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If you are eligible, you can receive NHS continuing healthcare in a care home or your own home, among other places.
Your clinical commissioning group (CCG) should use your preferences as the starting point when agreeing a care package and where it will be provided. The CCG can take the cost of different options into account, but it should also consider other factors, such as your desire to live at home.
If you are eligible for NHS continuing healthcare in your own home, this means that the NHS will pay for healthcare (such as services from a community nurse or specialist therapist) and associated social care needs (such as personal care and domestic tasks, help with bathing, dressing and food preparation).
In a care home, the NHS pays for your care home fees, including board, accommodation and providing for your healthcare needs.
The National Framework for NHS continuing healthcare sets out a clear assessment process for establishing eligibility:
Initial screening is with a qualified health professional or social worker using a NHS continuing healthcare checklist tool. This does not show whether you are eligible for NHS continuing healthcare, only whether you need full assessment.
A multi-disciplinary team will carry out a full assessment with the decision support tool.
If a clinician considers you have a deteriorating condition that may be entering a terminal phase, he will use the fast track pathway tool.
You should have an annual review. The first review should happen within 3 months after the initial decision.
If you are unhappy with the care you are receiving, you can complain using the NHS complaints procedure.
If you’re not eligible, the Clinical Commissioning Group (CCG) can refer you to your local authority who can discuss whether you may be eligible for support from them.
If you are not eligible for NHS continuing healthcare but still have some health needs, then the NHS may pay for part of your support. This is sometimes known as a joint package of care. One way is through NHS-funded nursing care.
You should receive NHS-funded nursing care if:
The payment will help towards nursing care. It does not cover the accommodation, board or personal care costs of your care home fees.
If you feel that you have been wrongly screened out, you can make a complaint using the NHS complaints process.
If you disagree with the eligibility decision made by the Clinical Commissioning Group (CCG) after a full assessment, you can request a review. At first, this will be at a local level. The next stage is a review by an independent panel.
Write to your CCG. It will contact the National Commissioning Board (the Board) and ask them to arrange a review.
It’s helpful to have an independent advocate who can guide you through the process and give you support. Each local authority has a local healthwatch that can give details of a local independent advocacy service.
You can also get support from local disability advice service, carer’s centres and law centres.
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