Did you know that if you have significant and ongoing health needs, the NHS might be able to cover the cost of your care? Together with Compass CHC, this page explains what NHS continuing healthcare is, who it is designed for and how the assessment works.

What is NHS continuing healthcare?

NHS continuing healthcare (or NHS CHC) is free healthcare provided by the NHS. The funding is for individuals living in England, aged 18 or over, and who have significant and ongoing healthcare needs. It is part of adult social care provision arranged and funded solely by the NHS.

This package of care can be received in any setting outside of hospital, including care homes, hospices or even within your own home. You do not need to be in a nursing home to be eligible for funding. Your health needs, not where you live is the key factor.

For more information, contact the Patients Association free helpline.

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Who is eligible for NHS continuing healthcare?

To be eligible for NHS continuing healthcare, it must be established that your need for care is primarily health related. Additionally, this need must be assessed as being complex, intense or unpredictable. Intensity looks at how much and how severe the care needs are, complexity considers how different conditions or symptoms interact and require skilled oversight, and unpredictability reflects how unstable or changeable the person’s health is and the risks this creates. Taken together, they help identify when a person’s needs amount to a primary health need eligible for NHS Continuing Healthcare.

Unlike social care, it doesn’t matter what your income is or what savings you have, if you meet the criteria, you are entitled to free NHS CHC funding.

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How does the NHS continuing healthcare assessment work?

Stage 1 – Continuing healthcare checklist

A nurse assessor or social worker will complete the checklist tool. This identifies whether you need to have a full NHS continuing healthcare assessment.

Stage 2 – Decision support tool

A multi-disciplinary team (referred to as an MDT) will carry out a full assessment using the decision support tool (DST). The MDT is made up of clinicians, often a social worker, social healthcare professional, a GP and a nurse assessor.

The MDT will assess you against 12 care domains and score on a scale from no needs to priority needs.

The MDT will review your needs in relation to four characteristics: nature, intensity, complexity, and unpredictability. This will help the team decide whether you have a primary health need and are eligible for continuing healthcare funding.

Stage 3 - Outcome

The MDT will recommend to your Integrated Care Board (ICB) whether you are eligible for CHC or not. There are two outcomes:

• If you are eligible, the NHS becomes responsible for planning, sourcing, and funding the package of support based on the care needs identified. The package of care will be reviewed after three months and then annually.
• If you are found to be not eligible for CHC, you can ask the ICB to review its decision through an appeal.

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More information on NHS continuing healthcare

Navigating the continuing healthcare process can be complicated, sometimes decisions are inconsistent, and people can be told they won’t qualify, when they might.

To speak to our free helpline about NHS continuing healthcare, call 0800 345 7115 or email [email protected].

We partner with Compass CHC, who are experts in continuing healthcare funding and provide advice, advocacy and support to ensure those eligible receive the funding and care they deserve.

Compass CHC provide a free, confidential and no obligation assessment, visit the website for more information: https://www.continuing-healthcare.co.uk/.

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