NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS. Some people have continuing healthcare arranged for them in a nursing home. Other people have care in their own home or elsewhere in the community and some people receive a Personal Health Budget (PHB).
Anyone who is eligible for continuing healthcare is also eligible to access regular NHS services, such as care from their GP or local hospital. The NHS would not fund regular NHS services in a package of continuing healthcare because they are already available, unless there were exceptional circumstances.
Funded nursing care is the name given to a weekly payment made by the NHS in specific circumstances. The payments can only be made to a care home with nursing, to pay for care from a registered nurse. The weekly payment is set by the Government. It is currently £156.25 Per Week .
How Can I apply for Continuing Healthcare or Funded Nursing Care?
An initial checklist assessment should be done if you or the person you look after ask for one. You can find a copy of the Checklist Tool here. You can ask for one by talking to a health or social care professional working with the person you care for, or by contacting the NHS continuing healthcare coordinator at the Clinical Commissioning Group (CCG).
Following checklist assessment, an individual may then be referred for a full assessment for NHS continuing healthcare and a Decision Support Tool (DST) will be completed. The DST asks multidisciplinary teams (MDTs) to set out the individual’s needs in relation to 12 care domains. Each domain is broken down into a number of levels, each of which is carefully described. For each domain, MDTs are asked to identify which level description most closely matches the individual’s needs and then a recommendation is then made by the MDT to the Clinical Commission Group (CCG). The patient, carer and/or family will be fully involved in this process. A copy of the DST tool can be found here.
Who makes the decision?
The CCG will review the MDT’s recommendation and decide if the evidence provided allows a sound decision to be made. The CCG may however ask for further information to be provided on occasions.
Is a full assessment needed if someone is close to the end of their life?
There is a fast track assessment process, for people who are close to the end of their life and are rapidly deteriorating. It may only be completed by a doctor, nurse or other clinician, who has detailed knowledge of the person’s needs and experience in dealing with their condition. Click here for a copy of the Fast Track Tool.
What if I don’t agree with the outcome of the DST or the CCG’s decision?
If you wish to lodge an appeal against the outcome of the comprehensive assessment using the Decision Support Tool you can do so on the following grounds.
- You disagree with the outcome of the DST
- You do not consider the process used was in accordance with the Department of Health National Framework
- You disagree with the evidence used in the assessment
- You disagree with the MDTs recommendation to the CCG
- You disagree with the CCGs decision
An information leaflet regarding North Tyneside CCG’s NHS Continuing Healthcare Local Appeals Process can be found here.
CHC Eligibility Criteria
- National Framework here
Please see related documents below: