A relative who needs ongoing medical support may be able to get their care costs covered if they’re eligible for NHS Continuing Healthcare (CHC), although it can be a struggle to secure this funding.
This little-known support covers costs for people who need the highest level of care at home, in a hospital, nursing home or hospice. Unlike care costs that are covered by the local authority, NHS Continuing Healthcare isn’t means-tested, so may be available to someone with complex healthcare needs who is paying for their own care from savings, or by selling their home.
To receive NHS Continuing Healthcare, you must have ‘a complex medical condition with substantial, ongoing care needs’, and there’s a rigorous assessment process to apply for funding. In reality, many applications aren’t successful, but it may be worth persevering. In 2021/22, around 104,000 in England received NHS Continuing Healthcare funding, down from 160,000 in 2015.
Here, we explain how NHS Continuing Healthcare works, and how to give yourself the greatest chance of success if you’re applying for this funding.
Contents
- What is NHS Continuing Healthcare?
- Who is eligible for NHS Continuing Healthcare (CHC)?
- What happens during the assessment process?
- Tips for success: How can you increase your chances of getting NHS Continuing Healthcare?
- What happens if your parent or relative qualifies for NHS Continuing Healthcare?
- When will you find out if your parent or relative is entitled to receive NHS Continuing Healthcare?
- What can you do if your application is unsuccessful?
- How can you apply for NHS Continuing Healthcare?
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a funding programme that pays for someone’s care, including care home fees, or carers if they’re living in your own home. If an adult becomes seriously ill, for example, and they’re admitted to hospital, you may choose to apply for this funding on their behalf to cover nursing home fees or care costs once they’re discharged.
It’s designed to cover additional costs that someone might need, such as help with dressing or washing, or specialist therapy. If someone is in a nursing home, it might also include the cost of accommodation, or the cost of home carers if they’re living at home. Read more about NHS Continuing Healthcare on the NHS website.
If an application is successful, NHS Continuing Healthcare can potentially save families tens of thousands of pounds in ongoing care costs, as the average cost of a residential care home place is £3,293 a month, or £960 a month for a nursing home, according to latest figures from carehome.co.uk. If you’re worried about meeting the cost of care, read more in our article How to pay for long-term care.
NHS Continuing Healthcare is a funding programme specifically for adults, while children and young adults may receive what’s known as a ‘continuing care package’ instead.
Who is eligible for NHS Continuing Healthcare (CHC)?
There isn’t one particular condition that means someone will be eligible for this funding. However, a person is more likely to qualify for NHS Continuing Healthcare if they have mostly healthcare needs rather than social care needs.
A person who receives this funding must have a ‘primary health need’, which is based on if ‘the main aspects or majority part of the care they require is focused on addressing and/or preventing health needs’, according to NHS rules.
This means, for example, that they’re more likely to qualify for support if they need specific medical rather than general care, and that their health may be at risk if this care isn’t given at the right time. Whether or not someone is eligible for this funding also depends on how intense their medical care needs are, with those who have complex, and ongoing health and social care needs taking priority.
Whether someone qualifies for this funding ultimately depends on the outcome of an assessment, which will be carried out by a so-called ‘multidisciplinary team’ (MDT) made up of at least two professionals from different healthcare professions (typically both health and social care professionals who are already involved in the care of the person being assessed). You can find out more about this below.
What happens during the assessment process?
Initial screening
To determine whether a parent or relative might be eligible for NHS Continuing Healthcare, there will be two assessments by a multidisciplinary team. The first is an initial screening of needs which is carried out by a nurse, doctor or social worker (other another healthcare professional) at home or in hospital. They’ll consider everything from their mobility and continence to communication, understanding of what’s going on, and other major needs. If their health is rapidly worsening, you can request a full assessment immediately rather than go through the initial screening process.
The assessment
If the initial screening determines that your parent or relative might be entitled to NHS Continuing Healthcare, they’ll be put forward for a full assessment. This is based on paragraph 60 of the National Framework (see below) to determine if the local authority is able to provide the services to care for someone’s needs, and if they are low, moderate, or severe.
