NHS Continuing Care

If ongoing care is required primarily for medical reasons and not principally because of frailty you may qualify for Continuous NHS care funding. NHS continuing healthcare is the name given to a package of services and funding for long term care which is paid for by NHS for people outside hospital with ongoing health needs. You can get continuing healthcare in any setting, including your own home or in a care home.

Anyone assessed as requiring a certain level of care need can get NHS continuing healthcare. It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided.

On October 1st 2007 a new National Framework for NHS Continuing Care was introduced in England and with it a new Decision Support Tool to try and more fairly assess people’s entitlement to free continuing care through the National Health Service, based on their own needs and to try and prevent inconsistencies of decisions around the country over who qualified for this type of free funding for long term care.

The Primary Care Trust (PCT) in whose area your GP practice is located, is responsible for deciding your eligibility

Not everyone living at home or in a care home and who has ongoing health needs is likely to qualify for free NHS care funding, but we would suggest that in the following situations you should ensure your eligibility for it has been assessed ;-

• If you have a rapidly deteriorating condition, which may be entering a terminal phase;
• Before you are discharged from hospital, particularly if it seems a permanent place in a care home may be necessary;
• When your care needs are being formally reviewed on a regular, usually annual, basis;
• If your physical or mental health deteriorates significantly and your current care package seems inadequate

A primary health need should be assessed by looking at all of your care needs and relating them to four key indicators:

• Nature – the type of condition or treatment required and its quality and quantity
• Complexity – symptoms that interact, making them difficult to manage or control
• Intensity – one or more needs which are so severe that they require regular interventions
• Unpredictability – unexpected changes in condition that are difficult to manage and present a The first stage of any assessment will be screening – your potential eligibility for NHS funding by using a checklist of degrees of need in following criteria

Degree of need

Behaviour - L,M, H, S, P
Cognition - L,M, H, S, P
Psychological and emotional needs L,M,H
Communication L,M,H
Mobility_ L,M,H, S
Nutrition – food and drink - L,M,H, S
Continence – L,M,H
Skin and tissue viability – L,M,H,S
Breathing - L,M, H, S, P
Drug therapies and medication: symptom control - - L,M, H, S, P
Altered states of consciousness - L,M, H, S, P

Key : L=Low M=Medium, H=High, S = Sever, P = Priority.

This preliminary check will ask the person doing it ( which can be a variety of professionals possibly a GP or nurse visiting a patient at home or in a residential home or a social worker who is carrying out a community care assessment), whether the person in need of care exceeds the high level of need statement, meets it or “clearly does not meet it”.

If it is assessed that in 2 or more of these categories the person has a high level of need or more, or
in 5 or more categories they might potentially have a high level of need, then a multi disciplinary team will do a full assessment using the decision support tool.

If screening shows that you may qualify for full Continuous NHS healthcare, you will then undergo a full assessment. The full assessment will be a comprehensive assessment of your physical, mental, psychological and emotional needs. This assessment will involve contributions from all of the health and social care professionals involved in your care (the multi-disciplinary team), to build an overall picture of your needs

The completed tool is not meant to determine eligibility for Continuous NHS care funding, but to support the process of establishing a primary health need. However the decision support notes do say that “A clear
recommendation of eligibility should be made if:

• There is a priority need in any of the four domains carrying this level or
• There is a total of two or more incidences of identified severe needs across all domains.”

If there is ;-

• One domain recorded as severe, together with needs in a number of other domains; or
• A number of domains with high and / or moderate needs

this can also indicate a primary health need.

If your assessment says that you don’t qualify for NHS continuing healthcare and you don’t agree with this, you can take this up with the healthcare professionals who are working with you. If you prefer, you can seek help from the Patient Advice and Liaison Service (PALS), which can be contacted through your primary care trust or NHS trust. If you remain dissatisfied with the decision, you may have a ‘right to a review’ by an independent panel of people.

Should your appeal be unsuccessful and do not qualify for Continuous NHS care funding for long term care, you will need to look at other ways of funding your care including Long Term Care Insurances or Investments. To find out more about Long Term Care Insurance then click here