initially. This will help to decide if a full assessment, known as a Decision Support Tool (DST) should be undertaken. The DST is used to collate information about your health needs and support the recommendation regarding eligibility. In some cases an urgent decision is needed, for example those who are terminally ill, and can be 'fast tracked' to provide timely NHS continuing healthcare.

Your health needs are assessed by looking at all of your care needs and relating them to four indicators:

  • Nature – the type of condition or treatment required
  • Complexity – symptoms that interact; therefore difficult to manage or control
  • Intensity – one or more health needs, so severe they require regular intervention
  • Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to the person or others

If you are eligible, Herts Valleys CCG will be responsible for identifying and funding a package of care that has been discussed and agreed with you and your family or representative. Funding is subject to regular review and if your healthcare needs change, the funding arrangements may also change. As this is a health funded service it is not dependent on savings or income.

Care and support planning

If you are eligible for fully funded NHS Continuing Healthcare, the next stage is to arrange a care and support package which meets your assessed needs either with a nursing home placement or within your own home.

If you are eligible for NHS Funded Nursing Care, the CHC Team will work with you and your family and the Continuing Healthcare Team to find a nursing home that can meet your needs.

If NHS continuing healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive 'mixed' packages of care, where some services come from the NHS and some from social services. Where local social services provide your care, they will usually do a financial assessment to decide whether the person must make any financial contribution.

Review

If you are eligible for NHS Continuing Healthcare, or NHS Funded Nursing Care, your needs and support package will be reviewed within three months and thereafter at least once a year. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider: whether you are still eligible for fully funded NHS Continuing Healthcare; or whether your needs are now higher than those usually considered eligible for NHS Funded Nursing Care and that you should be reassessed for fully funded NHS care.

Further information and links:

To find out more about NHS Continuing Healthcare visit the NHS Choices website or contact the Continuing Healthcare Team  01442 284130

If you phone continuing healthcare and the line is engaged we would encourage you to leave a voicemail message with your contact details. That way a member of our team can get in touch with you as soon as they become free.

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