NHS Continuing Healthcare (NHS CHC) is a package of care provided outside of hospital for adults aged 18 or over which is arranged and funded solely by the NHS Clinical Commissioning Groups. It is designed to support individuals aged 18 or over who have significant ongoing healthcare needs and have been assessed as having a "primary health need"
People who are assessed for CHC include those who need a very high level of support. Some people may be reaching the end of their lives, or have long-term conditions as a result of a disability, accident or illness. When someone is assessed as eligible for CHC, their local CCG is responsible for funding their full package of health and social care.
This means that the CCG will find suitable care to meet someone's assessed needs. The CCG will always try to give options and choices that best match the patient and family's preferences for the type and place of care provided.
Where can NHS Continuing Healthcare be provided?
NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a nursing home. The CCG will find suitable care to meet someone's assessed needs. The CCG will always try to give options and choices that best match the patient and family's preferences for the type and place of care provided. See our policy on CHC and Funded Nursing care (FNC) Choice and Equity Policy.
Am I eligible for NHS Continuing Healthcare?
NHS Continuing Healthcare is for adults (18 and over). To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a "multi-disciplinary team") as having a "primary health need". Whether or not someone has a primary health need is assessed by looking at all their care needs and relating them to:
- what help you need
- how complex your needs are
- how intense your needs can be
- how unpredictable they are, including any risks to your health if the right care isn't provided at the right time
- the nature of your needs
Your eligibility for NHS Continuing Healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS Continuing Healthcare may change.
You should be fully involved in the assessment process and kept informed and have your views about your needs and any support you require taken into account. Carers and family members will also be consulted where appropriate.
After your assessment
You will be notified in writing of the outcome of your assessment. If you are not eligible, the reasons will be explained in the letter.
If you're not eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.
If you still have some health needs then the NHS may pay for part of a package of support. This is sometimes known as a "joint package of care".
If you are not eligible to NHS CHC and have been are assessed as needing care from a registered nurse and live in a nursing home you'll be eligible for NHS-funded nursing care. NHS FNC is a weekly payment made by the NHS to cover nursing care provided by a Registered Nurse. FNC is only provided if you need nursing care within a care home with nursing setting. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees and is paid directly to the care home provider. The weekly FNC figure is set by the Department of Health and is reviewed each year.
How can I appeal a decision?
If you are assessed as not eligible for NHS Continuing Healthcare, you have the right to appeal. You can also instruct someone to appeal on your behalf.
The request should be made in writing, no later than 6 months from the date of the initial decision. The first stage is to let us know why you are unhappy with the decision and give a clear rationale for your appeal. Please note the decision stays in place during the appeals process. Find out more about how to appeal and the local resolution process. The professional who referred you will also be informed of the outcome of your assessment.
Care and support planning
If you are eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable. The continuing healthcare team will consider your views when agreeing your care and support package and the setting where it will be provided, and factors such as the safety, quality, cost and value for money of different options will be taken into account. If it is agreed that a nursing home is the best option for you, there could be more that one local care home that's suitable. The CCG has a duty to ensure that public funds are used carefully to meet the needs of all patients. The team will also explain about the option and different types of Personal Health Budget (PHB).
NHS Continuing Healthcare Review
If you are eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within three months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs and will also consider whether you are still eligible for NHS continuing healthcare.
Merton CCG Continuing Healthcare Service
Merton CCG commission CHS Healthcare to deliver the continuing healthcare service. They manage all new referrals, assessments, reviews and existing caseloads and arrange care.
How to contact the CHC team
Further information and advice
The process involved in NHS Continuing Healthcare Assessment can be complex, the Department of Health offers some public information on NHS continuing healthcare.
You can find this information here or on the NHS Choices website or by watching a film on NHS England Continuing Healthcare (CHC) film
In addition, free advice from continuing healthcare advisers funded by NHS England at Beacon can be accessed on 0345 548 0300 or http://www.beaconchc.co.uk/how-we-can-help/
Continuing Healthcare policies