NHS Continuing Healthcare

What is NHS Continuing Healthcare?
How long may NHS Continuing Healthcare be provided?
Where is NHS Continuing Healthcare provided?
Who can get NHS Continuing Healthcare?
How do I find out if I should receive NHS Continuing Healthcare?
How is eligibility decided?
What if I don't agree with the decision?
What happens if I am not eligible?
Further information

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of health care that is arranged and fully funded by the NHS where someone has been assessed as having very high level care needs.

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How long may NHS Continuing Healthcare be provided?

It may be provided for prolonged periods of time to meet ongoing physical or mental health needs that have arisen as a result of disability, accident or illness, but is not necessarily for life. It will be subject to ongoing review.

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Where is NHS Continuing Healthcare provided?

The care can be provided in a variety of settings, usually a hospital, nursing home or hospice. 

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Who can get NHS Continuing Healthcare?

Any individual of any age, with any illness or disability, may be entitled to NHS Continuing Health Care.  It is entirely dependent on whether an individual is eligible according to their assessed needs and not on a particular disease, diagnosis, condition or age.

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How do I find out if I should receive NHS Continuing Healthcare?

If you are in hospital, you should speak to a member of your hospital care team.

If you are not in hospital, you should contact your GP or your social worker, who will arrange a referral for assessment if they think you may qualify.

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How is eligibility decided?

A comprehensive NHS Continuing Health Care Assessment must be carried out by a multi-disciplinary team, including a medical professional and any appropriate specialist expertise. 

The assessment requires that the views of patients and carers should be taken into account when making any decision.

Copies of the assessment should be provided to patients and carers and the reasons for the decision fully explained. 

To help the multi-disciplinary team record the results of an assessment for NHS Continuing Healthcare, the Scottish Government has developed an Assessment Summary Template.  This is available on the Scottish Government website.

NHS Continuing Healthcare Assessment Summary Template
External Link:
http://www.scotland.gov.uk/Topics/Health/care/17420/AssessmentSummary


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What if I don't agree with the decision?    

A patient or their carer or advocate is entitled to ask for a review of the decision on eligibility for NHS Continuing Healthcare if they do not agree with the decision reached or the process undertaken in reaching a decision.

In the first instance, a request for review should be lodged directly with the multi-disciplinary team within fourteen days.  The NHS Board will then appoint another competent professional with the same level of expertise, to review the decision. Help is provided to those who might need it in terms of deciding to appeal and preparing an appeal. 

The second competent professional will review the documentation and re-assess the patients' needs to decide on whether the correct procedures have been followed and whether the outcome is the correct one. 

Should the patient, carer or advocate remain unhappy with the decision they may proceed to the NHS Complaints Procedure.  The NHS Complaints Procedure is not a route for appeals against decisions on eligibility. However, consideration of a complaint about the process by which a decision has been reached may result in a conclusion that the process was flawed and should be re-run.

If you remain unhappy with the decision from the NHS Complaints Procedure, you can take your case to the Scottish Public Services Ombudsman.

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What happens if I am not eligible for NHS Continuing Healthcare?

If you are not eligible, the NHS remains responsible to meet your ongoing health needs.

A social work Assessment of your Care Needs is still needed to receive social care services from the Local Authority.

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Further information

Age Scotland produce the following factsheet for people aged 60 or over who live in Scotland:

37s Hospital discharge arrangements and NHS continuing healthcare services
External link: http://www.agescotland.org.uk/documents/1022

The Independent Advice and Support Service is a service run by the Citizens Advice Bureau and is available for anyone who uses the NHS and aims to support patients, their carers and families in their dealings with the NHS and in other matters affecting their health.

Independent Advice and Support Service
External link:  http://www.cas.org.uk/Projects/iass-healthcare-concerns/iass-healthcare-concerns

You can contact this service by calling the

Citizens Direct Helpline:

0844 848 9600

or by visiting your local branch of Citizens Advice Bureau. 

Find your local branch on their website:

Citizens Advice Bureau
External link:  http://www.cas.org.uk/

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last updated 04/05/2012