NHS - Continuing Healthcare

NHS - Continuing Healthcare

This is the term that describes NHS funding that pays for the whole of your package of care. The eligibility threshold in order to get continuing healthcare is high – you (or your loved one) needs to have significant and intense ‘primary health needs’. Continuing healthcare can be provided in a range of settings including a Care Home, or a person’s own home.

How do I apply for Continuing Healthcare?

The assessment process usually takes place:

  • When you are ready for discharge from hospital and require a package of care
  • When you live in the community or a care home and your health needs have increased significantly

It is vitally important that you are proactive in requesting an assessment and attending the meetings, particularly if you pay for your own care.

The process is in stages:

  • 1. The Initial Checklist

    The aim is to get a general indication of your level of health needs. The threshold for passing to the next stage is quite low.
  • 2. Full assessment

    A ‘Decision Support Tool’ document is completed at a meeting involving family members / representatives and health and social care professionals.

What happens at the Assessment?

The decision support tool meeting will be held and should include the following people:

  • A nurse from the Clinical Commissioning Group (the local NHS provider)
  • A social worker
  • A member of your care team

You will be invited to attend and you can bring along someone to represent you. Our team are regularly requested by families to attend these meetings.

At the assessment you will work through a decision support tool. This document looks at your health needs under twelve ‘domains’, which include areas such as mobility, nutrition, skin, behaviour and psychological needs. A score, ranging from ‘no needs’ to ‘severe’ or (in some domains) ‘priority’ is awarded for each domain. The higher the scores awarded, the more likely it is that you will have a ‘primary health need’ and therefore be eligible. Your needs will also have to be shown to be intense, unpredictable or complex to manage. You will be able to contribute to this assessment and it is vital that you do.

The professionals at the meeting make a recommendation of eligible / not eligible, which is then presented to a local panel for ratification.

What happens if I am eligible?

Your care package will be funded from the 29th day after the checklist was received. Your eligibility will be reviewed after three months and if you are still eligible will be reviewed every year after this. It is important to remember that you can lose this funding and have to make a significant contribution to your care.

I have been told I am not eligible – can I appeal?

You can appeal the decision if you believe:

  • The eligibility criteria has not been applied properly
  • The meeting has not been properly conducted

How we can help / Our services

Our specialist Health and Community Care team has a wealth of experience offering tailored and comprehensive support to clients and their families who are going through the assessment process.

We have developed excellent working relationships with the local Clinical Commissioning Groups who are responsible for determining whether a person is entitled to the funding and ensure the assessments are conducted fairly, transparently and in a collaborative manner.

What we can help you with:

  • The assessment process
  • Eligibility for continuing healthcare
  • Appeals of decisions
  • Challenges
  • Annual Reviews
  • Retrospective Applications

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