RELEVANT INFORMATION

Department of Health and Social Care documents:

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care 

NHS Continuing Healthcare Decision Support Tool

NHS Continuing Healthcare Checklist

NHS-Funded Nursing Care Practice Guidance

NHS Continuing Healthcare Fast-Track Pathway Tool

May 2019: This chapter was amended to reflect the revised guidance, as linked above. Section 1, Introduction has been updated and links to guidance information have been updated.

1. Introduction

Continuing Healthcare is care arranged and funded by the NHS, and provided to adults with ongoing healthcare needs. It is free of charge, unlike care from adult social care for which there may be a charge depending on the adult’s income and savings (see Charging and Financial Assessment).

It can be provided in any setting, including a care home, nursing home, hospice or the home of the adult with the healthcare needs. It will cover the person’s care home fees (including board and accommodation), personal care (help with bathing, dressing and laundry for example) and healthcare costs (community nursing or specialist therapy services for example).

For adults living at home, it will cover their personal care and healthcare costs.

Support for carers may also be available – see NHS Continuing Care: Information for Carers.

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health and Social Care) was revised in October 2018. The updated framework includes updates to practice guidance and checklist, decision support and fast track pathway tools. It also clarifies key areas of policy and practice including:

  • most CHC assessments should be done outside acute settings in order to ensure more accurate assessments and avoid unnecessary hospital stays;
  • when no screening is needed;
  • that reviews should look at the appropriateness of care packages rather than reassessing eligibility; and
  • new principles for clinical commissioning groups (CCGs) to resolve local disputes.

2. Eligibility

See also Decision Support Tool for NHS Continuing Health Care and NHS Continuing Health Care Checklist

To be eligible for NHS continuing healthcare, the adult must be assessed as having:

  • a ‘primary health need’; and
  • a complex medical condition with substantial and ongoing care needs.

Not all those with a disability or long term health condition will be eligible.

A decision about whether or not an adult is eligible should usually be made within 28 days of completion of the assessment.

If the person is not eligible for continuing healthcare funding, the local authority maybe responsible for assessing their care and support needs and providing services if they are eligible to receive such services.

If the adult is not eligible for NHS continuing healthcare but are assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For an adult who lives in their own home, this may be provided as part of a joint package of care and support, where some services come from the NHS and some from adult social care services (see Integration, Cooperation and Partnerships, Eligibility and Charging and Financial Assessment chapters).

If the adult moves into a nursing home, the NHS may contribute towards their nursing care costs.

Once eligible for NHS continuing healthcare, care will be funded by the NHS but this is subject to review, should care needs change the funding arrangements may also change.

3. Information for Adult Social Care Staff

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health and Social Care) sets out the principles and processes which should be applied in order to assess an adult’s eligibility for NHS continuing healthcare and NHS funded nursing care. NHS funded nursing care is also referred to as ‘single band nursing’ or ‘FNC’.

Joint working between NHS and adult social care and any other partner organisation who are involved, is essential in order to ensure the person’s needs are met in the right way and that their care is effectively coordinated. The National Framework sets out local authority responsibilities in relation to NHS continuing healthcare.

3.1 Other links to national guidance and legislation

NHS Funded Nursing Care Practice Guide July Department of Health 2013

The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations (2013)

3.2 Issues for adult care practitioners

In order to understand and be able to implement continuing healthcare procedures, staff should:

  • familiarise themselves with the National Framework for NHS Continuing Healthcare documentation as above;
  • understand the definition of ‘primary health need’;
  • be familiar with the Decision Support Tool;
  • be able to apply the four key indicators:
    • nature,
    • intensity,
    • complexity and
    • unpredictability,

as well as the primary health need test to the adult’s assessed needs.

Where at all possible the same staff member should be involved with the adult and their carers throughout the continuing healthcare assessment process.

3.3 Consent

Before completing the Checklist and the Decision Support Tool (DST) (see below), consent must be obtained and recorded. Consent is sought for:

  • completion of the DST;
  • sharing of the adult’s personal information between different organisations involved in their care, and the continuing healthcare assessment and decision making process.

If there is a concern that the person may not have Capacity to give consent, this should be determined in accordance with the Mental Capacity Act 2005 and Code of Practice (see Independent Advocacy chapter). A third party cannot give or refuse consent for an assessment of eligibility for NHS continuing healthcare on behalf of a person who lacks capacity, unless they can demonstrate they have a valid Lasting Power of Attorney for Welfare or that they have been appointed a Welfare Deputy by the Court of Protection. A third party holding Enduring Power of Attorney or Lasting Power of Attorney for Finance cannot give consent for continuing healthcare.

3.4 Decision Support Tool

See Decision Support Tool for NHS Continuing Health Care and NHS Continuing Health Care Checklist

The Decision Support Tool is used to inform the decision as to whether a person is eligible for NHS continuing healthcare. It is not an assessment in itself; the information gathered will need to be supplemented with professional analysis and conclusion. It is designed to assist data collection, analysis and presentation of information of the adult’s healthcare needs, including evidence from assessments and reports completed by other members of the multidisciplinary team (MDT).

3.4.1 Multidisciplinary working

All assessments should be completed before the adult attends the MDT meeting. Adult social care staff should actively participate in deciding the MDT’s recommendation regarding the adult’s eligibility.

Where they do not agree, they should state their opinion / recommendation/s which should be supported in writing using the four key indicators as listed in 3.2 Issues for Adult Care Practitioners and apply the primary health need test.

Both the MDT recommendation and the decision should be recorded in the adult’s case records.  The continuing healthcare process regarding an adult’s eligibility for NHS continuing healthcare, including assessment and decision, should not take longer than 28 days for to completion. This target is set by the Department of Health and Social Care.

3.5 Disputes

There are two types of disputes that may arise in relation to NHS continuing healthcare:

  1. challenges by the adult or their carer / advocate, including requests for reviews (also known as appeals). Staff may be involved in the appeal process, including undertaking an assessment / review of the person’s needs and attending MDT/DST meetings;
  2. disputes between NHS and local authorities. In such cases staff should provide a clear rationale for disputing the outcome. This should include reference to the four key indicators. A dispute in relation to an outcomes should usually be made in writing within 28 days of the date on the letter. Local Clinical Commissioning Group processes should be followed.

3.6 Equipment

Adults who are eligible for fully funded NHS continuing healthcare should have access to joint equipment services, where appropriate, the equipment provided, however, will be funded by the NHS. Standard catalogue items will be funded by local community health services; specialist items will be funded by NHS continuing healthcare.

3.7 Ordinary residence

See also Ordinary Residence chapter

An adult’s eligibility for NHS continuing healthcare may vary, due to changing needs. Eligibility, therefore, is not necessarily permanent. Following a review, this may mean someone who is receiving fully funded NHS continuing healthcare becomes eligible for local authority service provision and funding.

Where an adult is an ordinary resident in a local authority area when they are awarded fully funded NHS continuing healthcare and placed in an out of county care home, they remain the responsibility of that adult social care if, following a review, they are no longer eligible for fully funded NHS continuing healthcare.

See Guidance on the Identification of the Ordinary Residence of People in Need of Community Care Services, (Department of Health, 2011).