1. Introduction

Continuing Healthcare is care arranged and funded by the NHS, and provided to adults with ongoing healthcare needs. It is free of charge, unlike care from adult social care for which there may be a charge depending on the adult’s income and savings (see Charging and Financial Assessment).

It can be provided in any setting, including a care home, nursing home, hospice or the home of the adult with the healthcare needs. It will cover the person’s care home fees (including board and accommodation), personal care (help with bathing, dressing and laundry for example) and healthcare costs (community nursing or specialist therapy services for example).

For adults living at home, it will cover their personal care and healthcare costs.

Support for carers may also be available – see NHS Continuing Care: Information for Carers.

2. Eligibility

See also Department of Health (2012) Decision Support Tool for NHS Continuing Health Care and NHS Continuing Health Care Checklist.

To be eligible for NHS continuing healthcare, the adult must be assessed as having:

  • a ‘primary health need’; and
  • a complex medical condition with substantial and ongoing care needs.

Not all those with a disability or long term health condition will be eligible.

A decision about whether or not an adult is eligible should usually be made within 28 days of completion of the assessment.

If the person is not eligible for continuing healthcare funding, the local authority maybe responsible for assessing their care and support needs and providing services if they are eligible to receive such services.

If the adult is not eligible for NHS continuing healthcare but are assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For an adult who lives in their own home, this may be provided as part of a joint package of care and support, where some services come from the NHS and some from adult social care services (see Integration, Cooperation and Partnerships, Eligibility and Charging and Financial Assessment).

If the adult moves into a nursing home, the NHS may contribute towards their nursing care costs.

Once eligible for NHS continuing healthcare, care will be funded by the NHS but this is subject to review, should care needs change the funding arrangements may also change.

3. Information for Adult Social Care Staff

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health, 2012) sets out the principles and processes which should be applied in order to assess an adult’s eligibility for NHS continuing healthcare and NHS funded nursing care. NHS funded nursing care is also referred to as ‘single band nursing’ or ‘FNC’.

Joint working between NHS and adult social care and any other partner organisation who are involved, is essential in order to ensure the person’s needs are met in the right way and that their care is effectively coordinated. The National Framework sets out Local Authority responsibilities in relation to NHS continuing healthcare.

3.1 Other links to national guidance and legislation

3.2 Issues for adult care practitioners

In order to understand and be able to implement continuing healthcare procedures, staff should:

  • familiarise themselves with the National Framework for NHS Continuing Healthcare documentation as above;
  • understand the definition of ‘primary health need’;
  • be familiar with the Decision Support Tool;
  • be able to apply the four key indicators:
    • nature,
    • intensity,
    • complexity and
    • unpredictability,

as well as the primary health need test to the adult’s assessed needs;

Where at all possible the same staff member should be involved with the adult and their carers throughout the continuing healthcare assessment process.

3.3 Consent

Before completing the Checklist and the Decision Support Tool (DST) (see below), consent must be obtained and recorded. Consent is sought for:

  • completion of the DST;
  • sharing of the adult’s personal information between different organisations involved in their care, and the continuing healthcare assessment and decision making process.

If there is a concern that the person may not have Capacity to give consent, this should be determined in accordance with the Mental Capacity Act 2005 and Code of Practice (see Independent Advocacy). A third party cannot give or refuse consent for an assessment of eligibility for NHS continuing healthcare on behalf of a person who lacks capacity, unless they can demonstrate they have a valid Lasting Power of Attorney for Welfare or that they have been appointed a Welfare Deputy by the Court of Protection. A third party holding Enduring Power of Attorney or Lasting Power of Attorney for Finance cannot give consent for continuing healthcare.

3.4 Decision Support Tool

See Department of Health (2012) Decision Support Tool for NHS Continuing Health Care and NHS Continuing Health Care Checklist.

The Decision Support Tool is used to inform the decision as to whether a person is eligible for NHS continuing healthcare. It is not an assessment in itself; the information gathered will need to be supplemented with professional analysis and conclusion. It is designed to assist data collection, analysis and presentation of information of the adult’s healthcare needs, including evidence from assessments and reports completed by other members of the multidisciplinary team (MDT).

3.4.1 Multi-disciplinary working

Social workers and care managers are involved in the multi-disciplinary process and will be asked to provide a specialist assessment and participate in a multi-disciplinary meeting to determine eligibility. All assessments should be completed before the adult attends the MDT meeting. Adult social care staff should actively participate in deciding the MDT’s recommendation regarding the adult’s eligibility.

Where they do not agree, they should state their opinion / recommendation/s which should be supported in writing using the four key indicators as listed in 3.2 Issues for Adult Care Practitioners and apply the primary health need test.

Both the MDT recommendation and the decision should be recorded in the adult’s case records.  The continuing healthcare process regarding an adult’s eligibility for NHS continuing healthcare, including assessment and decision, should not take longer than 28 days for to completion. This target is set by the Department of Health.

In Manchester there is an agreement that the person who is facilitating the meeting should provide the social care worker with a written copy of the decision, including the date from which the person is eligible for funding. In most cases the NHS will fund the care and support package from the date the person is eligible but in some cases, particularly where there is a cash personal budget, the local authority may need to continue funding until health can take over. In these cases it is the responsibility of the social care worker to contact Manchester City Council Finance to let them know so that the costs can be recovereds. Those eligible for CHC do not have to pay a contribution towards their care; therefore Manchester City Council should recover the full cost of the care from health.

3.4.2 Joint Working Agreement (JWA)

This agreement is between Central Manchester Foundation Trust, South Manchester University Hospitals Trust, North Manchester General Hospital and Manchester City Council. It allows patients who require a care home placement to be funded by health on discharge from hospital providing:

  • a care home placement was not previously funded by MCC and,
  • the person is eligible for CHC consideration at a full MDT.

Health will fund the placement for up to four weeks until a decision is made regarding eligibility for CHC. It is important the patient is aware that if they are not eligible for CHC funding they may not be able to stay in the placement following assessment, and if they are assessed as needing a placement they will need to contribute towards the cost of their care (including selling their home if necessary).

3.4.3 Fast Track CHC

For some patients nearing end of life there is a fast track process to qualify for CHC. This is used where the person’s health is deteriorating rapidly and their eligibility is obvious. In such cases an MDT would be an unnecessary delay.

3.5 Disputes

There are two types of disputes that may arise in relation to NHS continuing healthcare:

  1. challenges by the adult or their carer / advocate, including requests for reviews (also known as appeals). Staff may be involved in the appeal process, including undertaking an assessment / review of the person’s needs and attending MDT/DST meetings;
  2. disputes between NHS and local authorities. In such cases staff should provide a clear rationale for disputing the outcome. This should include reference to the four key indicators. A dispute in relation to an outcomes should usually be made in writing within 28 days of the date on the letter. Local Clinical Commissioning Group processes should be followed.

3.6 Equipment

Adults who are eligible for fully funded NHS continuing healthcare should have access to joint equipment services, where appropriate, the equipment provided, however, will be funded by the NHS. Standard catalogue items will be funded by local community health services; specialist items will be funded by NHS continuing healthcare.

3.7 Ordinary residence

See also:

An adult’s eligibility for NHS continuing healthcare may vary, due to changing needs. Eligibility, therefore, is not necessarily permanent. Following a review, this may mean someone who is receiving fully funded NHS continuing healthcare becomes eligible for local authority service provision and funding.

Where an adult is an ordinary resident in a local authority area when they are awarded fully funded NHS continuing healthcare and placed in an out of county care home, they remain the responsibility of that adult social care if, following a review, they are no longer eligible for fully funded NHS continuing healthcare.