NHS Continuing Healthcare is funding provided by the NHS for people in full time care
It’s for people who are assessed as having a ‘Primary Health Need’.
NHS Continuing Healthcare is also known as ‘Continuing Care’ or ‘Fully Funded NHS Care’.
Over the last 9-10 years we have been contacted by over 1,000 families needing help navigating the Continuing Healthcare funding system. Many have never been told about NHS funding by the health and social care authorities, and yet the NHS has a duty to promote this funding.
Listen to the BBC’s File on 4 programme: ‘Continuing Healthcare – The Secret Fund’, broadcast on 18/11/14. It highlights some of the problems families experience in the funding assessment process.
What does NHS Continuing Care cover?
It covers 100% of care fees for people who need full-time care primarily for health reasons, i.e. they have a Primary Health Need. It’s available whether you’re in a care home, in your own home, in a hospice or somewhere else.
- If you’re in a care home, NHS Continuing Healthcare covers all care fees, including the costs of accommodation.
- If you’re receiving full time care at home, Continuing Healthcare covers all nursing care plus personal care (bathing, dressing, etc.) plus any household costs directly related to care needs.
It doesn’t matter whether you’re in a residential home or a nursing home, the same rules apply: It’s about your health needs first, not where you live or how much money you have.
The landmark Coughlan case, reinforced the difference between health needs and social care needs.
Should you be assessed?
If you have healthcare needs and you need full-time care, you should have a Continuing Healthcare assessment. NHS guidelines and the Standing Rules Regulations require local Clinical Commissioning Groups (formerly Primary Care Trusts) to assess anyone who appears potentially eligible for Continuing Healthcare.
However, many people find that they are assessed first by the local authority, to test their financial means.
If your local authority does a means test before you’ve been assessed for NHS Continuing Care, it can put the local authority in a potential unlawful position. Why? Because your care needs could be beyond the local authority’s legal remit for providing care, and you could end up wrongly paying. A Continuing Healthcare assessment needs to be carried out to clarify who is actually responsible for paying.
Many people with health and nursing care needs are automatically means tested first, and end up paying, and yet families report there will often have been no assessment for Continuing Healthcare. It is this that has led to thousands of retrospective claims for Continuing Healthcare being made.
What is the ‘National Framework’?
Prior to 2007 each Health Authority had its own eligibility criteria for Continuing Healthcare. The result was a ‘postcode lottery’, great confusion and thousands of complaints to the Health Service Ombudsman.
In 2007 the Department of Health introduced a new ‘National Framework’ for England, with the aim of providing a consistent single assessment process for everyone. Most (but not all) of these National Framework guidelines apply to Wales as well.
This National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care defines NHS Continuing Healthcare as follows:
“‘NHS continuing healthcare means 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’… 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. …Eligibility for NHS continuing healthcare places no limits on the settings in which the package of support can be offered or on the type of service delivery.”
Read these frequently asked questions about NHS Continuing Healthcare – we’ve included lots of tips to help you.
How to get through a Continuing Healthcare assessment
Care To Be Different was set up by The Founder, after she won a tortuous four-year battle to secure Continuing Healthcare funding for both of her parents. Since then she has had personal contact with over 900 families needing help understanding Continuing Healthcare. Almost all of those families had either not been told about NHS funding when a relative first needed nursing care and/or faced obstacles in the assessment process.
How To Get The NHS To Pay For Care, to help families get through Continuing Healthcare assessments and argue their case. It shows you what to do – and what not to do – and it can save you losing everything in care fees. It’s easy to follow and cuts through the confusion to show you step by step how things work.
“We were so grateful to find a clear and helpful guide to the process at a time when my mum was so vulnerable. It gave our family the confidence to successfully fight for NHS funding. The NHS should be ashamed of the way families/carers are treated: incorrect records, withholding information, conflicting information… I felt I must write to thank you for the information.” Rachel
“We have heard today that my mother-in-law is to receive NHS Continuing Care funding. We could not have done it without your book and website. Thank you so much.” Ian Johnson