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 throughout it. Your client’s carer and family members should also be consulted where appropriate. A decision, or a request for a full assessment is usually made within 28 days of the initial 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 them.1
Here are the stages
Initial Assessment (Checklist)
The initial assessment is called a Checklist and 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:
- Skin integrity
- 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 for NHS continuing healthcare (stage 2).
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 needs.2
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.
If your client is not eligible for NHS continuing healthcare
- Your client can appeal the decision if they don’t agree.
- Your client may still be entitled to funded nursing care.
- NHS continuing health care decisions may not be permanent; if your client's health deteriorates your client can ask for it to be reviewed again.
If your client is eligible for NHS continuing healthcare
- Their funding should be awarded and paid from the point 29 days after the positive checklist assessment was received by the CCG.
- The package of care and support that's agreed upon will be reviewed after three months and at least every year thereafter.
- Your client will also have the right to ask for a Personal Health Budget, which can give them more choice over the services and care they receive. However, this can't be used to pay for care home fees.
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.
NHS continuing healthcare
For the full Department of Health & Social Care Framework please click below.
Funding nursing care
To understand funded nursing care we have written a summary for you.
Challenging a negative decision
If your client has been declined NHS continuing healthcare, they can challenge the decision.
1NHS continuing healthcare, View - NHS
2What is NHS continuing healthcare, View - Beacon
Information researched and accurate 21 June 2019. Not to be relied upon by advisers or their clients.