NHS Continuing Healthcare: A Guide for Families

This guide explains what NHS Continuing Healthcare means, who may qualify, how the assessment process works and what families can do if they disagree with a decision. It is intended as general information and should not replace advice from the NHS, a healthcare professional or a qualified adviser.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is care funded by the NHS for adults who have a primary health need. It can cover the full cost of an assessed package of health and social care, depending on the person’s needs and where the care is provided.

Support may be arranged in:

• The person’s own home.

• A care home.

• A nursing home.

• Another suitable care setting.

Eligibility is based on the person’s assessed care needs, rather than simply their age, diagnosis or financial circumstances. The assessment considers factors including how complex, intense and unpredictable the person’s needs are, as well as the risks to their health if suitable care is not provided.www

NHS Continuing Healthcare is different from means-tested social care. If a person qualifies, their care package is funded by the NHS rather than being paid for entirely by the individual or their family.

Who might be eligible?

A person may be considered for NHS Continuing Healthcare if they have significant health needs that require ongoing care and support.

This could include needs relating to:

• Mobility and physical disabilities.

• Breathing.

• Nutrition and hydration.

• Continence.

• Skin integrity and pressure-area care.

• Communication.

• Cognition and memory.

• Psychological or emotional needs.

• Medication and symptom management.

• Altered states of consciousness.

• Complex or unpredictable behaviours.

Having one particular condition does not automatically mean that someone will qualify. Similarly, a person does not need to have a specific diagnosis to be considered.

The decision is based on the totality of the person’s needs and how those needs interact. For example, someone may have several moderate needs that together create a level of complexity requiring ongoing healthcare support.

How does the assessment work?

The NHS Continuing Healthcare process normally starts with an initial Checklist assessment. This is usually completed by a trained health or social care professional, such as a nurse, doctor or social worker.

The Checklist helps identify whether the person should receive a full assessment. It is not the final decision on eligibility.

If the Checklist indicates that a full assessment is needed, a multidisciplinary team will consider the person’s care needs in more detail. The team may include health and social care professionals who understand the person’s condition and circumstances.

The full assessment uses a Decision Support Tool. This considers different areas of need and helps the team decide whether the person has a primary health need.

The relevant Integrated Care Board, or ICB, is responsible for making the eligibility decision. If it appears that someone may need NHS Continuing Healthcare, the ICB should arrange an assessment.

What information should families prepare?

Families can make the assessment more accurate by gathering clear, up-to-date information about the person’s needs.

Useful evidence may include:

• Current care plans.

• Medical letters and hospital discharge information.

• Medication records.

• Notes about falls, seizures or other incidents.

• Records of changes in health or behaviour.

• Details of support provided by family members.

• Information from district nurses, GPs, therapists or social workers.

• Examples of what happens when care is delayed or unavailable.

Try to describe what the person needs on their more difficult days, not only when they are relatively well. It is also important to explain how often support is needed, how long it takes and whether the person requires skilled intervention or close monitoring.

A diagnosis alone does not show the full extent of someone’s needs. Practical examples can help the assessment team understand the level of care involved.

NHS Continuing Healthcare Fast Track

The Fast Track pathway is intended for people whose condition is rapidly deteriorating and may be entering a terminal phase.

An appropriate clinician, such as a doctor or registered nurse involved in the person’s care, completes the Fast Track Pathway Tool. This allows the NHS to consider urgent funding without going through the standard Checklist and full assessment process.www

The purpose of Fast Track is to help arrange an appropriate care package quickly, particularly when someone wishes to be cared for at home or in a chosen care setting. NHS guidance states that urgent packages are usually arranged within 48 hours, although practical arrangements can depend on the individual circumstances and local processes.www

Families should speak to the person’s GP, consultant, district nurse or another professional involved in their care if they believe the Fast Track pathway may be appropriate.

What happens if someone is not eligible?

Not qualifying for NHS Continuing Healthcare does not mean that a person has no care needs or will receive no support.

Depending on their circumstances, they may be able to receive:

• A local authority care needs assessment.

• Means-tested support towards social care costs.

• NHS-funded nursing care.

• Community nursing or other NHS services.

• Support from voluntary organisations or local services.

• Privately arranged home care.

NHS-funded nursing care is different from NHS Continuing Healthcare. It may be available when a person lives in a nursing home, has been assessed as needing care from a registered nurse and does not qualify for full NHS Continuing Healthcare. The NHS pays a contribution towards the nursing element of the care, while other care-home fees may still need to be funded separately.

Ask the NHS or local authority to explain which forms of support may apply to your situation. Funding arrangements can differ depending on the person’s assessed needs and where they receive care.

Can an NHS Continuing Healthcare decision be challenged?

If you disagree with the outcome, you should ask the relevant ICB to explain its decision and the reasons behind it.

You may be able to request a local appeal or review. The process and timescales should be explained in the decision letter. If the person’s needs have changed significantly, you can also ask for their situation to be reassessed.

Before requesting a review, it can help to:

• Read the assessment and decision carefully.

• Identify information that is missing or inaccurate.

• Note changes in the person’s needs.

• Gather supporting evidence from healthcare professionals.

• Explain how needs affect one another.

• Ask for help from an advocate, social worker or experienced adviser.

Keep copies of all correspondence and record the dates of conversations. If you are unsure about the process, contact the relevant ICB or seek independent advice.

Questions to ask about NHS Continuing Healthcare

Families may find it useful to ask:

1. Has the person completed an NHS Continuing Healthcare Checklist?

2. Who is responsible for arranging the assessment?

3. What evidence should we provide?

4. When will the full assessment take place?

5. Who will be involved in the multidisciplinary team?

6. How will the person’s needs be recorded?

7. What happens if the person’s condition changes?

8. Could the Fast Track pathway be appropriate?

9. If NHS CHC is not awarded, could NHS-funded nursing care apply?

10. What are our rights if we disagree with the decision?

11. Who will arrange the care package if funding is approved?

12. How often will the package be reviewed?

Do not be afraid to ask professionals to explain unfamiliar terms. You should understand what has been decided, how the decision was reached and what will happen next.

Finding care in West Sussex

Families in West Sussex may need to consider whether support should be provided at home, in a nursing home or in another care setting. The right option depends on the person’s assessed needs, preferences, safety and available funding.

If you are researching care in Bognor Regis, Littlehampton, Chichester, Rustington or nearby areas, speak to providers early so you understand what types of support they may be able to discuss. A care provider can explain its services and availability, but it cannot decide whether someone qualifies for NHS Continuing Healthcare.

At Ashton Care, we understand that funding and care decisions can feel complicated. Our team can discuss care options and help families understand the practical questions to consider when planning support. We recommend confirming eligibility and funding directly with the NHS or the relevant Integrated Care Board.

If you are arranging care for yourself or someone close to you, contact Ashton Care to discuss your circumstances and explore the next steps.

Important: NHS Continuing Healthcare rules and local processes can change. Always check the latest information with the NHS.