NHS Continuing Healthcare

NHS Continuing Healthcare is a package of ongoing care that is arranged and funded solely by the NHS. It is designed to support individuals aged 18 or over who are found to have a primary health need which have arisen as a result of disability, accident or illness.

The National Framework for NHS Continuing Healthcare and NHS funded nursing care sets out the principles and processes for determining eligibility. The framework ensures that those assessing and delivering NHS Continuing Healthcare do so in the same way.

If you are not eligible for NHS Continuing Healthcare and are resident in a care home with nursing, you may be eligible for something called NHS-funded Nursing Care (FNC). This type of funding is available for people who have registered nursing needs and are receiving their care in a care home with nursing. Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for FNC.

If you are eligible for FNC, it will be paid to the care home directly to fund your care. This means care provided, supervised, or planned by registered nurses that are employed by the care home. Please talk to the manager of the home to discuss how FNC affects your fees. If your placement is funded by social services, the FNC payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

If you become eligible for NHS Continuing Healthcare, the NHS will be responsible for funding your care and support.  Social services might still have some responsibility to provide services for you or your carers, such as carers assessments or support with parenting activities. 

Sometimes, people who are not eligible for NHS Continuing Healthcare have mixed or joint packages of care, where social services fund some of your care, and the NHS funds part of it, too.  Where local social services arrange or fund care, they will usually do a financial assessment to decide if you must make any financial contribution.

We recognise that NHS Continuing Healthcare (CHC) can appear to be a complex and highly sensitive process and often affects people at a very uncertain stage of their lives.

 Our team follows National Guidance to ensure that everyone has fair and consistent access to NHS Continuing Healthcare, regardless of where they live in Norfolk or Suffolk. 

The CHC team will ensure that the process of assessment of eligibility and decision-making is person-centred. This means ensuring you are at the heart of the assessment and care-planning process. It also means making sure that you have the opportunity to play a full role in the assessment process and receive the support to do this where needed. You could do this by asking a friend or relative to act as your representative and help explain your views. 

The NHS Norfolk and Suffolk ICB is responsible for identifying someone to co-ordinate the assessment process and this person will be your main point of contact and will be a professional from health or social care.

 The assessment will, with your permission, involve contributions from a range of professionals involved in your care to build an overall picture of your needs. This is known as an ‘assessment of needs’. Your own views should be given appropriate weight alongside professional views to help achieve an accurate picture of your needs.

 The ICB would like to assure you that there is no requirement to instruct a solicitor or claim firm as NHS Continuing Healthcare is not a legal process and we would like to assure you that the NHS CHC process is applied fairly and openly to all.

If you feel you may be eligible for either NHS Continuing Healthcare or NHS-funded nursing care and you are registered with a GP in Norfolk or Suffolk, you should speak to a health or social care professional involved in your care to ask them to consider carrying out an NHS Continuing Healthcare checklist.  This checklist, along with a consent form should be sent to the ICB’s CHC teams using the contact details on this page.

There will be situations where practitioners decide it is not necessary to complete an NHS CHC checklist, including where it is clear to the practitioner that there is no need for NHS CHC at this time, or your needs are short term or temporary in nature and you have not yet reached your optimum potential.  If you have previously had a full NHS CHC assessment and it was decided that you are not eligible for NHS CHC, it would not be necessary for practitioners to complete another NHS CHC checklist if your needs have not changed since that assessment. 

You can’t complete an NHS CHC checklist yourself, and your family or friends can’t complete one for you.  If you have no other health or care professionals involved in your care and you need help in obtaining an NHS CHC checklist, you should contact the ICB’s CHC teams via the contact details listed on this page.

The assessment process for NHS Continuing Healthcare is person-centred; this means you, your views about your needs and the care and support you require are at the centre of the process.

For most individuals, stage 1 is a screening tool called an NHS Continuing Healthcare checklist. This is the screening tool used by health and social care staff to identify those people who may be eligible to undertake a full assessment for NHS Continuing Healthcare. The Checklist does not indicate whether the individual is eligible for NHS Continuing Healthcare, only whether they require full assessment of eligibility for NHS Continuing Healthcare.

The Checklist is a national tool and 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 have this opportunity. If your checklist indicates further assessment is required, this does not mean that you will be eligible to receive NHS Continuing healthcare.

