NHS continuing healthcare is arranged, provided and funded solely by the NHS. It is free for those who are eligible, unlike help from social services for which a charge may be incurred depending on income and savings.
Care arranged as part of NHS continuing healthcare can be provided in a variety of different settings including care homes, hospices or an individual’s home.
Eligibility for NHS continuing healthcare funding is determined by a detailed assessment, which looks at all aspects of a person’s health and social care needs. As part of this, four key areas are considered:
- The type of condition or treatment required
- The complexity of the condition (symptoms that interact and are therefore difficult to manage or control)
- The intensity of the condition (one or more health needs so severe they require regular care and support)
- The unpredictably of the condition (unexpected changes in condition that are difficult to manage and present a risk to the individual or to others)
To find out how to request an assessment of eligibility and apply for continuing healthcare funding within your area, see the options below.
Address: King Edward VII Hospital, St. Leonards Rd, Windsor, Berkshire SL4 3DP
Tel: 01753 636 302
Address: NHS Continuing Healthcare and Funded Nursing Care Team, 5th Floor, Civic Offices, Civic Way, Fareham, Hampshire, PO16 7AZ
Tel: 0300 123 4448
Address: NHS Funded Healthcare Team, Cedar Court, Guildford Road, Leatherhead, Surrey, KT22 9AE
Tel: 01372 201645
Referral: I think I need an assessment
If someone needs to be assessed for NHS continuing healthcare, a referral should be made to the team. The referral form can be obtained from each Continuing Healthcare team (see the 'How To Apply' section on this page for details) within the Frimley CCG.
Checklist: Am I eligible for an assessment?
In order to identify whether an individual requires a full CHC assessment, a CHC checklist is undertaken. The checklist will be completed by a health or social care professional trained as part of their role. Trained professionals will identify which statement describes the level of need and individual has across 11 care domains. To see the form, instructions and read more about the checklist, visit the Department of Health’s website.
The checklist will be sent to the CCG for consideration and approval. Where the CCG identifies a full NHS continuing healthcare assessment is required, and the individual is the responsibility of one of the CCG's place areas (Slough, Bracknell and Ascot, or Windsor, Ascot and Maidenhead, North East Hampshire and Farnham, Surrey Heath), our CHC Team will arrange the assessment.
When an individual is not eligible for a CHC assessment, the CCG will confirm you of this in writing. You have the right to ask the CHC team to review their decision if you believe they are wrong.
CHC Assessment: The assessment
The holistic continuing healthcare assessment involves the patient, people caring for them, professionals and their family and/or representative. Friends, relatives and official advocates may also be present.
Decision Support Tool
The CHC assessment will usually take 2-3 hours.
The meeting will usually include the patient and/or their representative, professionals involved in providing care, a CHC assessor and a social worker. The CHC assessor will facilitate a discussion of the patient’s needs with a multi-disciplinary team (MDT). The MDT will be skilled and knowledgeable in the National Framework. Using their professional judgement, and guided by information from all those present, the assessor and social worker (or identified representative) will complete the Decision Support Tool, and make a recommendation as to whether the patients’ care should be funded by the NHS.
The Decision Support Tool can be found on the Department of Health's website.
At the end of the assessment the MDT will make a recommendation as to whether or not the individual being assessed has a “primary health need”. In making a recommendation the MDT carefully consider all the individual’s care needs, relating them to four key indicators:
When the Care Needs Portrayal and Decision Support Tool are complete, you will be asked to check if you believe the recorded care needs of the care person being assessed are accurate. If there are any amendments required, you should let the service know.
Fast Track Tool
If you need urgent care due to a rapidly deteriorating condition which means a person is coming to the end of their life, the Fast Track Tool may be used instead of the Decision Support Tool. The Fast Track Tool can be downloaded from the Department of Health’s website.
An appropriate clinician will complete the Fast Track Tool and send it to the CHC Team. The CHC Team will arrange care and support as quickly as possible.
Determination: Decision Making
Quality Assurance is undertaken by each place-based CHC Team. This is to ensure the assessment and recommended outcome are compliant with the National Framework and can therefore be ratified. The CCG should usually accept the recommendation of an MDT except in exceptional circumstances. Once a decision is made, the CCG will write to the individual that was assessed and/or their representative(s) to confirm the outcome and the reasons for any decisions. If you are not happy with the outcome you can appeal the decision.
Appeal: Your right to recourse
If you are not happy with the CCG’s decision, or are concerned about the process followed by the CCG, you have the right to appeal and request a review of the CCG’s decision. There are 3 stages to this process. You can also seek independent advice from Beacon CHC.
Local resolution – The CHC team will arrange a local review of the assessment to carefully consider your grounds for appeal. We will agree with the appellant the best way to resolve their concerns, which may include another assessment or consideration of the case by an Appeal Panel.
After local resolution if the appellant remains unhappy with the CCG’s decision, they will be advised of their right to request an Independent Review of the decision.
Independent Review – Requests for an Independent Review can be made in writing to: Eileen Roberts, Continuing Healthcare Manager (South Region), NHS England, South West House, Blackbrook Park Avenue, Taunton, TA1 2PX. NHS England has produced a helpful leaflet which describes the Independent Review process.
Requests must be made within 6 months of local resolution being completed. The appellant will need to tell NHS England why they believe the CCGs’ decision should be reviewed and why they believe the decision or process they followed was wrong. If the request for a review is accepted, the appellant will be invited to a meeting to put forward their case. The Independent Panel will consider the evidence and decide whether or not the CCGs’ process and decision were robust. In all but exceptional cases, this decision will be accepted by the CCGs.
Ombudsman - If the appellant remains dissatisfied with the decision, you can write to: The Parliamentary and Health Service Ombudsman (PHSO), Millbank Tower, Millbank, London, SW1P 4QP. You can visit the Ombudsman website or call them on 0345 015 4033. The PHSO will review the case and make recommendations as appropriate.
Commissioning of Care: Planning your care
Individuals eligible for NHS funding, will be contacted by the CHC Team. We will work with you to identify the type of care that best meets your needs from organisations that are registered with the Care Quality Commission, and are able to demonstrate their ability to deliver satisfactory care standards. Your wishes and expectations of how and where the care is delivered should be documented and taken into account. If you wish, you can ask for a Personal Health Budget by contacting the team.
Review: Monitoring and review
Once you are eligible for Continuing Healthcare, we will review your eligibility at least once within the first three months and annually thereafter, or sooner if your needs change. The NHS and local authority should not stop your care or funding without a joint review and reassessment of your needs. They should also consult one another and you about any proposed changes and ensure that alternative funding or services are in place.