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?
Can I apply to reclaim my care home fees in Scotland?
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 will consider whether you qualify according to the eligibility criteria contained in the NHS Continuing Healthcare guidance.  The guidance states that NHS Continuing Healthcare 'should be provided where there is a need for ongoing and regular specialist clinical supervision of the patient as a result of:

• the complexity, nature or intensity of the patient's health needs, being the patient's medical, nursing and other clinical needs overall;
• the need for frequent, not easily predictable, clinical interventions;
• the need for routine use of specialist health care equipment or treatments which require the supervision of specialist NHS staff; or
• a rapidly degenerating or unstable condition requiring specialist medical or nursing supervision.'

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. 

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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 after you are discharged.  However, you do not have the right to remain indefinitely in hospital once you are ready for discharge.   

A social work Assessment of your Care Needs will be carried out to help identify any social care services you may need arranged for you by your Local Authority Local Authority.

Can I apply to reclaim my care home fees in Scotland?

There have been a number of recent news articles and advertisements by legal claims companies highlighting how people can reclaim care home fees paid in England. 

This scheme does not apply in Scotland.   

Following a number of legal challenges the Department of Health issued new guidance on NHS Continuing Healthcare.  This guidance changed the eligibility criteria to 'those whose overall care needs show that their primary need is a health need'.  This was a significant change to their eligibility criteria, leading the Department of Health to offer to retrospectively repay care home fees of people assessed under the previous guidance.

Scotland has for some time had it's own legal system, and since devolution responsibility for health and social care policy and legislation falls to the Scottish Parliament,  The legal judgements on the English guidance, and repayment of care home fees offered by the department of Health do not therefore apply in Scotland. 

In 2008 the Scottish Government issued updated guidance on NHS Continuing Healthcare to provide more clarity and tighten up assessment and record keeping procedures.  This update did not change the existing eligibility criteria, detailed above. 

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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

The Patient Advice and Support Service is a service run by the Citizens Advice Bureau. It 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.

Find your local branch on the Citizens Advice Bureau website.

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last updated 25/04/2013