Continuing Health Care
What is Continuing Health Care
Continuing NHS healthcare and NHS-funded nursing care is provided over an extended period of time to meet physical or mental health needs that have arisen as a result of disability, an accident or illness. The care can be provided in a variety of settings including a hospital, nursing home, hospice or the patientís own home.
The care package is normally arranged and funded by the NHS and is awarded depending on whether a person's primary need is a health need. It can be provided in a care home or a persons own home.
NHS Continuing Healthcare (CHC) and NHS Funded Nursing Care (FNC)
Question and Answers Fact Sheet
Q What is NHS Continuing Health care
A ďContinuing CareĒ means care provided over an extended period of time to a person aged 18 or over to meet physical or mental health needs which have arisen as the result of disability, accident or illness. NHS continuing healthcare is the name given to a package of services which is arranged and funded by the NHS for people outside of hospital; this may be at home, in a care home or a specialist care home. NHS healthcare is free and there are no charges made to your savings or income. Where a personís primary need is a health need, the NHS is regarded as responsible for providing all their needs. To receive NHS Continuing Healthcare you will need to have an assessment undertaken which will identify your health and care needs.
Why have I been asked to have an assessment
NHS continuing healthcare and NHS-funded nursing care changed on 1st October
2007 when the National Framework for NHS Continuing Healthcare and NHS-funded
Nursing Care was implemented. This recommended that anyone whose care needs
changed was now "screened" to see if they may be eligible for their care needs to be
funded by the NHS rather than self-funding or by the Local Authority (Social Care)
services. A change in care needs may mean that you have been admitted to hospital
and your needs have changed, or that you now need care in a Care Home with a
Registered Nurse rather than residential care or that you live at home but your health
needs have changed. Once a change in needs has been identified a "Checklist" is
completed (by a NHS Health Professional involved in your care) who forwards this to
the Primary Care Trust to undertake a full assessment if this is appropriate. The
checklist is not an indication that eligibility for NHS Continuing Health Care will be
met, but if you meet the standard criteria on the checklist you are entitled to an
assessment to consider whether NHS CHC applies to your needs.
The assessment is a process where your total care needs are considered by trained
healthcare professionals. This information is used to judge whether you meet the
qualifying conditions for continuing healthcare.
Who makes the assessment
An Assessor will undertake a comprehensive assessment and will involve gaining
collaborative information from the Local Authority and other people from
multidisciplinary teams involved in your care. The assessment will take into account
your physical, mental and psychological and emotional needs.
NHS CHC Fact sheet
You will be asked to consent for this assessment to be undertaken and for your
permission to gather information from others involved in your care. You may invite
relatives/representatives to this assessment. Where the person lacks capacity to
consent then a best interest decision will have to be made whether or not to invite
them (ref. Mental Capacity Act.). If the person being assessed does not have mental
health capacity to consent, this will again be in the patient's best interest and in
accordance with the Mental Health Capacity Act.
What is a Decision Support Tool?
A Decision Support Tool is a tool which is recommended for use by the Department
of Health in conjunction with the Multidisciplinary assessment. The Decision Support
Tool supports practitioners in obtaining a full picture of needs and by indicating a
level of need which could constitute a primary health needs. The Decision Support
Tool, combined with practitioners' own experience and professional judgement,
should therefore enable them to determine evidence of a primary health need.
What happens if I do not agree with the assessment?
There is a statement within the assessment form which requests that you sign that
you agree/disagree with the information within the assessment tool. This is not an
indication that you will/will not agree with the final decision of eligibility but that the
information relating to your needs is accurate, and it is here that you may give your
written comments if you wish. If possible a Decision Support Tool will be completed
at the assessment at the same time and you will also be able to give your comments
to this document.
What happens when the assessment is completed?
The assessment and Decision Support Tool will be scrutinised at a Panel, who will
look at the information collated and confirm whether eligibility has or has not been
met. The outcome of the Panel will be communicated to you in writing as soon as
What happens if I meet NHS Continuing Healthcare (CHC)
Should your needs be found to meet NHS CHC eligibility then the NHS will fund your
identified care needs. An Assessor will liaise with you or your family/representative
to discuss what care you need and how this can be provided and will assist to coordinate
this. A Community Nurse from the Neighbourhood Team will routinely carry
out a review of care needs no later than 8 weeks from the date of the decision for
CHC eligibility. A review will then be undertaken annually as a minimum or as
identified by the Assessor.
