What is NHS Continuing Healthcare?

NHS Continuing Healthcare is the name given by the NHS to the service provided to an individual where the NHS pays for the costs (fees) for providing healthcare. The individual must be eligible to receive NHS Continuing Healthcare, as they have a ‘primary healthcare need’ that sets this care apart from other types of care, such as social care.

You can receive NHS Continuing Healthcare in any setting outside of hospital, including care homes, nursing homes, hospices and your own home. It is the individual’s health need that is being cared for, not their location.

It is important to note that there is a very clear distinction between healthcare and social care. Social care can be provided by the Local Authority (LA) and is ‘means tested’. This will often result in the individual paying or contributing for the care they receive, such as paying their own care home fees. Healthcare means the individual has health needs that go beyond those that can be lawfully provided by social care workers and so should be provided by the NHS. Unlike social care, healthcare is NOT means tested.

It is important to note that not all individuals with care needs will have healthcare needs. Social care provides support for individuals, but it may be the case that an individual has incremental needs beyond the care provided by social care. If this is the case, the individual needs an assessment for NHS Continuing Healthcare. This will determine what these needs are, and if they are eligible to receive NHS Continuing Healthcare and the funding provided by the NHS for this care.

In reality, many thousands of people are paying for social care when they actually need, and would be eligible for, NHS Continuing Healthcare. This is not a well-advertised NHS service. People find themselves funding their own place in a care home to receive incremental help. They end up paying for long-term care without ever having an eligibility assessment for NHS Continuing Healthcare. They become stuck in the system.

If you or a family member are paying care home fees and have not had an assessment for NHS Continuing Healthcare, then we can help.

Contact us to find out more.

What is the National Framework for NHS continuing healthcare?

The National Framework for NHS continuing healthcare and NHS-funded nursing care is a document produced by the NHS Board. It sets out the principles and processes for the two named services, those being NHS Continuing Healthcare and NHS-funded Nursing Care.

It reflects the new framework, following the Health and Social Care Act 2012, and has been in force since 1 April 2013. Currently this is a 140-page document. You can read it by clicking here.

The Framework and the associated tools (the checklist, decision support tool and fast track pathway tool) are designed to help clinicians and practitioners with the decision making process. It concentrates mainly on the process for establishing eligibility for NHS continuing healthcare and the principles of care planning and dispute resolution relevant to that process, rather than specifying every detail of the planning of NHS continuing healthcare.

In practice, the Framework is complex. The understanding and use of it within the CHC process is mixed, with some practitioners knowing of it, but not necessarily working to all of its guiding principles.

For you, there are a number of key points to note:

  • The Practice Guidance (PG) section states that the whole of the NHS CHC process should be ‘Person-centred’; this includes full involvement in all the assessment and decision processes.

  • Take full account of the individual’s own views and wishes, ensuring that their perspective is clearly the starting point of every part of the assessment process.

  • If the individual is not able to represent himself or herself fully, then the family, friends and carers are empowered to act on a ‘best interest’ basis. This is important if you do not have Power of Attorney, as others could have a say on what is best for the individual.

  • Obtain consent to assessment and sharing of records.

  • Ensure that the individual concerned and/or their representative is fully and directly involved in the assessment and the decision-making process.

  • Be evidence-based; provide objective evidence for any subjective judgements made.

As with all areas of NHS Continuing Healthcare, the team at Care Fees Covered are on hand to answer your questions and support you through the complete process of your NHS CHC journey.