NHS continuing healthcare is the name given to a package of care, which is arranged and funded by the NHS. It’s for people over the age of 18 who have a primary health need. Continuing healthcare can be received in any setting outside of hospital, so it can be received in a non-nursing residential healthcare home. It can be received in a care home with nursing and even in your own home. The important thing to bear in mind with continuing health care is that it’s not based on a diagnosis. Eligibility for continuing health care has to be purely based on your care needs alone.

So why is this significant? Nursing care in this country is free at the point of delivery and so those people who are eligible for continuing healthcare will have the full cost of their care and residential accommodation, where that’s part of their care, paid for by the NHS. Whereas those who are not eligible will either have to self-fund their care or they may get some support from social services.

The assessment process for continuing healthcare is a two-stage process and that consists, for most people, of an initial screening using what we call the checklist tool and then moving on to the full assessment process. So with a checklist [um] that can be carried out by any health or social care professional, who has been trained to do so, and so that could be a social worker, that could be a nurse at your care home, a district nurse, GP, for example, any of those people who have the training should be able to carry out the checklist. And the checklist is used to organise an overview of your care needs into 11 what we call care domains. And the care domains, these are sort of categories for organising your, your care. Things like behaviour, cognition, communication, mobility, medication, those sorts of areas.

Now the full stage of assessment is a bit different. This is organised and overseen and administered by your local CCG or clinical commissioning group. Now the CCG should assign a coordinator. So the coordinator brings together that multidisciplinary team they meet with you, as the individual being assessed or your representative, which could be a family member, and they’ll carry out the full continuing healthcare assessment. Once the multidisciplinary team have assessed you, they will then make a recommendation to the clinical commissioning group who should verify that recommendation and make a final decision

If, after a continuing healthcare assessment or indeed a checklist, it’s determined that you do not have a primary health need, so you’re not eligible for continuing healthcare, but you are going into or already in a residential care home with nursing, you would most likely be entitled to something called FNC or funded nursing care. Now funded nursing care is assessed in its own right. So not everybody in a nursing home will be eligible, but the majority of people will be, and this is a small amount of money, which is paid on a weekly basis, usually to the care provider. And that is to pay for the nursing care, which is being delivered by a registered nurse within that care setting so it’s a fairly small amount.

So the whole assessment process, this is, from the point in which a checklist is completed and referred to the clinical commissioning group, through to the point in which you receive your final decision, that should take no longer than 28 days. So the point of referral to final decision, 28 days.

If you have been assessed for continuing health care and found to be not eligible so that you don’t have a primary health need, there is an appeal process. There’s a way of requesting a review of that eligibility decision and that process is in three stages. The first stage is in two parts, so what you would do initially is to contact the clinical commissioning group, the CCG, which made the eligibility decision, within six months of the date on your decision letter and to ask them for a review of the decision. Provide them with as much information as you can as to why you disagree. If you are still unhappy following that local resolution process, you can move to stage two.

Stage two is called independent review and that process is overseen and administered by NHS England. If you’re still not happy with the decision that’s been made at the end of the independent review process, you can then move on to the third stage of appeal, which is to make a formal complaint to the parliamentary and health service Ombudsman.

If you have been screened for continuing healthcare using the checklist, which is the first stage of the assessment process, and that checklist is negative, or in other words, you don’t meet the criteria to move forward for a full assessment, the decision can’t be appealed but you can request for a review of the checklist decision.

For people who are perhaps nearing the end of their life there is a slightly different process involved in assessing them for continuing healthcare and that’s called the fast track process. That decision needs to be made by an appropriate clinician. They then complete the fast track paperwork, without having to get a whole multidisciplinary team together, they should send that off with justification to the clinical commissioning group who should then authorise it and put that care and funding in place.

If you have been assessed as eligible for continuing health care, one thing to be aware of is that eligibility is not guaranteed for life. It’s normally reviewed initially three months after the first assessment and then annually thereafter.