NHS continuing healthcare in England
What is NHS Continuing Healthcare, who is eligible for it, how are patients assessed for it, and how can decisions be reviewed?
NHS continuing healthcare (CHC) is a package of ongoing care, for adults aged 18 years and older, provided outside hospital. It is arranged and funded solely by the NHS, where it has been assessed that someone’s need for care is primarily due to their health needs (a ‘primary health need’). It is designed to meet physical and/or mental health needs that have arisen because of disability, accident or illness.
Services may be provided in any setting outside of hospital including, but not limited to, a residential care home, nursing home, hospice or a person’s own home. If provided in a care home, it means the NHS has a contract with the care home and pays the full fees for the person’s accommodation, board and care.
Who is responsible for arranging care?NHS Integrated Care Boards (ICBs) are responsible for commissioning CHC in England. NHS England also has commissioning responsibilities for some specific groups of people (for example, prisoners and military personnel). Further information on CHC in England can be found in the Library briefing NHS continuing healthcare in England. Equivalent provision in Scotland, Wales, and Northern Ireland are covered in section 6 of this briefing.
Services provided by the NHS are free at the point of use whereas those arranged by local authority social services in England are means-tested. The outcome of any decision about who has responsibility for providing care can have significant financial consequences for the individual concerned. A separate Library briefing paper, Paying for adult social care in England, is designed to help answer constituents’ queries about the local authority means-test for care home charges. Packages of support provided or funded by both the NHS and the local authority are known as a “joint packages” of care.
Who is eligible?Eligibility for CHC is based on a person’s needs rather than a diagnosis of a specific medical condition. There are no limits on the setting where the package of support can be offered or on the type of service delivery. The actual services provided as part of a package of CHC should be tailored to meet the specific needs of the individual, in the context of best practice and service development for each “client group”.
The Government publishes a National Framework for CHC, to improve the consistency of approach taken by local NHS bodies. The latest version of this framework was issued in May 2022. This provides information on what constitutes a ‘primary health need’, as well as outlining certain characteristics of need and describing what should not be used to judge eligibility.
While CHC is for adults, children and young people under the age of 18 may receive a ‘continuing care package’ if they have needs arising from disability, accident or illness that cannot otherwise be met by statutory services. The Children and young people’s continuing care national framework provides guidance on this.
What’s involved in the assessment process?The NHS must carry out an assessment for CHC if it seems that someone may need it. Carers and family can ask for an assessment for the person they look after by talking to a health or social care professional working with them or the NHS continuing healthcare coordinator for their area.
In most cases the NHS continuing care checklist is used to carry out an initial assessment, to decide if an individual needs to be referred for a full assessment. However, if someone needs care urgently, for example if they are terminally ill, they should be assessed under the Fast Track Pathway Tool.
The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional, or social worker. The patient should be told that they are being assessed and be asked for their consent. Depending on the outcome of the checklist, they will either be told they do not meet the criteria for a full assessment of CHC and are therefore ineligible, or they will be referred for a full assessment of eligibility.
Full assessments for CHC are undertaken by a “multi-disciplinary” team made up of a minimum of two health or care professionals who are already involved in the patient’s care. The Government provides a CHC Decision Support Tool, which includes a detailed questionnaire used to help assess eligibility.
How is the specific healthcare package decided?The National Framework says if a person qualifies for CHC, the package provided must be appropriate to meet all the individual’s assessed health and associated care and support needs, as assessed by the ICB. The practice guidance within the Framework states that it is also necessary for the ICB to take full account of the individual’s own views of their needs and their preference as to how they should be met.
The NHS website explains people who are eligible for CHC have the right to ask for a Personal Health Budget, to provide more choice over the services and care they receive. These are designed to give people with long-term health conditions and disabilities more choice and control over the money spent on meeting their health and wellbeing needs.
How can a patient request a review of an eligibility decision?If someone receives a decision confirming they are not eligible for CHC they have the right to request a review. The letter from their Integrated Care Board (ICB) explaining the decision should tell them how to appeal.
There are three possible levels at which a review of an eligibility decision (as distinct from an initial assessment) may take place:
- A local review and resolution process run by the ICB
- A request to NHS England for review by an Independent Review Panel
- If the Independent Review Panel upholds the original decision and there is still a challenge, the next stage is referral to the Health Service Ombudsman
Where a patient is receiving CHC, a case review should be undertaken no later than three months after the initial eligibility decision, to reassess care needs and eligibility and ensure they are being met. Reviews should then take place annually, as a minimum. These reviews are separate from the dispute resolution reviews.
Further InformationAs part of the CHC process, NHS England funds a social enterprise called Beacon, which can act as a patient’s CHC adviser (see NHS England’s website on NHS CHC).
There are also several introductory sources that constituents may find useful. For example:
- Department of Health and Social Care Public Information Leaflet, NHS Continuing Healthcare and NHS Funded Nursing Care (August 2022)
- NHS website: NHS Continuing Healthcare (reviewed 25 March 2021)
- Age UK webpage NHS continuing healthcare, and Age UK, Factsheet 20, NHS continuing healthcare and NHS-funded nursing care (PDF) (revised July 2022)
The Commons Library does not intend the information in this article to address the specific circumstances of any particular individual. We have published it to support the work of MPs. You should not rely upon it as legal or professional advice, or as a substitute for it. We do not accept any liability whatsoever for any errors, omissions or misstatements contained herein. You should consult a suitably qualified professional if you require specific advice or information. Read our briefing for information about sources of legal advice and help.