NHS continuing healthcare

NHS continuing healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals outside of hospital who have long-term complex health needs.

You can receive NHS continuing healthcare in any setting, including your own home or in a care home. NHS continuing healthcare is free, unlike support provided by local authorities for which a financial charge may be made depending on your income and savings.

Anyone over the age of 18 assessed as having a certain level of care needs may be entitled to NHS continuing healthcare. It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided. Our local offer for children and young people is at the bottom of this page.

If your overall assessment of care needs shows that you have a ‘primary health need’, you should be eligible for NHS continuing healthcare. Once eligible, your care will be funded by the NHS. This is subject to regular reviews, and should your care needs change the funding or arrangements may also change.

As a CCG, we operate under the following policies:

Requesting an assessment

If you think that you or a member of your family may be eligible for an assessment, you can request a professional involved in the person’s care to complete the first stage of the assessment, which is called the checklist. This can be a nurse, doctor, or other qualified health or social care professional, and they should have knowledge of the person and their care.

If you are being discharged from hospital, the Discharge Planning Team can complete a checklist when you are medically fit to be discharged. If you are leaving a period of rehabilitation such as an intermediate care placement, you may also be assessed using the checklist when you are medically fit to go home.

If a person is suffering from a terminal illness and entering the final stage of their illness, they can be assessed using a fast-track assessment tool. This can only be completed by a medical professional who has knowledge of the person and their care.

Visit the NHS website for more details on the assessment process and eligibility.

What happens next?

If you are eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.

Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget – see below for our local offer.

If it’s agreed that a nursing home is the best option for you, there could be more than one local care home that’s suitable. You will be given 3 options to choose from.

The team will work collaboratively with you and consider your views when agreeing your care and support package and setting where it will be provided. However, there are other factors that will be taken into account, such as the cost and value for money of different options.

Your needs and support package will normally be reviewed within 3 months and thereafter at least annually to consider whether it meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.

A personal health budget (PHB) is an amount of money to support your identified health and wellbeing needs, planned and agreed between you and your local NHS team. The aim is to give people with long-term conditions and disabilities greater choice and control over the healthcare and support they receive.

Eligibility for a PHB is determined by national legislation, along with local health needs, financial constraints and other factors. Hastings and Rother, Eastbourne, Hailsham and Seaford and High Weald Lewes Havens CCGs have identified the following groups of people to be eligible to apply for a PHB at this time:

  • Those receiving children and young people’s continuing care
  • Adults eligible for NHS continuing healthcare

 


Personal health budgets have been available to certain groups since 2014.  A Letter from NHS England to CCGs (1st May 2018) sets the expectation that PHBs for adults will become the default/standard operating model for NHS CHC home care packages by April 2019.

People will know what their budget is, will be involved in personalised care and support planning and have greater control over how the budget is used, including the option of a direct payment. This will be implemented gradually from August 2018 as home care packages are reviewed by the case management team within continuing healthcare.

Your local Clinical Commissioning Group (CCG) is accountable for the local offer and governance of PHBs, working together with partners to ensure that they are managed and issued appropriately. PHBs are signed off by the CCG and all direct payment cases and high-risk items are discussed at a monthly risk panel where cases are considered against the CCG policy, NHS continuing healthcare framework and the NHS commitment to fairness and equality.

If you are not eligible for NHS continuing healthcare, but you’re assessed as requiring nursing care in a nursing home, you’ll be eligible for NHS-funded nursing care.

NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.

You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care. Most people don’t need a separate assessment for NHS-funded nursing care, but if you do need one, the CCG can arrange one for you.

If you are eligible, the NHS will fund nursing care provided by registered nurses employed by the nursing home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.

Some children and young people (up to the age of 18) have very complex health needs that may be a result of congenital conditions, long-term of life-limiting conditions, a disability, serious illness or injury.

Children with such complex needs may need additional health support to that which is routinely available from GP practices, hospitals or in the community through Universal Services.

If a child or young person meets the criteria for children and young people’s continuing care, the CCG will commission care at home or in external respite to support their health needs.

Assessment of needs and eligibility takes place in collaboration with other services such as education, social care and allied health professionals using a decision support tool and checklist. We are governed by the National Framework for Children and Young People’s Continuing Care.

If your child needs immediate support, for example because they need palliative care, there is a fast-track process to ensure that their care can be put in place as soon as possible.

Planning for transition into adult services (NHS continuing healthcare) begins at the age of 14 and assessment takes place in the months running up to a young person’s 18th birthday. Speak to a health or social care professional who works with you if you think your child should be assessed for NHS continuing care.

Click here to download an information leaflet about children and young people’s continuing care.

The CCG team can help if you have any further questions. Call 01323 466120, email Hrccg.eastsussexchildrenscontinuingcare@nhs.net or send queries to:

Children and Young People’s Continuing Care Team
Limousin House
Lower Ground Floor
4 Athelstan Close
Eastbourne
BN23 6TE

Contact us

Integrated Continuing Healthcare Team
Limousin House
Lower Ground Floor
4 Athelstan Close
Eastbourne
BN23 6TE

T: 01323 466120
F: 01323 466149

Email: ASC.CHCDutyteam@eastsussex.gov.uk

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