The Integrated Care Board will arrange for a multidisciplinary team to do the assessment, which must include at least one NHS doctor and one local authority social worker.
They will use a Decision Support Tool to look more closely at all care needs related to: what help the person needs, the complexity of needs, and intensity of needs. This will look in more detail at their mobility, behaviour, ability to communicate and cognitive awareness. However, assessments by their nature are subjective, so it’s difficult to know if someone will qualify for funding.
Tips for success: How can you increase your chances of getting NHS Continuing Healthcare?
Before applying for NHS Continuing Healthcare, it’s important to understand the rules, and get to grips with what will happen at each stage of the assessment process. The NHS National Framework sets out the rules that must be followed, although it’s made up of 187 pages, which indicates how complex and difficult the process can be to secure funding. However, the professionals involved in someone’s assessment should be well-versed in the rules stated in this document, and if they aren’t following these, you have a greater chance of challenging their assessment.
You can also get help at the Beacon CHC, a charity that can guide people applying for NHS Continuing Healthcare so they are able to understand the intricacies of the process. Alternatively, if you are financially able to do so, you may choose to consult specialist lawyers.
Make sure the right people attend the assessment, so at least one NHS clinician and one local authority social worker. If one of these people isn’t present, you can complain/appeal that the assessment isn’t being done by the rules.
Bear in mind that if someone is being cared for in a nursing home, they are generally considered to be eligible for NHS funding, as the local authority cannot legally provide the necessary registered nursing care in this scenario. However, this doesn’t mean everyone who is eligible receives this funding.
What happens if your parent or relative qualifies for NHS Continuing Healthcare?
If your application and the assessment is successful, a care and support package should be arranged to meet the person’s needs. This is usually done by your local NHS authority, which is a Clinical Commissioning Group or Local Health Board, who may work with your local council. Various options may be considered and offered, such as care in a nursing home, yor own home or a ‘personal health budget’. This essentially enables you to plan and pay for the necessary health and social care. Once received, this will be reviewed periodically by the NHS. You can find out more about personal health budgets on the NHS website.
When will you find out if your parent or relative is entitled to receive NHS Continuing Healthcare?
If you’ve applied for CHC on behalf of a parent or relative, you should be kept informed, and your opinion about their needs and support should be taken into account. Likewise, if you’ve applied for funding for yourself, your views and support needs should be carefully considered. You should receive a decision about eligibility for a full assessment within 28 days of the initial assessment, or you can request a full assessment.
What can you do if your application is unsuccessful?
In the year April 2022 to the end of March 2023, a total of 48,591 NHS Continuing Healthcare assessments were done in England, but a huge 37,770, or 78%, were unsuccessful.
If you’re not eligible for NHS Continuing Healthcare, you may be referred to your local council to discuss what financial support they may be able to offer in your situation. Alternatively, it may be that the NHS agrees to pay some support for your health needs, such as for palliative care, NHS Nursing Care, or rehabilitation and recovery.
If you wish to appeal the decision about NHS Continuing Healthcare funding, you can do so through an integrated care board, or NHS England. You should request a review of the decision within six months of a failed assessment (if the person only received an initial screening, ask for a full assessment). Bear in mind that someone’s needs can change over time, and they might qualify for this funding in the future, to make sure their situation is regularly reviewed.
If you’ve been paying for care home fees and believe these should have been covered by the NHS, you could appeal by asking for a retrospective assessment. You should speak to your health practitioner or social worker to get more information on this, and their input. If you get nowhere, you may ask for an NHS England independent review panel, or ultimately to the Health Service Ombudsman.
How can you apply for NHS Continuing Healthcare?
You can find out more about whether a parent or relative may be eligible for NHS Continuing Healthcare funding and how to apply for it on the NHS website. You’ll find similar schemes in Wales and Northern Ireland. However, Scotland has a scheme called hospital-based complex clinical care (HBCCC).
If someone isn’t eligible for NHS Continuing Healthcare funding, and they live in England or Northern Ireland, they might be able to get the local council to pay towards the cost of their care, but they will need to be means tested to make sure they are eligible. Read more in our article How to pay for long term care.
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