If you have long-term complex health needs, you may qualify for health and social care that’s arranged and funded entirely by the NHS, a service that’s known as continuing healthcare.
Typically, people have to pay for some or all of the healthcare services they receive, but if you are assessed as having a primary health need, you will likely be eligible for this care package, regardless of whether you’re still living independently at home or whether you’re in a specific care facility.
If you’re at home, the NHS will cover all the costs associated with the care you need, while if you’re in a care home, the health service will pay the relevant fees.
Eligibility for this package of care isn’t based on specific health conditions, but rather on whether or not you have ongoing and significant physical or mental health requirements, as well as whether or not the main aspects of most of the care you receive is focused on preventing or addressing health needs.
How do I apply for NHS continuing healthcare?
If you think you might be eligible for the continuing healthcare programme, speak to your GP, live-in carer or social worker as they’ll be able to help and support you along the way.
You can also get in touch with your local integrated care board to explain that you believe you may be a good fit for the service.
An assessment process will then begin, usually with the completion of a Checklist tool by a social worker or nurse to identify whether you need to have a full assessment for the programme.
If you’re referred for a full assessment, evidence will be collected from all those involved in your healthcare provision to develop a more in-depth understanding of your physical, mental health and social care needs.
This evidence will then be reviewed and a recommendation made to your local ICB as to whether or not you’re eligible for the service. The ICB will then confirm their recommendation in writing, explaining their reasons for their decision.
What do I do if I’m not eligible for NHS continuing healthcare?
If the ICB comes back and says you’re not eligible for the continuing healthcare service, you are able to appeal the decision and you can ask the ICB to reconsider. Alternatively, you can use the NHS complaints system to escalate your concerns.
You can also ask to be referred to your local authority if you decide against appealing or if the original decision isn’t overturned. The council will then look at what care and support you may be eligible for, with a means test potentially carried out to judge how much you should contribute towards any care costs you have to pay.
