Are you eligible for NHS continuing healthcare funding?

Money Advice Service

In England, Wales and Northern Ireland, if you have a disability or complex medical problem, you might qualify for free NHS continuing healthcare (CHC). Not many people know about it, so it’s important to find out if you’re eligible and get an assessment. In Scotland there are different care arrangements called Hospital Based Complex Clinical Care.

What is NHS continuing healthcare or NHS continuing care?

Where a person’s primary need is a ‘health need’, the NHS is regarded as responsible for providing for and fully funding all their needs in any setting, this could be in:

  • a hospice,
  • a care home, or
  • your own home.

In England, the NHS can arrange care for you or you can choose to receive funding for your care as a direct payment, known as a personal health budget.

A personal health budget gives you more choice and control over how you plan and pay for your healthcare and wellbeing needs.

Personal health budgets are not currently available in Wales, Scotland or Northern Ireland.

Who is eligible?

Top tip

The only sure way to know if you’re eligible is to ask your GP or social worker to arrange an assessment.

There’s no clear-cut list of health conditions or illnesses that qualify for funding.

Most people with long-term care needs don’t qualify for NHS continuing healthcare or NHS continuing care because the assessment is quite strict. Being frail, for example, isn’t enough.

But don’t let that put you off.

Free healthcare could be worth thousands of pounds each year, so it’s important to find out where you stand.

What are eligible health needs?

As a guide, ‘eligible’ health needs might include:

  • mobility problems
  • terminal illnesses
  • rapidly deteriorating health
  • long-term medical conditions
  • physical or mental disabilities
  • behavioural or cognitive disorders
  • complex medical conditions that need additional care and support.

There are plenty of grey areas and you might have other conditions that mean you qualify.

What costs are covered?

NHS continuing healthcare or continuing care covers personal care and healthcare costs, such as paying for specialist therapy or help with bathing or dressing.

It might also include accommodation if your care is provided in a care home, or support for carers if you’re being looked after at home.

If you don’t qualify for NHS continuing care and you need care in a nursing home you might get NHS funded nursing care which is a non-means tested contribution towards your nursing costs.

Funding varies by region, so you’ll need to check with your local Clinical Commissioning Group, Health Board or Health and Social Care Trust to see what’s covered.

Find out more in our guide to NHS funded nursing care

How to apply for NHS continuing healthcare

To apply for NHS continuing healthcare, ask your GP or social worker to arrange an NHS continuing healthcare assessment.

What happens during the assessment process?

Step 1 – The initial screening

First of all, you’ll have an initial screening to see if you’re eligible for funding.

It’s usually carried out in hospital or at home by a nurse, doctor, social worker or other healthcare professional.

They’ll assess your general health and care needs with a simple checklist that will cover:

  • Mobility
  • Breathing
  • Continence
  • Communication
  • Nutrition (food and drink)
  • Skin (including wounds and ulcers)
  • Psychological and emotional needs
  • Altered states of consciousness
  • Symptom control through drug therapies and medication
  • Cognition (everyday understanding of what’s going on around you)
  • Other significant care needs

If your health, or the health of someone you care for, is getting worse rapidly, ask about a fast track assessment to bypass the initial screening.

Step 2 – The assessment

Don’t be put off

Even though the assessment process can be complex, most people and families who’ve been through it say the benefits are worth it.

If the initial screening shows that you might be able to get free NHS Continuing Care, you’ll need to have another assessment.

It will be carried by a team of two or more health- and social-care professionals who are involved in your care.

The team will use the same checklist above but will go into a lot more detail.

They will mark each of your care needs as low, moderate, high or severe.

Find out more about the assessment process in the Department of Health leaflet ‘NHS continuing healthcare and NHS-funded nursing care’ (PDF).

What to do if you don’t agree with the assessment

Top tip

Circumstances change, so even if you were turned down for funding at first, make sure you have your situation regularly reviewed particularly if your health deteriorates. Your GP or social worker can help you.

Ask your local Clinical Commissioning Group, Health Board or Health and Social Care Trust for a review of their decision.

You must ask for this in writing within six months of the notification that you were ineligible.

If their decision was only based on an initial screening, ask for a full assessment.

You should be given an opportunity to contribute to the review and to see all the evidence that was taken into account.

You might be able to appeal if you’ve already been paying for care home fees and think you should have received NHS funding.

To do this, speak to your social worker or health practitioner, and ask for a retrospective assessment.

If this doesn’t resolve the issue for you, again within 6 months you can request an independent review panel to consider your situation. As a last resort, you can ask for your complaint to be determined by the Parliamentary Health Service Ombudsman.

What if you don’t qualify?

Even if you don’t qualify for NHS Continuing Care, you might still be eligible for other NHS services to support you including:

  • palliative care;
  • respite health care;
  • rehabillitation and recovery, and
  • community health services specialist support for healthcare needs.

Alternatively, there might be local authority funding to meet some of your care needs.

Detained under Mental Health Act

Section 117 of the Mental Health Act 1983 provides that the NHS and Local Authority jointly provide aftercare services if you have been detained under some provisions of the Mental Health Act for assessment and treatment.

All services provided under this section should be free.

Hospital Based Complex Clinical Care in Scotland

NHS continuing healthcare in Scotland was replaced on June 1 2015 by a scheme called Hospital Based Complex Clinical Care.

This scheme is only available to people in hospital.

If you need long-term complex clinical care, your needs will be assessed based on one question asking whether your care needs can be properly met in a setting other than hospital.

