What is NHS Continuing Healthcare?

nurse feeding a disabled woman

NHS Continuing Healthcare

NHS Continuing Healthcare is a package of care that some people are entitled to receive as a result of disability, accident or illness. It covers the full cost of the person’s care and residential accommodation.

NHS Continuing Healthcare is available to adults living in England who have particularly intense, complex or unpredictable care needs. Unlike local authority funding, it is not means tested.

Who is eligible?

Eligibility is not based on diagnosis, so it’s not possible to say that if you have a particular condition – or group of conditions – you will be eligible for NHS Continuing Healthcare.

Instead, it must be proven that the individual has a ‘primary health need’. This means that their care requirements are primarily for healthcare, rather than social or personal care needs.

This is usually judged via a two-step assessment process; a Checklist followed by a Full Assessment.

How does it work?

To work out if you are eligible for NHS Continuing Healthcare, a team of professionals should assess your needs against a set of criteria. They make a recommendation of whether they think you’re eligible or not to your local Clinical Commissioning Group (CCG – the people who make spending decisions about healthcare in your area).

To be eligible, most people are assessed over a two-stage process: an initial Checklist, which if positive, is followed by a Full Assessment.

If an individual is reaching the end of their life, they may instead have a Fast Track Assessment.

Problems in the system

The first problem is that many people who may be eligible for NHS Continuing Healthcare, are not made aware of it.

Second, the eligibility criteria used in assessment are open to interpretation and applied inconsistently. On top of this, the administration of the system is often flawed. Our experience is that the coordinators assigned by CCGs to carry out assessments have sometimes not be trained to properly understand the National Framework – the guidelines that should be followed – or principles of eligibility.

This lack of openness, clarity, consistency and good practice has created an imperfect system that is poorly understood. Patients and professionals, alike, find it extremely difficult to navigate.

Many of our clients tell us that the process is stressful, complex and overwhelming.

How we can help

At Beacon, we live and breathe NHS Continuing Healthcare and – for more than a decade – our experts have helped more than 15,000 people to navigate the process. And we have helped families win over £8 million in care funding.

We can provide free advice and answer your questions about the process through our Information and Advice Service.

And our caseworkers can provide affordable services to support you at any stage of the process; from being your expert advocate at your assessment, to managing your appeal from start to finish.