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If you or a loved one has an ongoing and complex medical need, you may be able to apply for NHS continuing healthcare. Under the scheme, the NHS will pay for all the care you or your loved one needs, whether it’s provided in a residential care home or by a live-in personal assistant.
NHS continuing healthcare is free and – unlike the local authority funding for social care – it’s not means-tested. It’s provided for people who have conditions such as long-term illnesses, cognitive disorders and mobility issues. However, the rules on eligibility are strict and having a disability or being diagnosed with a long-term illness does not automatically mean you or a loved one will qualify.
Do I qualify?
The decision on whether you qualify for NHS continuing healthcare is based on a medical assessment carried out by a multi-disciplinary team of healthcare professionals. The team includes both medical and social care specialists.
The team will look at what help you need, how complex your needs are, how intense your needs can be and how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time.
Factors taken into account include your breathing, nutrition, continence, mobility, psychological and emotional needs, cognition (understanding), behaviour, drug therapies and medication. The medical assessment team will rate your needs according to whether they are “priority”, “severe”, “high”, “moderate”, “low” or “no needs”. If you have at least one priority need or severe needs in at least two areas, you can usually expect to be eligible for NHS continuing healthcare.
How to apply
The first step is to talk to your GP or social worker about requesting a continuing healthcare assessment. For the assessment, a medical professional will carry out an initial screening at home or in hospital to determine whether you may be eligible for funding.
If the medical professional decides that you are likely to be eligible, the multi-disciplinary team will carry out a more detailed assessment of your condition and healthcare needs.
The results of your assessment will be sent to your local clinical commissioning group (CCG). A CCG is a group of general practices that work together in their local area to commission services for their patients and population.
Your local CCG will make the final decision about whether you receive NHS continuing healthcare. If you are deemed eligible for continuing healthcare, you will be invited to discuss with the CCG the details of how and where you wish to receive your care and which care provider you would prefer to use.
Personal health budgets
Personal health budgets were introduced to give people eligible for NHS continuing healthcare more freedom over how they receive it. Your personal health budget is paid as a tax-free sum that you can use to set up a care package with a provider of your choice.
Vitality Home Health’s live-in care teams look after many people with personal health budgets. We work closely with NHS teams to ensure the best possible care outcomes. Please call one of our team for more information and to talk about your care needs. You can also visit the NHS website.