What is NHS Continuing Healthcare?

‘NHS continuing healthcare’ is the name given to a package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised November 2012). A copy is held in the General Information and Leaflets section in our Library.  Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness.

People who are eligible for NHS Continuing Healthcare (CHC) do not pay anything towards the cost of their care.

If you are eligible you can receive NHS Continuing Healthcare in your own home or a care home.

For more information on continuing care, please visit the NHS Choices website

If you feel you may be eligible, please speak with the health or social care professionals involved in your care and/or contact the North East Essex Continuing Healthcare Team on 01206 918681 or 01206 918682.

Who is eligible for NHS Continuing Healthcare funding?

Eligibility decisions for NHS CHC are ‘needs based’ and rest on whether your need for care is primarily due to your health needs. This is referred to as having a ‘primary health need’.

To find out if you are eligible for NHS Continuing Healthcare, you need to go through a process of two different steps.

• The first step in the process for most people will be a screening process, using the NHS Continuing Healthcare Checklist. Before the Checklist is applied, it is necessary to ensure that the individual and (where appropriate) their representative understand that the Checklist does not necessarily indicate that the individual will be eligible for NHS continuing healthcare – only that they are entitled to consideration for eligibility. The checklist will indicate if you move on to the second step.
• The second step is a multidisciplinary assessment that involves the completion of the Decision Support Tool, the result of which will decide if you are eligible for Continuing Healthcare.

When assessing your needs, the Framework guidance advises staff to consider your needs in relation to the following characteristics:

• Nature: the type and particular characteristics of your needs -physical, mental or psychological. This influences the type (quality) of interventions required to manage them.
• Intensity: this relates to both the extent (quantity) and severity (degree) of your needs and the support required to meet them on an ongoing basis.
• Complexity: how different needs present and interact to increase the knowledge and skill needed to monitor your symptoms, to treat you and/or any multiple conditions you have and/or the interaction between them, and how this affects the management of your care. Unpredictability: unexpected changes in your condition that are difficult to manage and challenge staff required to care for you; the level (quantity) of monitoring required to ensure you and others are safe and the degree of risk to you or others if adequate and timely care is not provided. Someone with unpredictable healthcare needs is likely to have either a fluctuating, unstable or rapidly deteriorating condition

When the  Decision Support Tool is complete, you need to check if you agree with what has been written about you.

The multi-disciplinary team will give you a copy of all the forms and documents that have been written.

Planning your support

If you are eligible for Continuing Healthcare, you now have the right to ask to have a Personal Health Budget (PHB).

Personal health budgets give patients real control and choice over how to meet their health and care needs.

Please see the links to a local introductory leaflet and the longer explanation booklet.

What is NHS-funded nursing care?

NHS-funded nursing care (FNC) is care provided by a registered nurse for people who live in a care home. The NHS will pay a flat rate contribution directly to the care home towards the cost of this registered nursing care.

Who is eligible for NHS-funded nursing care?

You may be eligible for NHS-funded nursing care if:

• you are not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse

• you live in a care home registered to provide nursing care

If you have been assessed for Continuing Healthcare and deemed not eligible but live in a care home registered to provide nursing care, the Continuing Healthcare nurse will speak to you about Funded Nursing care and advise you regarding the process and eligibility criteria for receiving this payment.

If you live in a care home registered to provide nursing care and no one has spoken to you about Funded Nursing care we would advise you to speak with the care home manager in the first instance. The nursing home will contact the North East Essex Continuing Healthcare Team and make an application for an FNC assessment. An assessment for Funded Nursing care involves the completion of the NHS Continuing Healthcare checklist and therefore ensures you have access to the full assessment process as indicated. 

What if my care needs change?

Your eligibility for NHS Continuing Healthcare and NHS-Funded Nursing care will be reviewed regularly. If your care needs change, the funding arrangements may also change. For more information, see When will my needs for continuing care be reviewed?

Feedback

If you have had experience of using the Continuing Healthcare service funded by NHS North East Essex Clinical Commissioning Group, we’d like to hear your feedback.

General Advice

For general help and advice, please contact our patient advice and liaison service (PALS) on 01206 918730.