Continuing Healthcare

What is NHS continuing healthcare?

NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals outside of hospital who have on-going health care needs. A person can receive NHS continuing healthcare in any setting, including their 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 income and savings.  

If found to be eligible for NHS continuing healthcare in your own home, the NHS will pay for healthcare (e.g. services from a community nurse or any specialist therapist that may be required) and associated social care needs (e.g. personal care and domestic tasks, help with bathing, dressing and food preparation) – in a care home, the NHS also pays care home fees, including board and accommodation.

Who is eligible for NHS continuing healthcare?

Anyone over 18 years of age assessed as having complex, intense or unpredictable health 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.

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 for NHS continuing healthcare, your care will be funded by the NHS – this is however, subject to regular reviews, and, should your care needs change, the funding arrangements may also change.

Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:

  • Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs
  • Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care
  • Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/on-going care
  • Unpredictability  this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.

Assessments for continuing healthcare are usually carried out using the decision support tool where a recommendation on eligibility is made by a multi-disciplinary team which is coordinated by a continuing healthcare nurse assessor. Referrals for assessment can be made by any healthcare professional, care manager or social worker who has been trained using a checklist.    

End of life care

Sometimes a person over 18 is in need of an urgent package of care due to a rapidly deteriorating condition which may be entering a terminal phase. Because of that deterioration, a person may be eligible for a healthcare assessment using a Fast Track Tool instead of the usual assessment in order to speed up decision making relating to continuing health care eligibility.

Birmingham and Solihull CCG is responsible for leading the process of identifying if a person is eligible for continuing healthcare or a Fast Track End of Life Care assessment for whom it has commissioning responsibility under Section 3 of the NHS Act 2006.

Continuing care

What is children and young people’s continuing care?

A continuing care package will be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or special services alone. 

Some children and young people (up to 18-years-old), may have very complex health needs. These may be the result of congenital conditions, long-term or life-limiting or life-threatening conditions, disability, or the after-effects of serious illness or injury.

These needs may be so complex, that they cannot be met by the services which are routinely available from GP practices, hospitals or in the community commissioned by CCGs or NHS England. A package of additional health support may be needed. This additional package of care is known as continuing care.

Continuing care is not needed by children or young people whose needs can be met appropriately through existing universal or specialist services through a directly contracted case management approach.

The CCG is responsible for leading the process of identifying if a child or young person is eligible for continuing care assessment for whom it has commissioning responsibility under Section 3 of the NHS Act 2006. 

 

More information is available below: