continuing healthcare

NHS continuing healthcare – 5 things you need to know about eligibility


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Continuing Healthcare Information and Advice

Thousands of people across the UK need to receive ongoing care due to disability, accident or illness. For those that are assessed as eligible, the NHS funds the full cost of this care for people in England under the policy called NHS continuing healthcare (CHC).

Sound simple? It’s not. The eligibility criteria are complex and nuanced, and their interpretation is open to disagreement. While some people have a positive experience of NHS continuing healthcare, some patients and carers receive little or confusing advice, or experience flawed eligibility decisions based on poorly interpreted information.

Here Dan Harbour from Beacon CHC has put together five quick facts about NHS continuing healthcare eligibility that you should bear in mind when preparing for your own, or your loved-one’s, assessment for funding or if you are considering challenging a decision. Consider this a starting point, and then keep on researching so you feel well prepared and informed.

5 important facts about continuing healthcare

Here we’ve put together five quick facts about NHS CHC eligibility that you should bear in mind when preparing for your own, or your loved-one’s, assessment for funding or if you are considering challenging a decision. Consider this a starting point, and then keep on researching so you feel well prepared and informed.

continuing healthcare

  1. Continuing healthcare is not just for nursing home residents

NHS continuing healthcare is not restricted to any particular setting and can be received anywhere, including in a care home without nursing, or in your own home. Assessments must be based on the individual’s assessed care needs, regardless of where that care is delivered or whether the setting is appropriate.

However, our experience has shown that some assessment teams still struggle to apply this important principle.

  1. Diagnosis doesn’t guarantee eligibility

Eligibility for NHS continuing healthcare is not judged on a person’s diagnosis. So, even if you’ve been diagnosed with Parkinson’s, Alzheimer’s or another degenerative condition, it doesn’t guarantee that you will assessed as having a ‘primary health need’ that qualifies you for NHS CHC.

Instead, eligibility is determined by the assessment of your day-to-day care needs and how those needs should be met.

  1. Beware promises

Unless a professional has spent time working within the dedicated field of NHS continuing healthcare, it’s worth treating personal opinions of your eligibility for funding with scepticism.

We frequently hear of false promises being made to people about their chances of eligibility by health and social care professionals. While this gives hope and reassurance at the time, it can be a cruel blow if continuing healthcare is then refused.

Conversely, a lack of understanding of your particular care needs – or of the continuing healthcare system – might lead an individual to assume that you wouldn’t be eligible, when perhaps you are.

Eligibility is based upon the presence of a ‘primary health need’ which is established through an in-depth assessment process involving a multidisciplinary team. Until this process has taken place nobody can unilaterally decide that an individual will or will not be eligible, even your GP.

  1. Money shouldn’t matter

NHS continuing healthcare is not means tested and financial considerations must not be taken into account in your assessment of eligibility. Coordinating assessors should not ask you questions about your financial situation and you should also be told whether or not you are eligible for CHC before a means-tested social care assessment takes place.

  1. Continuing healthcare eligibility is not for life

NHS CHC is based on an assessment of care needs and how those needs should be met, and it is common for these needs to change over time. Once eligible, expect your care needs to be reviewed three months from the original decision, and each year after.

Sadly this means that individuals can lose their right to NHS funding at a later stage, despite having similar needs.

For example, someone with dementia who presents with challenging behaviour may be immobilised by a fall or stroke. Although the diagnosis of dementia has not changed – and in fact the person’s health has worsened and other health needs have emerged – the management of their needs may have become less intense because they are no longer mobile. Consequently the person may be assessed as no longer having a primary health need. Of course, this type of scenario is extremely upsetting for families.

If eligibility for continuing healthcare is being withdrawn from you or your loved one, you should request a thorough written explanation of the change in care needs from your Clinical Commissioning Group. If you disagree with the explanation and you feel you are still eligible for NHS continuing healthcare, you can challenge that decision.

About Beacon

Beacon CHC is a UK-wide social enterprise with profits donated to charity to fund vital older peoples’ services.

We run a free Information and Advice Service – funded by NHS England but staunchly independent – for people in England who need help to understand and navigate the CHC system. We also have a free toolkit, which provides a comprehensive guide to the system, including eligibility assessments and appeals

In addition to our free service, our specialist caseworkers provide an affordable, comprehensive and ethical advocacy and support service for people that want extra support.

This blog was written by Dan Harbour.


More information on NHS continuing healthcare

You can read more about continuing healthcare here.

Advisors that can help you get continuing healthcare from the NHS

We have a directory of specialists that can help you apply for or challenge decisions regarding continuing healthcare.  You can find the directory here.

How can you pay for your care?

Read our detailed guides on the options you have available if you need to pay for your own care.