When can you qualify for NHS Continuing Healthcare?

NHS continuing healthcare (NHS CHC) is a package of care that is funded solely by the NHS for adults with a primary healthcare need.  This is on the basis that NHS care is meant to be free and not means tested.  As private care fees typically fall between £750 and £1,500 per week, those awarded with NHS CHC could save between £40,000 and £80,000 a year. 

Regardless of an individual’s own assets, means, or existing care, anyone who is eligible should be entitled to have their care costs fully funded. Even if the needs are being managed or family and friends are assisting, NHS CHC may be able to provide additional resources that can improve a person’s quality of life.

Nursing home care is expensive.  In some circumstances the cost of that care can be met by the NHS.

Who is Eligible for NHS Continuing Healthcare?

Contrary to popular belief, NHS CHC is not restricted to those with terminal illnesses, nor does a terminal diagnosis guarantee funding.  There are four key indicators which help determine whether an individual’s healthcare needs qualify as ‘primary’, thus triggering NHS involvement and funding.  Assessors will enquire about the nature, intensity, complexity, and unpredictability of a person’s healthcare needs.  However, these characteristics only serve as a guide; it is not always black and white, and no two cases are the same.

The NHS CHC eligibility assessment takes a variety of factors into account, assigning ‘scores’ to a list of specific domains:

  • Psychological and emotional needs (high)
  • Drug therapies and medication: symptom control (priority)
  • Altered states of consciousness (priority)
  • Other significant care needs (severe)
  • Cognition (severe)
  • Behavior (priority)
  • Breathing (priority)
  • Nutrition (severe)
  • Continence (high)
  • Skin integrity (severe)
  • Mobility (severe)
  • Communication (high)

Each domain has a description of what each level entails.  For example, with breathing, shortness of breath and the use of inhalers is classified as a moderate need.  If an individual is unable to breathe independently and requires invasive mechanical ventilation, it is a priority need.  Only four domains can reach a priority level, when anyone of them does it usually guarantees a primary healthcare need.  Otherwise, significant needs are required in multiple domains.

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What Type of Care is Included in NHS Continuing Healthcare?

Packages are person-centered.  Individuals who are able can have an active role in deciding what care is most suitable for them.  This means it is not always a case of funding care home fees.  If eligible, a person may receive a personal budget to make significant improvements to their health and wellbeing.  For instance, with mobility, this can range from providing assisted transport for activities and interests important to the individual, to a new wheelchair which is better suited to their personal lifestyle.

How do you get NHS Continuing Healthcare?

Referrals for NHS CHC assessments are often made by a social worker when they meet a person for the purpose of conducting a social care assessment.  Social Services have a duty to inform the NHS if they believe a person may be eligible. If this has not occurred automatically, the individual’s family or their representation may reach out to the relevant Local Health Board or Clinical Commissioning Group. In cases of rapid deterioration, a fast-track pathway may be available too.  For more information go to the NHS website (https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/).

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