If it is possible to provide care outside hospital, you’ll receive it in the place that’s best for you.

This could be your home, a care home or supported accommodation.

If you already getting NHS continuing healthcare under the old scheme, you’ll continue to receive it for as long as you’re eligible.

Find out more about Hospital Based Complex Clinical Care and how to get other care services in Scotland on the careinfoscotland website.

You can also read more about the changes and what to do if you don’t agree with a care assessment in the Age Scotland fact sheet Hospital Based Clinical Care and NHS Continuing care in Scotland.

Need more information?

For further free independent help regarding this you can call FirstStop Advice on: 0800 377 7070 (Monday to Friday, 9am – 5pm), or email them on [email protected].

This article is provided by the Money Advice Service.

Some important information about Rest Less Money

We want you to understand the positives, but also the limitations of using our site. We operate in a journalistic manner and therefore all information, guidance or suggestions provided are intended to be general in nature, and you should not rely on any of the information on the site in connection with the making of any financial decision.

When we set out to build Rest Less Money, we wanted to be a trusted place where you could find helpful information about financial matters affecting the over 50s. As a free to use resource, we try hard to provide the best information we can, but we cannot guarantee that we won’t occasionally make mistakes. So please note that you use the information on our site at your own risk, and we can’t accept liability if things go wrong.

Key things to remember when using Rest Less Money:

We do not offer financial advice – As a journalistic site, it’s important to know that we do not provide financial advice. You should always do your own research before choosing any financial product so that you can be certain it is right for you and your specific circumstances. If you are in any doubt, please seek professional financial advice from a regulated financial advisor.

No Liability – please note that you use the information on Rest Less Money at your own risk and we can’t accept liability for how you choose to use the information given on our site. We will often provide links to content or products and services available on other third-party websites. These are provided purely for your convenience and we cannot be held responsible for any content, or any of the products and services offered on any website that we link to.

 

Accuracy of Information – We try to make sure that all the information provided on Rest Less Money is correct at the time of publishing as we want it to be the most helpful resource possible. Sadly, we are not perfect however, and so we can make no guarantees as to the completeness, accuracy, adequacy or suitability of the information available on the site.
Whilst we work hard to try and provide accurate information, deals and prices can change, so whilst they may be correct at the time of writing, providers may subsequently decide to alter them later – so always double check first.

A final note on the Rest Less Community Forums – always remember that anyone can post their opinion on the Rest Less Community Forums, so it can be very different from our own opinion and may not be factual or well researched. Always be wary of any content posted on the forums and be sure to do your own research and due diligence on anything suggested. 

We hope you find Rest Less Money a useful resource and we would welcome your feedback at [email protected] on how to make it even better. For more information on any of the above you can read our full terms and conditions.

Some important information about Rest Less Money

We want you to understand the positives, but also the limitations of using our site. We operate in a journalistic manner and therefore all information, guidance or suggestions provided are intended to be general in nature, and you should not rely on any of the information on the site in connection with the making of any financial decision.

When we set out to build Rest Less Money, we wanted to be a trusted place where you could find helpful information about financial matters affecting the over 50s. As a free to use resource, we try hard to provide the best information we can, but we cannot guarantee that we won’t occasionally make mistakes. So please note that you use the information on our site at your own risk, and we can’t accept liability if things go wrong.

Key things to remember when using Rest Less Money:

We do not offer financial advice – As a journalistic site, it’s important to know that we do not provide financial advice. You should always do your own research before choosing any financial product so that you can be certain it is right for you and your specific circumstances. If you are in any doubt, please seek professional financial advice from a regulated financial advisor.

No Liability – please note that you use the information on Rest Less Money at your own risk and we can’t accept liability for how you choose to use the information given on our site. We will often provide links to content or products and services available on other third-party websites. These are provided purely for your convenience and we cannot be held responsible for any content, or any of the products and services offered on any website that we link to.

 

Accuracy of Information – We try to make sure that all the information provided on Rest Less Money is correct at the time of publishing as we want it to be the most helpful resource possible. Sadly, we are not perfect however, and so we can make no guarantees as to the completeness, accuracy, adequacy or suitability of the information available on the site.
Whilst we work hard to try and provide accurate information, deals and prices can change, so whilst they may be correct at the time of writing, providers may subsequently decide to alter them later – so always double check first.

A final note on the Rest Less Community Forums – always remember that anyone can post their opinion on the Rest Less Community Forums, so it can be very different from our own opinion and may not be factual or well researched. Always be wary of any content posted on the forums and be sure to do your own research and due diligence on anything suggested. 

We hope you find Rest Less Money a useful resource and we would welcome your feedback at [email protected] on how to make it even better. For more information on any of the above you can read our full terms and conditions.

Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp
Share on email

Join Rest Less Money Club

Helpful tips and guidance for making the most of your money – straight to your inbox

By providing us your email address you agree to receive emails and communications from us and acknowledge that your personal data will be used in accordance with our Privacy Policy and Terms and Conditions. You can unsubscribe at any time by following the link in our emails.

Join the Rest Less Money Club

Helpful tips and guidance for making the most of your money – straight to your inbox

Good luck with your application

Before you go, we’d love to stay in touch to find out how you get on. Sign up to Rest Less today to get free job alerts and inspiring content sent straight to your inbox.
By providing your email you agree to receive emails and communications from us and acknowledge that your personal data will be used in accordance with our Privacy Policy and Terms and Conditions. You can unsubscribe at any time through the link in our emails.