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NHS Continuing Healthcare and NHS-funded nursing care
NHS Continuing Healthcare may be available for your clients who have significant, long-term healthcare needs and are receiving care in a care home or in their own home. Any of your clients eligible for NHS Continuing Healthcare will have all the costs of their care paid for by the NHS. It doesn’t matter how much they're earning or what capital they have. It's not a means-tested benefit.
What action should be taken?
If your client believes they could be eligible for NHS Continuing Healthcare, the first step is to approach their GP.
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NHS Continuing Healthcare
If your client has long-term complex health needs they may qualify for free social care, arranged and funded solely by the NHS. This is known as NHS Continuing Healthcare.
To be eligible for NHS Continuing Healthcare, your client must be assessed by a team of healthcare professionals (a multi-disciplinary team - MDT).
The team will look at all their care needs and relate them to:
- what help your client needs
- how complex their needs are
- how intense their needs can be
- how unpredictable their needs are, including any risk to their health if the right care isn’t provided at the right time.
Your client should be fully involved in the assessment process and kept informed. Their views about their needs and support should be taken into account. Your client’s carer and family members should also be consulted where appropriate. A decision about eligibility for a full assessment for NHS continuing healthcare is usually made within 28 days of the initial assessment or request for a full assessment.
If your client is not eligible for NHS Continuing Healthcare, they can be referred to their local council who can discuss whether they may be eligible for support from them1.
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Initial Assessment (Checklist)
The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. Your client should be told that they’re being assessed, and be asked for their consent.
There are 11 sections (care domains) that are assessed. Each one is scored A, B or C (A is the highest and C the lowest). The 11 sections consist of:
- Breathing
- Nutrition
- Continence
- Skin integrity
- Mobility
- Communication
- Psychological/emotional
- Cognition
- Behaviour
- Drug therapies and medication
- Altered states of consciousness
This initial assessment is not a complete assessment; it is an indicator of whether they need to have a full assessment (stage 2).
There are two outcomes to this assessment:
- negative – the individual does not qualify for a full assessment
- positive – individual qualifies for a full assessment
If your client has a positive result from the initial assessment they'll be referred for a full assessment of eligibility for NHS Continuing Healthcare (stage 2).
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The Full Assessment
Full assessments for NHS Continuing Healthcare are undertaken by a multi-disciplinary team (MDT) made up of a minimum of two professionals from different healthcare professions. The MDT should usually include both health and social care professionals who're already involved in your client's care.
The assessment consists of an appraisal of recent care records, together with a face-to-face meeting which should fully involve your client and/or their representative (usually a family member).
The MDT use this evidence to complete a document called the Decision Support Tool (often referred to as the DST), which organises information about the individual’s care needs. The same 11 care domains will be looked at plus other significant care needs2.
The MDT will then make a recommendation to the Clinical Commission Group as to whether the individual is eligible for NHS continuing healthcare. The Clinical Commission Group makes the final decision but it’s generally in line with the MDT’s recommendation.
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The decision
If your client is not eligible for NHS Continuing Healthcare
- Your client can appeal the decision if they don’t agree.
- If your client decides not to appeal or the decision isn't overturned, they can ask to be referred to their local authority.
- Your client may still be entitled to NHS-funded nursing care.
If your client is eligible for NHS Continuing Healthcare
- Your clients’ existing care and support package will normally be reviewed within three months and at least every year thereafter.
Fast-track assessment for NHS Continuing Healthcare
If your client’s health is deteriorating quickly and they're nearing the end of their life, they should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
Our sources
1NHS Continuing Healthcare, NHSView - NHS
2What is NHS Continuing Healthcare, Age UK
Information researched and accurate October 2022. Not to be relied upon by advisers or their clients.
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NHS-funded nursing care
NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.
Your client may be eligible for funded nursing care if:
- they’re not eligible for NHS Continuing Healthcare but they’ve been assessed as needing care from a registered nurse
- they live in a nursing home.
Before finding out if your client qualifies for funded nursing care, they should go through the assessment process for NHS Continuing Healthcare. Normally they don't need a separate assessment.
If your client is eligible for funded nursing care, the NHS will arrange and fund it. The care will be provided by registered nurses employed by the care home.
NHS-funded nursing care is paid at the same rate across England. In April 2022, the rate was set at £209.19 a week (standard rate).
NHS-funded nursing care payments doesn’t affect entitlement to other benefits. However, in Scotland if your client receives a personal care allowance, they won’t be entitled to Attendance Allowance or the care component of Disability Living Allowance or Personal Independence Payment after the first 4 weeks.
Our sources
NHS-funded nursing care, NHSView - NHS
Information researched and accurate as of October 2022. Not to be relied upon by advisers or their clients.
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Challenging a decision
If your client has been through the NHS Continuing Healthcare assessment process and they disagree with the decision, they can challenge it by appealing.
The CCG should provide information on how your client can appeal the decision and the deadline for their appeal. Your client should confirm the deadline as soon as possible to make sure they have time to appeal. Beacon, an independent information and advice service funded by NHS England has stated that these deadlines can range from two weeks to six months1.
The process normally consists of three stages:
- Stage 1 – is the local resolution procedure adopted by the CCG. It varies but it normally involves a meeting potentially followed by a panel review.
- Stage 2 – is an Independent Review convened by NHS England, which, if accepted, may lead to a formal review of the CCG’s decision. Your client will be invited to attend part of the panel hearing.
- Stage 3 – is the referral of your client’s case to the Parliamentary and Health Service Ombudsman for a full independent investigation. Depending on this outcome there may be further stages involved.
The appeal process can be time-consuming and complicated and it may be in the person’s interests to seek independent information and advice.
Our sources
1Challenging and appealing a decision you don’t agree with, BeaconView - Beacon
Information researched and accurate as of October 2022. Not to be relied upon by advisers or their clients.
More about care funding
Find out more information from our care funding resources.
Useful sites
We've selected a range of articles and further information on NHS Continuing Healthcare.