Care and support guide

NHS continuing care

NHS continuing care, also known as NHS continuing healthcare or "fully funded NHS care", is free care outside of hospital that is arranged and funded by the NHS. This means that you will be looked after at no cost to you.

It is only available for people who need ongoing healthcare and meet strict eligibility criteria.

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Where can NHS continuing care be provided?

NHS continuing care can be provided anywhere, be it your own home, a care home, or a hospice. If you get NHS continuing care and you’re being cared for in a care home, it will cover the fees, including the cost of accommodation (not including your own home), personal care and healthcare costs.

Eligibility for NHS continuing care

To be eligible for NHS continuing care, you must be assessed as having a "primary health need" and have a complex medical condition and substantial and ongoing care needs. Not everyone with a disability or long-term condition will be eligible.

You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers can also be consulted where appropriate, although family members should indicate that they are willing to be involved.

A decision about eligibility should usually be made within 28 days of an assessment for NHS continuing care being carried out.

If you don’t qualify for NHS continuing care, your local authority will be responsible for assessing your care needs and providing services.

NHS continuing care assessments

Clinical commissioning groups, known as CCGs, (the NHS organisations that manage local health services) must assess you for NHS continuing care if it seems that you may need it. For example, the assessment should be carried out:

  • if your physical or mental health worsens significantly
  • before you are awarded NHS-funded nursing care
  • when you are discharged from hospital; this should happen before a local authority assessment

You can also ask for an assessment by talking to a health or social care professional working with the local authority or the NHS continuing care coordinator at the CCG. You can find out the name of your local co-ordinator by asking your GP, contacting your local Patient Advice and Liaison Service (PALS), or by contacting your CCG directly.

For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently for example, if you’re terminally ill your assessment should be "fast tracked".

Initial assessment for NHS continuing care

The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed, and be asked for your consent.

Depending on the outcome of the checklist, you will either be told that you’re not eligible for NHS continuing care, or be referred for a full assessment. Being referred for a full assessment doesn’t necessarily mean that someone will be found eligible for NHS continuing care.

Whatever is decided, the professional completing the checklist should record written reasons for their decision, and sign and date the checklist. You should be given a copy of the completed checklist. You can download a blank copy of the NHS continuing care checklist from GOV.UK (PDF, 168kb).

Full assessment for NHS continuing care

Full assessments for NHS continuing care are done by a team made up of several different health and care professionals who are already involved in your care. You should be told who is co-ordinating the NHS continuing care assessment.

The team’s assessment looks at issues such as:

  • behaviour
  • cognition (understanding)
  • communication
  • psychological/emotional needs
  • mobility
  • nutrition (food and drink)
  • continence
  • skin (including wounds and ulcers)
  • breathing
  • symptom control through drug therapies and medication
  • altered states of consciousness

They have to consider:

  • what help is needed
  • how complex these needs are
  • how intense and unpredictable these needs can be
  • any risks that would exist if adequate care was not provided

These issues are then given a level of urgency marked "priority", "severe", "high", "moderate" or "low".

If you have at least one priority need, or severe needs in at least two areas, you should be able to get NHS continuing care. You can also qualify if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs.

In these cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing care should be provided.

The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.

You can download a blank copy of the NHS continuing care decision document from GOV.UK.

Fast-track assessment for NHS continuing care

If someone’s condition is deteriorating quickly and they are nearing the end of your life, they should be assessed under the NHS continuing care fast track pathway, so that an appropriate care package can be put in place as soon as possible – usually within 48 hours.

Care planning

If you are found to be eligible for NHS continuing care, the next stage is to arrange a care package which meets your assessed needs.

Depending on your situation, different options could be suitable, including support in your own home. If it’s decided that you need care in a care home, there could be more than one local care home that meets your assessed needs.

Your CCG should use your views as a starting point when agreeing your care package and the setting where it will be provided. However, they can also take other factors, such as the cost and value for money of different options, into account.

NHS continuing care reviews

If you are awarded NHS continuing care, your case will be reviewed after three months. Your care needs will be reassessed and your eligibility will be looked at again. This review also looks at whether your existing care package meets your assessed needs.

Afterwards, reviews will be carried out at least once a year.
If the outcome of a review means that your care package needs to change, you should be told in writing. If you don’t agree with it, you will need to use the NHS complaints procedure.

Refunds for delays in NHS continuing care funding

CCGs should make a decision about eligibility for NHS continuing care within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.

If the CCG decides that you are eligible, but takes longer than 28 days to decide this, and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.

If your CCG decided that you weren’t eligible for NHS continuing care, but then revised this decision after a dispute, it should refund your care costs for the period between their original decision and their revised decision.

If you aren’t eligible for NHS continuing care

If you aren’t eligible for NHS continuing care, but you’re in a nursing home (a care home that is registered to provide nursing care) you may be eligible for NHS-funded nursing care. This means that the NHS will pay a contribution towards your nursing home fees.

NHS-funded nursing care is only used to pay for the costs of nursing care. People who get it will still need to pay for costs of accommodation, board and personal care (although you can have a care needs assessment to see if you can get help with these fees from your local authority).

The assessment for NHS-funded nursing care should be done automatically when you move into a nursing home. Eligibility depends on whether you’re assessed as having needs that require a nursing care environment.

Frequently asked questions about NHS continuing care

I have a local authority care package that works well. I have now been awarded NHS continuing care  will my care package change?

If someone is eligible for NHS continuing care, they may have medical needs that can’t be met by their existing care package. There are also some aspects of local authority care packages that aren’t currently available through all CCGs, such as direct payments to enable people to organise their own support.

If you are concerned about changes to your care package because of a move to NHS continuing care, your CCG should talk to you about ways that it can give you as much choice and control as possible. This could include the use of a personal health budget.

Find out about choice in the NHS and personal health budgets.

If you’re still not satisfied, you may want to complain.

Can someone refuse an assessment for NHS continuing care? If they do refuse, will they be able to get services from their local authority instead?

An assessment for NHS continuing care can’t be carried out without someone’s consent, so it is possible to refuse. However, if they do refuse, there is no guarantee that they will be able to get community care services from their local authority instead.

In this situation, the local authority doesn’t necessarily have any additional responsibility to meet the person’s needs, and they can decide not to provide services. This could happen if someone has medical needs, as local authorities are not legally allowed to provide medical care.

If your local authority says you can no longer receive services, you should be given reasonable notice and clear reasons for the decision. You can ask the local authority to review its decision or complain.

If you refuse to be assessed for NHS continuing care for example, because you’re worried about your care package changing the CCG should explore your reasons for refusing, and try to resolve the situation. If there’s a concern about someone’s ability to make decisions because of their mental capacity, the Mental Capacity Act will apply.

The person I look after is in a care home and has been awarded NHS continuing care. The CCG says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different one. I think a move will have a negative effect on the person I look after. What can we do?

If you can show that someone’s needs mean that a move could involve significant risk to their health and wellbeing, the CCG should consider funding their existing care home place.

If the CCG decides to arrange an alternative placement, you should get a reasonable choice of providers. The CCG should put a transition care plan in place, and keep in touch with you and the care home to make sure the move has worked well.

Is it possible to pay top-up fees for NHS continuing care?

No, it’s not possible to top up NHS continuing care care packages, like you can with local authority care packages.

The only way that NHS continuing care packages can be topped up privately is if you pay for additional private services on top of the services you get from the NHS. These private services should be provided by different staff and preferably in a different setting.

Page last reviewed: 15/01/2015

Next review due: 15/01/2017

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