What is NHS continuing healthcare and who’s it for?
NHS continuing healthcare (sometimes called NHS CHC) is a funding programme. If you’re eligible, it pays for all your social care, including care home fees or carers if you’re living in your own home.
NHS continuing healthcare isn’t means-tested, so it doesn’t depend on how much money you have. Instead, it depends on how your illness affects you and what help you need. NHS continuing healthcare is only for adults.
Having a terminal illness isn’t enough on its own to make you eligible for NHS continuing healthcare. To get it, the NHS says you must have ‘a complex medical condition with substantial, ongoing care needs’, and you have to be assessed as needing it.
I didn’t have any kind of idea who could get it – I thought you couldn’t get it unless you were on the breadline. That was a misconception.
Where is NHS CHC available?
NHS continuing healthcare is available in England and Wales.
In Northern Ireland, continuing healthcare is available but it isn’t as easy to access and the assessment process is different from what’s described on this page. You can find out more on the Department of Health’s website .
It’s not available in Scotland, which has a different system.
What does NHS CHC cover?
If you are eligible for NHS Continuing Healthcare, your local NHS authority (a Clinical Commissioning Group or Local Health Board) will organise your care.
They will arrange a care and support package to meet the needs you’ve been assessed as having. They may work together with your local council.
How each NHS authority arranges care can vary locally. You can check with your health and social care professionals.
Care home fees
If you’re staying in a care home, NHS continuing healthcare can pay the fees and other related costs (for example personal care costs and specialist equipment).
If you’re in a care home where the fees are higher than what the NHS would normally pay, it may be suggested you move to a different home. However, if a move might negatively affect your health or wellbeing, the NHS should take this into account.
Care in your own home
If you’re living in your own home, NHS continuing healthcare can pay for carers to help with daily activities, such as eating, washing and getting dressed. It will also pay for laundry and for essential equipment (eg a hoist).
NHS continuing healthcare doesn’t pay for:
- food
- clothes
- rent or mortgage payments
- utility bills.
Age UK has a factsheet, NHS continuing healthcare and NHS-funded nursing care, which has more information about what’s covered.
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How long does it take to get NHS continuing healthcare?
If you are very ill or approaching the end of your life, you may get fast tracked.
Otherwise, you may have an initial checklist assessment. If successful, you’ll then go on to have a full assessment. It should take no more than 28 days to complete the full assessment and make a decision.
The NHS says if your situation is complicated it could take longer. But if you’re awarded NHS continuing healthcare and the process has taken more than 28 days, you should get a refund for care costs from the 29th day onwards.
How do I get NHS continuing healthcare fast tracked?
You may be able to get NHS continuing healthcare faster than usual if your condition is getting worse quickly and you may be nearing the end of your life.
We have more information on this on our page, getting NHS continuing healthcare fast tracked.
How do I access NHS continuing healthcare?
To get NHS continuing healthcare, you have to be assessed.
You can apply for it if you are at home, in a care home, in a hospice or in hospital. If you apply for NHS continuing healthcare while you are in hospital and you are found to be eligible, it will be given to you when you go home, to a hospice or care home.
Your health and social care professionals will regularly consider if you need assessing for NHS continuing healthcare. For example, if you:
- are being discharged from hospital
- are having a care assessment
- are living in a care home and having an annual review
- are rapidly deteriorating and your current care doesn’t seem enough.
If a health or social care professional thinks you may need assessing, they’ll tell the local care commissioning organisation.
You don’t have to wait for a healthcare professional to recommend an assessment. You can ask your doctor, district nurse or social worker about it. Or your family or friends can ask for you.
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What happens at the assessments?
If someone is very ill, they may have a fast-track assessment, see above.
Otherwise, this is how the standard process works.
Initial checklist
A health or social care professional with training in this area can do the initial checklist assessment. They fill in a form which assesses things like breathing, nutrition, continence, skin condition, mobility, communication, mental capacity, behaviour, symptom control and medication.
They should ask you for your consent to having an assessment and a family member or carer can be there with you. You should also be given a leaflet about NHS continuing healthcare.
There are two possible outcomes. Either you don’t meet the criteria for NHS continuing healthcare, or you pass this initial assessment, and go on to have a full assessment (see below). For what happens if you don’t qualify, see below.
