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Advice on care

Experts in paying for care

NHS Continuing Healthcare

Nearly all treatment provided by the NHS is free and unknown to many this can also include long term care, but only if your need is primarily a medical or health need that have arisen because of disability accident or illness and not just a social need to help with maintaining independence. This is called NHS Continuing Healthcare and can be provided in any setting (your own home, hospice, or care home). NHS continuing healthcare is also sometimes described as NHS Continuous Care or fully funded NHS care. It is given in limited cases to avoid people remaining in hospital long term to avoid so called “bed blocking”.

Who is eligible for NHS Continuing Healthcare?

Anyone who is assessed as having a certain level of needs may receive NHS Continuing Healthcare. It is not dependent on disease; diagnosis or more importantly the amount of money you have. Providing your need is primarily a health need and not just a social care need, you may qualify for NHS continuing healthcare. Therefore everyone who needs long term care should ensure they are assessed to see if they would qualify as then the care needed would be fully funded by the NHS.

Key indicators as to what may constitute a primary health need include the nature, intensity, complexity and unpredictability of the need. It can also take into account the likelihood of any increase in your needs prior to any next scheduled review.

How do you qualify for NHS Continuing Healthcare?

Firstly you need an assessment. This you have always been able to request in any setting but whereas last year one needed to be carried out prior to any discharge from hospital, since October 2018 discharges can happen without one being carried out with the intention that one is then carried out shortly after the person needing care has either been discharged to either a rehabilitation centre for further observation or after being safely returned home.

Your local Clinical Commissioning Group (CCG) should ensure that a full assessment is carried out once it is possible to assess you, but will remain responsible for paying for your care during any interim period. You should check that an assessment has been done and if not you should ask for one to be done. To find the address of your local CCG check find your Clinical Commissioning Group.

If you are already resident in a nursing home and feel that you should be entitled to continuing care, ask the home manager or your GP to arrange an assessment which will be done by a nurse, doctor or other qualified healthcare professional.

What are the criteria for NHS Continuing Care?

In England an initial assessment is carried out by a single trained assessor using an new initial checklist to assess whether there is any chance of qualifying and therefore a more detailed assessment is even necessary. If so a more detailed Decision Support Tool is then used by a multi-disciplinary team of professionals (comprising at least 2 different people from different disciplines) to try and avoid the inconsistencies previously encountered around the country and therefore more fairly assess people's entitlement to NHS Continuing Care.

If this more indepth assessment deems you should qualify a recommendation is made to your local Clinical Commissioning Group, who will be ultimately responsible for deciding whether you qualify or not.

Both the initial checklist and the more detailed decision support tool looks at 12 different domains or need areas and the support tool also rates you as either low (L), moderate (M), high (H), severe (S) or in some cases priority (P) in each domain:-

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
Other Significant Care Needs – L,M,H,S

The preliminary checklist will ask the person doing it, whether the person being assessed simply exceeds the high level of need statement, meets it or "clearly does not meet it". If this preliminary checklist results in;-

  • 2 or more of these categories being assessed as "High" (or just one if it is a need which carries a priority rating), or
  • Being assessed as "Moderate" in 5 or more categories (unless there is also one which meets the high level when only 4 need to be "Moderate").

A full assessment using the decision Support Tool should be undertaken to assess more comprehensively the persons physical, mental, psychological and emotional needs.
Should this more detailed assessment indicate

  • 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."

A recommendation of eligibility for NHS Continuing Care should then be made to the Clinical Commissioning Group . Likewise if the assessment suggests that 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.

However please note neither of the above outcomes on their own will determine whether you are eligible, with the final decision being taken by the local Clinical Commissioning Group after also taking into account the healthcare's experience and judgement.

Terminal illness

If your claim for NHS Continuing Healthcare is because you or your relative is entering a terminal phase due to a rapidly deteriorating condition and you need a package of care to be put in place urgently, you can ask a Ward Sister or GP to consider an immediate provision of NHS Continuing Healthcare provision under the Fast Track process. If an assessment makes a recommendation for urgent care your local CCG should accept it and provide it immediately but can then reassess using the usual decision making support tool.

For how long will you continue to receive NHS Continuing Healthcare?

If your health merits it, you may receive NHS Continuing Healthcare indefinitely, but your ongoing entitlement will be subject to regular reviews.


Even if successful and you are awarded funding a review of eligibility will be carried out after three months and then again each year.

Appealing a decision

If at the checklist stage you are told you do not meet the criteria for NHS Continuing Healthcare and are therefore not given a full assessment, you can first ask to see your paperwork and then challenge the assessment through the NHS Complaints process.

Should your appeal be successful, the cost of services they deem you need and you have incurred should be refunded to you.

Should you still be unhappy you could take your complaint to the Parliamentary and Health Service Ombudsman (PHSO) The PHSO can be contacted on 0345 015 4033 or via their website

Will my pensions and benefits be affected if I receive NHS Continuing Healthcare?

The affect receiving NHS Continuing Healthcare will have on other benefits will depend on where you receive your care.

Care at Home – Social Security Benefits shouldn't be affected nor your pensions, so you will still be able to claim AA or DLA as long as you meet the eligibility criteria for these benefits. However any benefits which are based on local social services paying for the care might be affected if they stop being responsible for your care when you receive NHS Continuing Healthcare.

Living in a Care Home – State pensions not affected (nor any private or occupational ones) but you will lose Attendance Allowance or DLA after 28 days.

What happens if you do not qualify - Alternative funding – Care Fee Annuities

Should you not qualify for NHS Continuing Healthcare and any appeal is unsuccessful your need for care becomes the responsibility of your local authority, not the NHS. Your local authority is then duty bound to do a financial assessment to see if you can pay for your own care. 

They will only provide any help towards your care if your assessable capital is below £23,250 England, £27,250 Scotland or if you live in Wales £24,000 if you need domiciliary care or £40,000 for care in a care home (2018/19) If not, you will need to pay for your own care.

These threshold figures will include the value of all your own bank accounts, savings, investments, national savings, plus where married or in a civil partnership, also 50% held in any joint accounts. It also includes any money believed to have been deliberately given away over any time period (not just 7 years) if at the time care could have been foreseen. It also will include the net value of any main residence (unless a spouse or civil partner or certain qualifying relatives) will remain living in it and will certainly always include the value of any 2nd property or holiday home you have an interest in, so unfortunately most people do not qualify and have to fund their own care. 

To find out more about all options you may have to fund your own care you may like to view paying for care. To ensure your care can continue indefinitely and your money doesn’t erode totally you should consider a Care Fees Annuity or care fee funding plans ) which is a specialist care fees plan which you can buy with just a single premium but which will then guarantee to pay an income– (your requested benefit -usually just the difference between the cost of care and the income your or your parent/relative will continue to enjoy) indefinitely to meet the cost of care for however long is required. The benefit, if paid directly to your care home or registered care agency (for care at home) is also paid tax free under current rules, and is totally portable so no matter whether you need to change care providers it will continue to pay for the rest of your life.

If you would like us to obtain a free no obligation quotation for a care fees funding plan, please complete our care fees annuity quotation form and we will call you back to discuss it further.

Free Care Fee Annuity Quotes

Find out for yourself just how affordable a care fees annuity could be. Get you free market comparison from ALL providers easily by completing your details here and one of our advisers will call you back to discuss them.

Please note: These plans are not offered direct by the insurers

A Simple Guide To Care Fee Annuities

This may be the first you have heard of care fee annuities, so to help we have produced a free brochure that contains all you need to know about these very tax efficient care fee plans. Download or request your hard copy today.


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