NHS Continuing Healthcare

Due to the COVID-19 emergency strategy implemented by NHS South West London Clinical Commissioning Group (CCG) and the Government's requirement to place a focus on front line NHS services, the NHS Continuing Healthcare service is running critical functions only.

We have paused the set up of all new Personal Health Budget's (PHBs) as well as pausing new and current eligibility appeals and retrospective reviews.

We are unable to carry out annual Continuing Healthcare and Funded Nursing Care reviews and will be writing to those affected in the coming weeks. Please be assured that any current financial arrangements with nursing homes and care agencies will not change during this period.

We appreciate your understanding.

NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. In order to receive NHS CHC funding, individuals have to be assessed by a Clinical Commissioning Group (Croydon CCG) according to a legally prescribed decision making process to determine whether the individual has a 'primary health need'.

Children and young people may receive a Continuing Care package if they have needs arising from disability, accident or illness that can't be met by existing universal or specialist services alone. See our NHS Children and YP Continuing Care page.

Where can NHS Continuing Healthcare be provided?

NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a nursing home.  See our policy on choice and equity of CHC and Free Nursing Care location here

Am I eligible for NHS Continuing Healthcare?

To be eligible for NHS Continuing Healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). 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 particular diagnosis or condition. If your needs change then your eligibility for NHS Continuing Healthcare may change.

You will be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members will also be consulted where appropriate.

A decision about eligibility for a full assessment for NHS Continuing Healthcare is usually made within 28 days of an initial assessment or request for a full assessment.

If you aren't eligible for NHS Continuing Healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.

If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a joint package of care.

How can I appeal a decision?

If you're assessed as not eligible for NHS Continuing Healthcare, you have the right to appeal. You can also instruct someone to appeal on your behalf.

All requests are to be made in writing, no later than 6 months from the date of the initial decision. Please note, the recommendation stays in place during the appeals process.

See the Local Appeals Standard Operating Procedure here.

Information and advice

The process involved in NHS Continuing Healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS Continuing Healthcare.

Visit the Beacon website www.beaconchc.co.uk or call the free helpline on 0345 548 0300.

NHS Continuing Healthcare assessments

Clinical Commissioning Groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS Continuing Healthcare if it seems that you may need it.

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 may be fast-tracked.

Initial assessment for NHS Continuing Healthcare

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'll either be told that you don't meet the criteria for a full assessment of NHS Continuing Healthcare and are therefore not eligible, or you'll be referred for a full assessment of eligibility.

Being referred for a full assessment doesn't necessarily mean you'll be eligible for NHS Continuing Healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.

The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.

Full assessment for NHS Continuing Healthcare

Full assessments for NHS Continuing Healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of two professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care.

You should be informed who is co-ordinating the NHS Continuing Healthcare assessment.

The team's assessment will consider your needs under the following headings:

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

These needs are given a weighting marked "priority", "severe", "high", "moderate", "low" or "no needs".

If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS Continuing Healthcare.

You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.

In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS Continuing Healthcare 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.

Fast-Track assessment for NHS Continuing Healthcare

If your health is deteriorating quickly and you're nearing the end of your life, you should be considered for the NHS Continuing Healthcare Fast-Track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.

Care and support planning

If you're eligible for NHS Continuing Healthcare, the next stage is to arrange a care and support package that meets your assessed needs.

Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget.

If it's agreed that a nursing home is the best option for you, there could be more than one local care home that's suitable.

Croydon CCG will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, we can also take other factors into account, such as the cost and value for money of different options.

NHS Continuing Healthcare reviews

If you're eligible for NHS Continuing Healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you're still eligible for NHS Continuing Healthcare.

If you're not eligible for NHS Continuing Healthcare

If you're not eligible for NHS Continuing Healthcare, but you're assessed as requiring nursing care in a care home (in other words, a care home that's registered to provide nursing care) you'll be eligible for NHS Funded Nursing Care.

This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS Funded Nursing Care is available irrespective of who is funding the rest of the care home fees.

Further information

To find out more about NHS Continuing Healthcare visit the NHS website or contact the Continuing Healthcare team on 020 3668 1900 option 2, or email croccg.chcenquiries@nhs.net

Also, please visit the Department of Health website for detailed information on the National framework for NHS Continuing Healthcare and NHS Funded Nursing care https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care