Posted on 14 January 2025
NHS Continuing Healthcare – What You Need to Know
Posted in Advice
In this article, we’ll explore why NHS Continuing Healthcare Funding is essential to know about, its impact on individuals and their families, and why it’s an integral part of the NHS system.
The NHS Act places a duty on the Secretary of State to “promote” a comprehensive health service in the UK. IN general, this means free healthcare services to everyone based on their need, not on their ability to pay.
An important part of this, but one which is frequently overlooked, is NHS Continuing Healthcare Funding (“CHC”). CHC is the name given to funding designed to support people with long-term health needs. In practice, it covers the individual’s care costs, including their care home fees, if that is where their needs are being met.
CHC is little known by the public and many who do know about it have several misconceptions about who is eligible and who is not, so it is not well understood. However, anyone who has an adult relative who in receipt of long-term care due to their health needs should give CHC careful thought.
What is NHS Continuing Healthcare Funding?
NHS Continuing Healthcare (CHC) is a comprehensive healthcare package provided by the NHS for individuals who are assessed as having intense, complex or unpredictable needs.
Examples of adults who may be assessed as having such needs are those who require ongoing and skilled care due to conditions like dementia, neurological disorders, physical disabilities, or long-term illness. CHC covers the full cost of care, including personal care, medical treatment, and other services necessary to meet the individual's complex health needs.
NHS Continuing Healthcare can be provided in a variety of settings. Most commonly, this will be a care home, such as a residential home, nursing home, or a care home for the elderly, mentally and infirm (EMI). However, it can also be provided in a person’s own home (domiciliary care).
How does an Individual Qualify for NHS Continuing Healthcare Funding?
A practitioner must first refer the patient for full assessment by completing the Department of Health & Social Care NHS Checklist screening tool, which can be found here:
If the NHS Checklist is positive and indicates a need for full eligibility assessment, the NHS Integrated Care Board (ICB) should arrange for a Multi-Disciplinary Team (MDT) to consider the individual’s needs in detail. It must also complete the Decision Support Tool, which can be found here:
The MDT will make a recommendation to the ICB whether the individual has a Primary Health Need and is eligible for CHC. The ICB should accept the recommendation in all but exceptional circumstances.
The person assessed must meet the criteria laid down in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, which can be found here:
The Enormous Cost of Long-Term Care
NHS Continuing Healthcare is important because the NHS has a legal duty to provide it to those who are eligible. For those who are eligible, it alleviates a huge financial burden. For individuals with intense, complex and unpredictable healthcare needs, long-term care can be extremely expensive. In the UK, the cost of care in a nursing home can easily reach several thousand pounds per month, which may be unaffordable for many families.
Without CHC funding, many families would need to bear these significant costs, often draining their life savings. In the worst cases, families may even have to sell their homes to pay for their care, which can lead to additional emotional and financial distress.
On the other side of the spectrum, local authority social services teams will provide financial support, but unlike CHC, it’s means tested, and they’ll only support you with payment towards your care once the individual’s available capital drops to very low levels.
Those who are eligible for CHC-based on their health needs avoid this problem entirely.
Ensuring Access to High-Quality Care
Another key benefit of CHC is that it helps ensure access to high-quality, appropriate care for individuals with significant health needs. CHC can provide the flexibility to tailor care packages to the specific needs of the person who is eligible, ensuring they receive the right care.
By funding these comprehensive care packages, the NHS can ensure that individuals receive consistent and professional support from qualified healthcare providers, reducing the risk of neglect or poor-quality care. This is particularly important for individuals who may not have family members capable of providing the necessary level of care themselves.
If the individual’s needs are being fully met in the care placement and then becomes eligible for CHC, this typically involves the NHS simply taking over payment of the care placement.
NHS Continuing Healthcare Helps Family Carers
The role of family in care provision is another important consideration when discussing NHS Continuing Healthcare Funding. For those individuals who do not receive 24-hour care in a care home, it is common for members of the family to take on caring responsibilities. Where the individual’s needs are complex, intense or unpredictable, this can be physically, emotionally, and financially draining. The financial support provided by CHC funding help, which in turn can allow family members the time and space to provide love, emotional support and social companionship to their loved one.
Challenges in Accessing NHS Continuing Healthcare Funding
Despite the importance of NHS Continuing Healthcare Funding, access to this valuable source of funding can often be a challenge. The CHC assessment process is both difficult to navigate and to secure an award of funding, even where an individual’s needs appear to warrant it. CHC funding has been termed a postcode lottery, and where the NHS has made information available to the public via Freedom of Information Requests, the data suggests inequality in assessments and decisions from one geographical region to the next. There have been instances where people who are eligible for CHC funding are not properly assessed, are denied funding, or not assessed at all when they should be. This causes frustration and delays in care provision and often result in individuals and their families paying for care when they should not be.
Advocacy for individuals who require CHC funding is essential to ensure that those who need this support can access it and this why many people choose to instruct a professional, such as a solicitor, to help. It is crucial to be fully informed about your rights and the eligibility criteria.
NHS Continuing Healthcare Plays an Increasingly Important Role
In conclusion, NHS Continuing Healthcare Funding is an essential part of our health and social care system, providing valuable funding and expertise to individuals with some of the most intense, complex and unpredictable needs in our society.
As the population ages, and local authorities struggle increasingly to meet social care needs, NHS Continuing Healthcare Funding will play an increasingly important role in ensuring the needs of the most vulnerable people in society are met. Given the complexity of the eligibility process and criteria applied, it’s vital for these individuals and their families to explore its applicability and to seek independent advice from an expert.
