Most of us have to contribute financially to the care we need as we grow older or become infirm. However, some people with health needs due to disease or disability may be entitled to ongoing NHS care that is provided free, irrespective of means.
What is NHS continuing healthcare?
NHS continuing healthcare (CHC) is a fully-funded package of care, given over an extended period to support individuals with significant health needs. The care is arranged and totally funded by the NHS, however there is a careful assessment process to identify those people who are entitled to the service. There is a screening system to sift people who may be eligible and who require further assessment, this is known as the Continuing Healthcare Checklist.
Where can continuing healthcare be received?
Continuing healthcare can be provided in a residential facility or in your own home. The NHS pays for care home fees, or if you are at home, the service funds the necessary clinical support from health professionals and the personal and practical care to ensure you can live in safety and comfort.
Who can get NHS continuing healthcare?
Eligibility for continuing care isn’t based on having a specific condition, like cancer or dementia. It depends on having ongoing health needs and requiring care because of the nature of these needs. To evaluate this and identify people who may need a further full assessment for NHS Continuing Healthcare, health practitioners should complete the Continuing Healthcare Checklist. Age UK suggests:
‘Speak to your doctor or social worker if you think you might be eligible for NHS continuing healthcare. They can make a referral to the relevant CCG.’
Does passing the checklist mean I am entitled to continuing healthcare?
There are two potential results of the checklist; positive and negative. A negative result means that a person is ineligible and doesn’t need a further full assessment. However, it’s important to realise that getting a positive result and passing the checklist doesn’t mean that someone will definitely be able to get continuing care. It’s simply the first part of the process. The government said:
‘The threshold at this stage of the process has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility for NHS Continuing Healthcare have this opportunity.’
Following a positive checklist an individual will require a full assessment, so that eligibility for continuing healthcare can be definitively decided.
How is someone considered for continuing healthcare?
If you, or a loved one, have significant health needs, an NHS professional or your social worker may consider if you are eligible for NHS continuing healthcare. This may happen if your health is deteriorating, if you have a serious or life-limiting condition, in preparation for hospital discharge, after a period of rehabilitation, or when health and social care needs are being reviewed in a community or nursing care assessment.
You should be a central part of the process with your views and wishes considered throughout. That can be difficult when you are facing challenges with your health and wellbeing, so you can ask a friend or relative to support you. Anyone with capacity should be asked for their informed consent before completion of the checklist. For people who are too unwell or lacking capacity, those with Lasting Power of Attorney can provide consent.
Professionals have to be trained to correctly complete the checklist, which is a detailed questionnaire about your health and function. A practitioner like a nurse or a social worker will fill in the assessment form.
The form has been designed to identify your specific health and care needs. When completed, it provides information about your health, wellbeing and abilities. There are questions on breathing, continence, nutrition, skin health and mobility as well as information about your level of understanding, communication, behaviour and your emotional health. Medical details including therapies, medication and level of consciousness are also included.
How long does the Checklist take?
Checklist completion is quick and straightforward. The health and function criteria are scored A, B or C, with a score of A indicating that a greater level of support is needed. For example, when it comes to continence, an A score suggests that:
‘Continence care is problematic and requires timely and skilled intervention, beyond routine care. (for example frequent bladder irrigation, manual evacuations, frequent re-catheterisation).’
A score of C shows that the individual is continent of urine and faeces, or that day-to-day continence care is simple and routine.
Anyone with two or more A scores, or a total of five scores across A and B will be referred for a full assessment. This is a more detailed and lengthy process. Evidence is collected from many health and social care professionals to explore every aspect of physical, mental, emotional and social care needs.
For people with rapidly deteriorating health and those who are approaching the end of life, a quicker Fast-Track assessment can be completed instead.
Who decides eligibility for Continuing Care?
Unlike the initial checklist, which is completed by an individual, the final assessment is examined by an experienced team of health and social care professionals. At a meeting (which you or a representative are free to attend) the panel look at the evidence, make recommendations as to whether you’re eligible for care and pass on their opinions to the local Clinical Commissioning Group (CGC).
What happens with NHS continuing care?
If you’re eligible for NHS continuing healthcare, your local CCG will talk to you about the support you need and where you would prefer to receive your care. You can be cared for in your own home or in a care home.
A tailored package of care will be agreed. If you prefer, you can request a Personal Health Budget. This enables you to have more control and choice over sourcing the home care services that you prefer, but the funds can’t be used for nursing home fees.
For most people, care needs evolve and change. There will usually be a follow-up assessment after three months, then a year to check that the funding arrangements remain adequate and appropriate.
If you are assessed as not being eligible for NHS continuing healthcare, you can appeal the decision and ask for your case to be reconsidered. Alternatively, speak to your social worker and arrange a care assessment. You may be eligible for other financial assistance to help you access the care you need to continue to live in comfort and dignity.