The full assessment
The full assessment is done by at least two different health or social care professionals (for example a doctor and a social worker) who are involved in your care. If you live in Wales, someone from the local council will also be there.
They review your needs in different areas, such as: behaviour, cognition (understanding), communication, psychological needs, mobility, nutrition, continence, skin, breathing, symptom control, and other needs. For each category, they decide whether your needs are ‘priority’ (the most urgent), ‘severe’, ‘high’, ‘moderate’, ‘low’ or ‘no needs'.
If you score ‘priority’ in at least one area or ‘severe’ in at least two areas you may be eligible for NHS continuing healthcare. You may also be eligible if you score:
- ‘severe’ in one area and ‘high’ or ‘low’ in several other areas
- ‘high’ or ‘moderate’ in many areas .
The assessors will tell the care commissioning authority whether they think you are eligible for NHS continuing healthcare.
The care commissioning authority has the final say over whether to award NHS continuing healthcare. They will write to you as soon as possible with the decision.
What happens if the application is approved?
Someone from the care commissioning authority will work with you to create a care and support plan. It’s reviewed after three months to make sure it’s working properly and meets your needs. It will also be reviewed every 12 months to make sure it’s still meeting your needs.
You should be given a named person to contact about your NHS continuing healthcare.
The care commissioning authority can manage your continuing healthcare budget for you. But you can also ask for the money to be paid directly to you through a personal health budget. This allows you to have more control over how the money’s spent. The NHS has information about personal health budgets and how they work.
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What happens if the application is rejected?
Appealing the decision
If your application is rejected at the initial assessment you can ask for it to be done again or for a full assessment.
If it’s rejected at the full assessment stage, you can ask for a review. Beacon CHC has more information on appealing NHS continuing healthcare decisions.
NHS-funded nursing care
If you’re not eligible for NHS continuing healthcare and you’re in a care home, you may be offered NHS-funded nursing care. In this scheme, the NHS pays a contribution to the care home to help pay for your nursing care.
Or, you may receive a joint package of care, where the NHS and local council share the cost. You don’t need to go through another assessment for this. There is more information about this on the NHS website.
Care and support from the local council
If you can’t get NHS continuing healthcare, the local council can help.
The council will do a care needs assessment. If you need help with daily living, the council will look at how to help with this. After the assessment, the council may recommend support like a paid carer, changes to your home, or equipment like a walking frame. We have information about this on our page, How to get social care and support.
Can I claim if my loved one has died?
It’s possible to make a claim for NHS continuing healthcare on behalf of someone who’s died (as long as they died on or after 1 April 2012). If this is successful, it might mean a refund of some of their care costs (eg care home fees). It may take some time as there’s a backlog of cases.
The Parliamentary and Health Service Ombudsman has information on its page, How we can help with complaints about continuing healthcare funding.
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How does NHS continuing healthcare affect benefits?
If you’re getting NHS continuing healthcare and living in your own home, your Attendance Allowance, Disability Living Allowance and Personal Independence Payment remain the same.
If the NHS is paying your care home fees, the care component of Disability Living Allowance and the daily living component of Personal Independence Payment and Attendance Allowance will normally stop after 28 days. Your pension shouldn’t be affected.
To get further information about benefits, you can contact the government’s Disability Service Centre . You can also contact the charity Turn2Us.
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Can you get NHS continuing healthcare in Scotland?
Scotland stopped using NHS continuing healthcare in 2015. If someone in Scotland got NHS continuing healthcare before it was stopped, they will continue to receive it so long as they’re eligible.
To get help with paying for social care in Scotland, including paying for a care home, you will normally need to have an assessment from your local council. You can ask your GP or nurse about this, or you can ask the council for an assessment yourself. We have more information about this on our page, How to get social care.
Personal care is free if you live in Scotland. Personal care covers things like help with bathing, showering, preparing food, going to the toilet and help with medicines. It doesn’t include all aspects of social care, including housework or paying for shopping. You may need to pay for these. Whether you need to pay, and how much, is decided by the local council.
If you’re in Scotland and you need to be cared for in hospital, this is free. It’s called Hospital Based Complex Clinical Care – Care Information Scotland has more information about this.
External websites
Beacon CHC- free advice on NHS continuing healthcare
Find your local clinical commissioning group
Find your local health and social care trust in Northern Ireland
NHS England - video on how NHS continuing healthcare works
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