NHS Continuing Healthcare

NHS continuing healthcare is a package of care arranged and funded solely by the NHS. It is designed to support you if you have been identified as having a primary health need as a result of disability, injury or illness.

In 2007, a National Framework for NHS Continuing Healthcare was published by the Department of Health. This was to ensure all primary care trusts across England were assessing and delivering NHS continuing healthcare in the same way. In October 2009 a revised framework was published, this is available on the Department of Health website.

How do we assess who is eligible for NHS continuing healthcare?

You will be assessed to identify whether you have a “primary health need”. This is likely to be a complex medical condition that requires substantial ongoing healthcare. Eligibility is not dependent on a particular diagnosis or disease or determined by the location of where your care is provided. If your assessment does not identify a primary health need you will not be eligible for NHS continuing healthcare. 

We follow national guidance and criteria in assessing your care needs and eligibility. You will be fully informed and involved throughout this process. If you wish, you can ask a member of your family, a friend, a carer or perhaps another representative to support you during this assessment process.  We encourage you do this.

A “checklist” screening tool assessment may be completed initially. This will help to decide if a full assessment, known as a Decision Support Tool (DST) should be undertaken. The DST is used to collate information about your health needs and support the recommendation regarding eligibility. In some cases an urgent decision is needed, for example those who are terminally ill, and can be ‘fast tracked’ to provide timely NHS continuing healthcare.

Your health needs are assessed by looking at all of your care needs and relating them to four indicators:

• Nature – the type of condition or treatment required
• Complexity – symptoms that interact; therefore difficult to manage or control
• Intensity – one or more health needs, so severe they require regular intervention
• Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to the person or others 

If you are eligible NHS Surrey will be responsible for identifying and funding a package of care that has been discussed and agreed with you and your family or representative.
Funding is subject to regular review and if your healthcare needs change the funding arrangements may also change. However, as this is a health funded service it is not dependant on savings or income.

NHS funded nursing care

If you do not qualify for NHS continuing healthcare and are resident in a care home with nursing you may be eligible for NHS funded nursing care (FNC). This type of funding is available for people that have registered nursing needs and are receiving their care in a care home with nursing. However, if you are a resident in a care home with nursing this does not mean that it is automatically suitable for you.

If you are eligible for FNC we will pay the care home directly to fund your care. This means care provided, supervised or planned by registered nurses that are employed by the care home.

If you are paying the full fees for your care home placement you may be reimbursed.  Please talk to the manager of the home to discuss how FNC affects your fees.

Responsibility of social services

If NHS continuing healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive 'mixed' packages of care, where some services come from the NHS and some from social services. Where local social services provide your care, they will usually do a financial assessment to decide whether the person must make any financial contribution.

Appeals

We want you to be happy with the way we assess your needs. If for any reason you are not, we would like to address the issues with you, your relative, friend or representative. We are also able put you in touch with agencies that can offer support and advice.

We will help and guide you through our establish appeals process. It is not necessary to engage legal counsel to pursue an appeal.

Applying for NHS continuing healthcare or NHS funded nursing care in Surrey

If you feel you may be eligible for either NHS continuing healthcare or NHS funded nursing care and you are registered with a GP in Surrey, then you will need to contact the NHS funded healthcare team. Please write to:

NHS Funded Healthcare Team
Pascal Place
Randall’s Research Park
Leatherhead
Surrey
KT22 7TW
or call 01372 201645
email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Useful documents:

The information booklet ‘NHS continuing healthcare and NHS-funded nursing care’ gives a brief overview that you may find helpful and we would recommend you read.

• Retropective Review - frequently asked questions
• Checklist Tool (162kb Word)  
• Decision Support Tool Glossary (38kb Word)
• Decision Support Tool (473kb Word)
• Decision Support Tool User Notes (76kb Word)·    
• Fastrack Tool (208kb Word)
• Fastrack User Notes (35kb Word)

Links to other useful publications and resources:

AgeUK
http://www.ageuk.org.uk/health-wellbeing/doctors-hospitals/nhs-continuing-healthcare-and-nhs-funded-nursing-care/

NHS choices
http://www.nhs.uk/carersdirect/guide/practicalsupport/pages/nhscontinuingcare.aspx

Department of Health
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_115133

Surrey County Council                                                                                        
http://www.surreycc.gov.uk/social-care-and-health/adults-going-into-and-leaving-hospital/nhs-continuing-healthcare

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