What is NHS continuing healthcare?
NHS continuing healthcare is the name given to a package of services which is arranged and funded by the NHS for people outside hospital with ongoing health needs. You can get continuing healthcare in any setting, including your own home or in a care home.
NHS continuing healthcare is free, unlike help from social services for which a charge may be made depending on your income and savings. If you do not qualify for NHS continuing health care you will still receive mainstream services free of charge, i.e. GP, district nursing services, specialist therapy. In your own home, the NHS will pay for healthcare (e.g. services from a community nurse or specialist therapist) and personal care. In a care home, the NHS pays for your care home fees, including board and accommodation.
If you’ve had experience of using the continuing healthcare service in Bradford and Airedale, we’d like to hear your feedback.
What is the National Framework for NHS continuing healthcare?
The Department of Health launched the national framework NHS continuing healthcare and NHS funded nursing care in November 2012 (revised version).
It sets out principles on who should qualify for different levels of NHS funding in England and what they get.
In the past, each strategic health authority had its own rules for deciding who was eligible for NHS funding and how these rules were applied in practice. The aim is to make the whole system simpler, and the National Framework will help make access to NHS funding fairer and more consistent. The National Framework proposes a single set of principles on who is eligible for the different types of NHS funding in England, and it also sets out a standard process for assessment.
Who is eligible for NHS continuing healthcare?
Eligibility for NHS continuing healthcare funding is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided. If the overall care needs show that a person’s primary need is a health one, they should qualify for continuing healthcare. It should be noted that entitlement to continuing healthcare funding could have an impact on a person’s welfare benefits.
What if I am not eligible for NHS continuing healthcare?
If a person does not qualify for NHS continuing healthcare then they may have to pay for some or all of their care although the NHS will still provide for their medical needs. They may have to take a local authority means test to decide how much they should pay towards their personal care and accommodation if they are in a care home. However, if the person is a resident of a residential home and require care from a registered nurse, this will be provided free of charge through mainstream district nursing services.
What is NHS-funded nursing care?
By law, local authorities cannot provide clinical services because the NHS is responsible for any care that must be provided by a registered nurse. For people in care homes, registered nurses are usually employed by the care home itself and, in order to fund this nursing care, the NHS makes a payment to the care home to cover the cost of providing the care for those who are eligible.
Who is eligible for NHS-funded nursing care?
A person should receive NHS-funded nursing care if:
- they have been assessed as requiring the services of a registered nurse for physical or mental health needs
- they do not qualify for NHS continuing healthcare (i.e. nursing and accommodation costs) but have been assessed as requiring the services of a registered nurse
- they are not receiving registered nursing care in any other way (e.g. directly from the PCT).
What happens if I go into hospital from a care home?
You will be assessed by the hospital nursing team who will deal with your discharge plans.
Can I refuse to be assessed?
Yes, however, you may find your benefits and care package are affected according to your individual circumstances. Your social worker will be able to advise you in more detail.
Where can I get benefit advice?
From the benefits enquiry line on 0800 882200.
Who pays if I do not get continuing healthcare funding?
You might be eligible for NHS funded nursing care payments. These pay the cost of your registered nursing care input whilst you are living within a nursing home setting.
If you are living at home or within a residential care setting, your social worker will advise you on ways of paying following a financial assessment.
For general help and advice, please contact our patient advice and liaison service (PALS) on 0800 0525 270.
The national framework for NHS continuing healthcare and NHS funded nursing care (revised November 2012)
NHS continuing healthcare checklist (revised November 2012)
Decision support tool for NHS continuing healthcare (revised November 2012)
Fast track pathway tool for NHS continuing healthcare (revised November 2012)