NHS Continuing Healthcare
Who is eligible for NHS Continuing?
Some individuals that suffer with long-term complex health needs are entitled to free care arranged and funded solely by the NHS. If your needs are complex, intense and/or unpredictable in their nature, it may be deemed that your primary need for care is a ‘health need’. If indeed you are deemed to have a primary healthcare need, you are eligible to have all your care funded by the NHS.
Not many people know about NHS Continuing care and as such, it is important to request an assessment to find out if you qualify.
What is a Primary Healthcare Need?
Unfortunately, for those trying to establish if their needs are primarily health care needs, there is no legal definition nor is there any straightforward definition of a primary healthcare need.
There is no clear-cut list of illnesses, health conditions or diagnosis that automatically qualify you for funding. Ultimately, the assessment will establish whether you have a primary healthcare need by assessing whether the nature of your needs that arise from your health condition are sufficiently complex, intense and/or unpredictable to warrant fully funded care.
Frequently Asked Questions
Integrated Care Boards, known as ICBs assess you for NHS continuing healthcare if it seems you may be eligible for it. It is noteworthy that people do slip through the net so even if a professional does feel you need assessment, they may not voice this directly to you. Further, they may not initiate the assessment, so you need to do so yourself. We can help you with this if you require assistance.
In regard to the process of assessment, for most people there is an initial checklist assessment which determines whether a full assessment (also known as a Decision Support Tool) is required. Indeed, if it is somewhat obvious that you will satisfy the checklist criteria, this step may be skipped, and it may be decided to progress straight the DST stage. Alternatively, if you are terminally ill and require immediate care, your assessment may be fast-tracked.
Many people find that as their needs change, especially following a serious injury where aspects of that injury may recover over time, and as such their eligibility for NHS continuing care may change. Eligibility is reviewed 3 months after an individual is deemed eligible and every 12 months thereafter. The review is in place to consider whether the package of care you are receiving meets your needs and if those needs have changed. It is noteworthy that funding cannot be withdrawn at a review meeting however, the assessor can refer the individual to the ICB/CCG to be reassessed should they feel that the needs have changed significantly.
If you believe the decision that the ICB has made is wrong, you can appeal this decision. Ensure you notify the ICB that you intend to appeal by contacting the ICB that is identified on the decision letter.
If you have been deemed ineligible for fully funded care, you may have been awarded NHS funded nursing care (FNC). Being awarded FNC means that the NHS will pay a contribution towards the costs of your nursing care. This money is only paid if the individual is in a nursing home and is paid directly to the home.