What is Continuing Healthcare?
“NHS continuing healthcare (NHS CHC) is a package of care arranged and funded solely by the health service in England for a person aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident or illness.”
NHS funded care can be delivered in any setting. If you receive care in your own home, the NHS funds an appropriate care package to meet your assessed health and personal care needs. If you live in a care home, the NHS contracts with the home and pays for accommodation & board and to meet your assessed health and personal care needs.
Who is eligible for NHS Continuing Healthcare?
The diagnosis of a particular disease or condition does not determine eligibility. People with the same diagnosis or health condition can have very different needs. However an understanding of the underlying condition(s) can inform the process.
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’.
The term ‘primary health need’ comes from an important Court of Appeal case (R v Coughlan ex parte North and East Devon Health Authority, ‘the Coughlan case’) about the legal responsibility for care in a nursing home. The court decided that there were legal limits on what sort of nursing care assistance a local authority could provide. It is limited to nursing care which is:
- merely incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide (the quantity test), and
- of a nature that a social services authority can be expected to provide (the quality test)
This means that certain characteristics of your needs, in combination or alone, may demonstrate a ‘primary health need’ because they help decide whether the quantity and/or quality of care needed to manage them is beyond the limits of a local authority’s responsibility.
Some people may need the supervision of nurses for their care, but their main needs are support for daily living, i.e. washing, dressing, feeding etc. This kind of care and support is classed as social care or personal care, not healthcare, even if the need for the care arose because of an illness such as dementia or a stroke.
So when assessing your needs, the NHS Continuing Healthcare Framework guidance advises staff to consider them 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, 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.
All Eligibility decisions are reviewed at 3 months and 12 months.
If you are approaching the end of your life you may be eligible to have a Fast Track Pathway Tool completed to enable you to receive prompt NHS funding for your end of life care, by-passing the full assessment process already described.
The criterion for the Fast Track Pathway Tool has two elements only:
- a rapidly deteriorating condition
- that may be entering a terminal phase
Such changes in your condition could be observed while you are in hospital or by staff caring for you at home or in a care home. If this happens, they should contact an ‘appropriate clinician’ and ask them to consider completion of the Fast Track tool.
An ‘appropriate clinician’ would be a doctor or nurse responsible for your diagnosis, treatment or care or with a specialist role in end-of-life needs, who would have an appropriate level of knowledge or experience to review your current type of needs.
Further information in relation to NHS Continuing Healthcare including the Framework and all relevant documents can be found here.
The Department of Health and Social Care has produced a helpful public information leaflet.
Contact for any enquiries you may have in relation to you or a member of your family being considered for NHS Continuing Healthcare should be directed to:
Continuing Healthcare Manager – City and Hackney CCG
Clifton House, 75 – 77 Worship Street, London, EC2A 2DU
Tel: 0203 688 1909
NHS City and Hackney Clinical Commissioning Group | 3rd Floor A Block, St Leonard’s | Nuttall Street | London | N1 5LZ |