Applying for NHS continuing healthcare
Chrissy shares some tips for applying for NHS continuing healthcare, and talks about her father's experience of applying.
Most people have to pay something towards the care they receive. But some people with ongoing significant health needs can get their care paid for through NHS continuing healthcare.
NHS continuing healthcare is a package of care for people who are assessed as having a 'primary health need'. It's arranged and funded by the NHS.
Your local Integrated Care Board (ICB) is responsible for the commissioning of NHS continuing healthcare. Eligibility isn’t based on whether you have a specific health condition.
To get NHS continuing healthcare you must:
Speak to your healthcare provider, doctor or social worker if you think you might be eligible for NHS continuing healthcare.
You can also approach your ICB and explain why you believe you should be considered for NHS continuing healthcare.
Chrissy shares some tips for applying for NHS continuing healthcare, and talks about her father's experience of applying.
There's a process staff must follow and tools they must use to decide your eligibility for NHS continuing healthcare.
1. If your ongoing needs are clear and you have significant health needs, there are times when NHS staff or a member of the social work team should consider whether you may be eligible for NHS continuing healthcare. These situations include:
You should be fully involved and your views should be considered at all stages of the assessment process. You can also ask a relative or carer to help and support you throughout.
2. The assessment process usually starts with the completion of the Checklist tool by a nurse or a social worker trained to complete it. This identifies whether you need to have a full NHS continuing healthcare assessment.
In some situations listed above, it'll be clear to health and social care staff that your needs don't qualify for NHS continuing healthcare at this time. If health and care staff agree, they should record this in your notes with their reasons. If there's any doubt between staff, they should complete the Checklist.
If your condition is getting worse rapidly and you may be approaching the end of life, the staff might decide to submit a proposal for you to be fast-tracked for NHS continuing healthcare, which follows a quicker process.
3. If you’re referred for a full assessment, evidence will be collected from all relevant health and social care professionals about your physical, mental health and social care needs.
4. A team of health and social care professionals will meet to look at this evidence, complete a Decision Support Tool, and make their recommendation on whether or not you’re eligible. You and/or your representative can attend and take part in this meeting.
5. Their recommendation is given to the ICB responsible for agreeing and funding your care package. Then the ICB confirms their recommendation, except in exceptional circumstances.
6. The ICB should write to you with their decision and explain the reasons for it.
If you’re found to be eligible for NHS continuing healthcare:
If it's decided you’re not eligible for NHS continuing healthcare there are different options open to you.
The ICB letter explaining the decision should tell you how to appeal.
If you're not happy with a Checklist decision you can ask the ICB to reconsider your case. If you're still unhappy, you can use the NHS complaints system to pursue your case.
If you’re not happy after a full assessment, you can ask the ICB to reconsider its decision. If you're still unhappy, you can ask for an independent review of your case.
If you decide not to appeal or the decision isn't overturned, you can ask to be referred to your local authority. They'll look at whether you’re eligible for care and support and if you are they'll apply a means test to see how much you should contribute to your care.
If you don’t qualify for NHS continuing healthcare, but have been assessed as needing to live in a nursing home, and need help from a registered nurse, the NHS pays a flat rate contribution to the home – known as NHS-funded nursing care. This payment is to support the provision of nursing care by nurses employed by the home.
You won’t usually need a separate assessment for NHS-funded nursing care if you had the full assessment for NHS continuing healthcare.
Your nursing needs should be reviewed no more than 3 months after the initial decision, and then at least once every year.
We offer support through our free advice line on 0800 678 1602. Lines are open 8am-7pm, 365 days a year. We also have specialist advisers at over 120 local Age UKs.
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