You should be aware that NHS funding can STOP following this review or future
reviews if you are then found not eligible for NHS CHC funding. At this stage,
funding will cease, therefore, for patients who were reviewed for an NHS CHC package of care and the
assessment of needs showed that your healthcare needs are not at a level to
continue to qualify for NHS CHC, funding for your care will cease 28 days from the
date of the Panel decision letter.
I am resident in a Nursing Home and have been assessed as eligible for NHS Funded
Nursing Care (FNC)
My local authority pays the nursing home fees, what does this mean for me?
The NHS pays for your Registered Nursing care and your Local Authority pays
towards your social care. The Funded Nursing Care (FNC) is a payment for the
Registered Nursing care part of the nursing home fees and therefore your Local
Authority will have taken both these payments into account when assessing your
personal contribution or any additional top-up fees you pay.
I pay the nursing home fees myself with no funding from my local authority
A Nursing homes will have their own methods to either refund or deduct payments.
This information is not known to the Primary Care Trust and therefore you should
discuss this with the nursing home direct to confirm how they deal with
reimbursement of the FNC.
My Nursing Homs is not in Wiltshire PCT, how to I claim the FNC payments?
The PCT where your GP is located will determine which PCT is responsible for
payment of NHS Funded Nursing Care (FNC). The nursing home will be able to
explain how this is arranged in your area.
My Home Care or Nursing Home fees are already funded by the Local
Authority. What does this mean for me?
If you are eligible for NHS Continuing Healthcare funding, Wiltshire Primary Care
Trust (PCT) takes over responsibility for funding all your care needs.
Do I still pay my personal contributions?
No, the NHS is now responsible for the funding of your care whilst you remain
Q Does funding affect my benefits?
Yes, CHC funding may affect your benefits. You will need to seek advice from the
benefits agency alternatively if you have a social worker they may be able to help
you with this. The benefits enquiry line can be contacted on 0800 88 2200 or the
Department of Works an Pensions on 0845 712 3456.
If I am in a residential care home (without Registered Nursing), why donít I qualify for NHS funded nursing care (FNC)?
If you are in a residential care home, any nursing needs would be met by the
Community Nurse. This service is free from the NHS.
If I am currently in a nursing home (care home with Registered nurses) but my letter says I donít qualify for any funding. Why is this?
FNC is to pay for the Registered Nurse employed by the Care home. People in
Nursing Homes are paying fees which include the employment of Registered Nurses
for your nursing needs and therefore the NHS pays a contribution to a nursing home
for people who are assessed as eligible for NHS Funded Nursing Care.
However, eligibility is based on your health needs not the type of care home you are
resident in. If you are not eligible for any funding this indicates that you either have
no registered nursing needs or that you have few nursing needs. These needs could
be met in another setting such as a residential care home or your own home and
therefore you do not qualify for registered nursing funding.
What can I do if I am not eligible for NHS Continuing Healthcare or disagree with the
If I am not eligible for NHS Continuing Healthcare funding how do I find out if I am eligible for funding from my Local Authority (Social Care)?
If you want to find out if you are eligible for funding from your Local Authority, you
can call Wiltshire Council, Social Care Helpdesk on 0300 4560111 who will be able
to advise you on what to do next.
What can I do if I disagree with the Panel decision?
If you disagree with the NHS CHC Panel decision and want to appeal you should
write to the Continuing Healthcare Team within 28 working days of the date of the
decision letter and send to:
Continuing Healthcare Team
Should you wish to appeal against the Appeal Panelís decision the next step would
be to apply in writing to the South West Strategic Health Authority within 14 working
days of the date of the appeal decision letter.
Contact details are:
Continuing Healthcare South West Strategic
South West House
Blackbrook Park Avenue
Eileen will then advise you of the process.
You may find it helpful to refer to the Continuing Healthcare Leaflet or the National
Framework for NHS Continuing Healthcare which are available on the Department of
Wiltshire Primary Care Trust, CHC Team, Southgate House, Devizes, SN10 5EQ,
Tel 01380 733865 Fax 01380 733796, firstname.lastname@example.org
What happens with funding if the appeal for NHS CHC eligibility is successful?
Funding is to be reimbursed to Social Care or the patient/patient representative following subsequent Appeal panel if appropriate.
Please notify us if:
-You move to a new care home
-You change from a residential placement to a nursing placement even if its within the same care home
-You are discharged from the care home
-There is a change in health needs and would like a new assessment
-If you would like to appeal