If the Checklist has been completed and indicates that there is a need to carry out a full assessment of eligibility for NHS Continuing Healthcare the NHS Norfolk and Suffolk ICB’s CHC teams will arrange for a multidisciplinary team to carry out an assessment of your needs.

A multidisciplinary team is made up of two or more health or social care professionals who may already be involved in your care.

The multidisciplinary team will share the information they hold about you or your relative’s care needs and jointly complete a Decision Support Tool. The team will look at all your care needs and relate them to:

• what help you need
• how complex your needs are
• how intense your needs can be

How unpredictable they are; including any risks to your health if the right care isn’t provided at the right time.

Your eligibility for NHS Continuing Healthcare depends on your assessed needs, and not on any diagnosis or condition.

You and/or your representative will be invited to attend the meeting to complete the Decision Support Tool document.  Usually, this will be carried out via Microsoft Teams. You should be invited to share your views during this meeting.

The multidisciplinary team will decide on a level of need for each domain of care within the Decision Support Tool document, complete something called a Primary Health Needs Test and make a recommendation on eligibility for funding.  This recommendation is put forward to the Integrated Care Board and considered by an experienced, senior professional who ultimately decides whether or not you are eligible for funding.

If your needs change then your eligibility for NHS Continuing Healthcare may also change.

If you need an urgent package of care due to a rapidly deteriorating condition, which may be entering a terminal phase, then the fast-track tool may be used to confirm eligibility for NHS Continuing Healthcare funding. If this is the case, an appropriate clinician will complete the fast-track tool and send it directly to the ICB, who will arrange for care and support to be provided as quickly as possible.

The team will keep in touch with your or your relative, to ensure that your care package is meeting your needs. After the review of care needs, if appropriate, due to a stabilised condition, NHS Continuing Healthcare will arrange to begin the process of assessing whether you or your family member remains eligible for NHS Continuing Healthcare.

Depending on level of needs, we may review your care and support requirements and eligibility throughout the period that you meet the Fast Track criteria.

A personal health budget is an amount of money to support someone’s health and wellbeing needs, which is planned and agreed between the individual or their representative, and the local Integrated Care Board. It isn’t new money, but a different way of spending health funding to meet the needs of an individual.

Personal health budgets are a way of personalising care, based around what matters to people and their individual strengths and needs. They give people more choice, control and flexibility over the care and support they receive.

A personal health budget may be used for a range of things to meet agreed health and wellbeing outcomes. This can include things like personal care and equipment. There are some restrictions on how the budget can be spent.

People who are eligible for NHS Continuing Healthcare have a right to have a personal health budget.  Your NHS Continuing Healthcare coordinator should explain this to you and if you are eligible for NHS Continuing Healthcare, you will receive support from the NHS CHC team to understand how a personal health budget might work for you.

Learn more about personal health budgets.

This depends on the type of care and support you need and the availability of care in the area that you live in or wish to reside in.  Nationally, there is a shortage of care workers and this means that sometimes it can take time for the NHS CHC team to commission care. We might have to offer interim or temporary options for care if we aren’t able to commission the care that you require in an appropriate timeframe.

Due to the restricted availability of care, the option provided will be the best that we are able to offer, maximising the use of available resources. This might mean that we might not be able to offer a particular provider or care setting, due to the wider constraints due to the national workforce shortages. You always have the right to decline care and to source and fund an alternative yourself should you decide to do so.

If you are unhappy with the decision the ICB has made regarding your eligibility for NHS Continuing Healthcare, you have the right to formally appeal this decision. You must do this within 6 months of the receipt of your outcome letter, and you can contact us by phone, email or post to do this. Contact details can be found on this page.

You have the right to complain about your experience with the NHS CHC team. You can also seek free, independent advice from Beacon CHC.

If you are found eligible for NHS funding for your care, you should have an initial review after 3 months, and a yearly review thereafter. The primary purpose of this review is to ensure your health and care needs are being met.  Only where a material change in need has been identified that might impact on your eligibility for NHS CHC will a full re-assessment of your eligibility be carried out.

No. NHS Continuing Healthcare is not a legal process, and you are not required to have a solicitor or someone from a company who provides a paid service to represent you or your loved one through the NHS Continuing Healthcare process. 

Having a solicitor or claims company representing you does not mean you are more likely to be eligible for funding, nor does it mean any appeal is more likely to be successful. In addition, it does not mean your case will be dealt with in a timelier way. 

Your NHS Continuing Healthcare assessment process is the same, whether or not you have formal representation, such as a solicitor.