NHS Continuing Healthcare Funding

What is continuing healthcare funding?

NHS continuing healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care November 2012 (Revised). More information about continuing healthcare funding can be found in the NHS Continuing Healthcare and NHS-funded Nursing Care Public Information Leaflet and in the easy read book 'What is NHS Continuing Healthcare'.

How to apply for funding

A health and social care professional such as Social Services, District Nurses, or other specialist Health services can refer you to Continuing Healthcare Care (CHC); please discuss your referral with them. If you do not see any professionals please ring a member of our CHC admin team on 0300 303 8674, or write to us at 2nd Floor, Kingswood House, 14 Wetherby Road, Harrogate, HG2 7SA. Alternatively, email SCRCCG.continuing-care@nhs.net

A CHC nurse will come to visit you  and complete a ‘checklist’ to see if you meet the criteria for a full referral to CHC. This checklist is a screening tool used to identify if an individual needs to be referred for full consideration of whether you qualify for NHS continuing healthcare funding (The National Framework, pages 25-26).

Alternatively you can download and complete this application form and return to the Continuing Healthcare Team.

Decision Support Tool

If you are referred for a full assessment for NHS continuing healthcare funding the Decision Support Tool will be completed following a multidisciplinary assessment. The Decision Support Tool provides a framework to record the various needs in the twelve care domains and should result in an overall picture of the individual’s needs that captures their nature, complexity, intensity and/or unpredictability (The National Framework, pages 27-29).

Fast Track Tool

The Fast Track Tool is used if you have a rapidly deteriorating condition that may be entering a terminal phase (The National Framework, pages 32-34).

Decision

Eligibility recommendations made by the Multidisciplnary team are then sent to the Continuing Care Team to be ratified at the eligibility with the local authority. Whatever the outcome of your assessment you will receive formal notification of the decision in writing.  Your letter will contain the following information:-

  • the date of the assessment/period under review
  • the decision
  • information of how to obtain reimbursement if you are found eligible
  • information about your right of a review of the eligibility decision
  • a contact number for you to call with any queries you might have

Consent and Information Collection

The CCG will require consent from the individual in order to carry out any assessments and to gather any evidence/information required to assess eligibility for continuing healthcare funding and NHS-funded Nursing Care.

If an individual is unable to sign the consent form the CCG will accept a signature from a person who is legally entitled to represent the individual, i.e. a person named in the Lasting Power of Attorney document, Grant of Probate, Deputy appointed by the Court of Protection or named in the Best Interest Decision Form (see more information, follow this link.

Under all circumstances the CCG will require supporting legal evidence for any signature on the consent form other than the individual’s own. When collecting or using personal information the CCG complies with Principle 1 of the Data Protection Act 1998.

Payments

If the CCG agrees to fund your care you will be asked to provide copies of relevant invoices/receipts and corresponding bank statements in order to arrange reimbursement from the date of the eligibility decision.

The CCG will ensure that invoicing arrangements are in place from the date of the eligibility decision. The CCG will only meet direct care costs. Other incidental costs such as hairdressing, chiropody and newspapers will not be met.

If your needs change in the future, you may cease to be entitled to NHS continuing healthcare funding. If this happens and care and support is still required, the CCG will refer you to the local authority for an assessment of your community care needs.

NHS-Funded Nursing Care

Funded Nursing Care (FNC) payments are paid to contribute towards the nursing element of your care in a care home with nursing.

You do not need to apply for FNC as the nursing home will apply for this. The manager of the care home with nursing will advise us of your admission and a Continuing Healthcare Clinical Assessor will carry out an assessment to determine if you are eligible for FNC payments. FNC assessments are undertaken on admission to a care home with nursing or in hospital prior to the admission.

You or your legal representative will be advised in writing of your eligibility. If you are dissatisfied with the outcome of a decision relating to your eligibility for NHS-funded nursing care, you are entitled to ask for a review of that decision. If you remain dissatisfied following local re-consideration you can pursue the matter through our complaints procedures.

For further information or if you have a query about Funded Nursing Care please see the Department of Health Public Information leaflet, the NHS-funded Nursing Care Practice Guide July 2013 (Revised) or contact the FNC Administration team on 0300 303 8294.

If you are eligible for FNC a weekly payment of £155.05 (from April 2017) will be made directly to the care home with nursing.

Funded Nursing Care Assessment Forms, Consent Forms and the Continuing Healthcare Checklist for Assessors to complete can be downloaded on this page.

Review of Eligibility Decisions

You can ask the CCG for a review of your eligibility decision. This needs to be done within six months from the date of your decision letter.

The Department of Health guidance states that if someone is determined as not eligible the 'not eligible' decision stands until the review process is completed which may or may not uphold the initial decision.

CCGs can cease funding from the date of the decision, but will give 28 days’ notice from the date of the decision letter to cease funding.

Continuing Healthcare videos

Personal Health Budgets

From April 2014, everyone who receives NHS continuing healthcare funding will be able to request a personal health budget The local CCG offer is about supporting individuals to achieve positive health outcomes. A Personnel Health Budget (PHB) is the opportunity for individual care to be specific and unique to anyone who meets the criteria for eligibility. If you are interested in a Personal Health Budget then please contact your Continuing Healthcare Coordinator in the Continuing Health Care (CHC) team on 0300 303 8674 or your GP.

For anyone either in receipt of CHC funding or in the process of being referred in to CHC then a PHB is a possible option for you. A PHB gives you the autonomy to select your care team and treatment/therapy that aids your health wellbeing, giving the opportunity for a more flexible approach to your care. Each request is given full consideration, with access to a PHB assessor who will work with you to look at eligibility and options.

For more information please click here

If you are interested in a Personal Health Budget and you are eligible for NHS CHC please contact the CHC team on 0300 303 8674 or email SCRCCG.Continuing-care@nhs.net.

1. PHB Local Offer

2. PHB FAQ's

3. PHB Action Plan