NHS CONTINUING HEALTHCARE · EXPLAINED
What is NHS Continuing Healthcare?
NHS Continuing Healthcare — usually shortened to CHC — is a package of ongoing care arranged and funded solely by the NHS for adults who are assessed as having a primary health need. It can fund care in a care home or in a person’s own home, and it is not means-tested.
What does CHC funding mean?
In practical terms, CHC means the NHS takes responsibility for arranging and funding the assessed package of care because the person’s needs are primarily health needs rather than needs that a local authority could lawfully be expected to meet as social care.
The Department of Health and Social Care’s National Framework describes NHS Continuing Healthcare as an ongoing package of health and associated social care for an adult who has a primary health need. The key issue is therefore not the diagnosis, the value of the person’s home or the amount in their savings account. The issue is the nature, intensity, complexity and unpredictability of the care needs.
What can NHS Continuing Healthcare pay for?
Care-home fees
Where the assessed care package is delivered in a care home, CHC can fund the care and accommodation required to meet the person’s assessed needs.
Care at home
CHC is not limited to nursing homes. An eligible person can receive an NHS-funded package in their own home, subject to the assessed care plan.
Nursing and personal care
The package can include nursing, personal care, supervision, therapies and other services required to meet the assessed needs.
Equipment and support
The care plan may include equipment, specialist input and support necessary to manage risks and deliver the agreed package safely.
Exactly what is funded depends on the individual assessment and care plan. CHC is not a fixed cash award and it does not mean that every preferred service or provider must automatically be funded.
Who may qualify?
There is no automatic qualifying diagnosis. Dementia, Parkinson’s disease, stroke, multiple sclerosis, acquired brain injury and other serious conditions may all be relevant, but the diagnosis alone does not determine eligibility.
The assessment asks whether the totality of the person’s needs amounts to a primary health need. The National Framework uses four characteristics to help analyse that question:
Nature
What the needs are, what interventions are required and the consequences if care is not provided properly.
Intensity
How severe, frequent and sustained the needs are, including the quantity of care required through the day and night.
Complexity
How different needs interact and whether those interactions require greater skill, judgement or coordination.
Unpredictability
How much the needs fluctuate, how difficult changes are to anticipate and the risks created by delay or an incorrect response.
THE ASSESSMENT ROUTE
How the CHC process works
Checklist
A screening tool is often used to decide whether the person should proceed to a full CHC assessment.
Full assessment
A multidisciplinary team considers the care needs and normally completes the Decision Support Tool across 12 care domains.
Recommendation and decision
The multidisciplinary team makes a recommendation and the Integrated Care Board makes the eligibility decision.
Challenge if necessary
If CHC is refused, there are routes to challenge the decision, including local resolution and potentially an Independent Review Panel.
CHC is different from NHS-funded Nursing Care
NHS-funded Nursing Care, usually called FNC, is different. FNC is a contribution from the NHS towards the registered nursing element of a nursing-home placement where the person is not eligible for full CHC but does require care from a registered nurse.
CHC is broader: where a person is eligible, the NHS is responsible for arranging and funding the assessed package of health and associated social care. FNC is a contribution towards nursing care rather than full CHC funding.
Can CHC apply if the family is already paying?
Yes. Being a self-funder does not prevent a person from being assessed for NHS Continuing Healthcare. If care fees have already been paid, it may also be appropriate to examine whether there is a basis for challenging an earlier decision or asking for a retrospective assessment of a previously unassessed period of care.
Current funding
If the person is receiving care now, the immediate issue may be whether a Checklist or full assessment should take place, or whether a recent refusal should be challenged.
Who qualifies for CHC? →Fees already paid
If substantial fees have already been paid, the relevant route may involve a retrospective CHC claim, depending on the dates, records and previous NHS decisions.
Retrospective CHC claims →Where can CHC be provided?
NHS Continuing Healthcare can be provided in a range of settings outside hospital. That includes a person’s own home, a residential care home, a nursing home and, depending on the circumstances, other appropriate settings. The location itself does not decide eligibility.
This page focuses on the English CHC framework. Wales has a separate system and guidance.
Official sources
For the underlying rules and public guidance, see the official National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, the NHS England Continuing Healthcare guidance and the NHS public guide to Continuing Healthcare.
FREE INITIAL CHECK
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