CHC Funding

CHC funding

This page was last updated on 1 November 2020

CHC Funding 

NHS CHC stands for NHS continuing healthcare, with continuing meaning long term life care. Health and social care can be expensive, especially if you have no savings, income, or other finances. 

For some people, though, this care is key. The point is, they need the care, regardless of the costs and fees.

Topics that you will find covered on this page

You can listen to an audio recording of this page below.

The system of NHS continuing healthcare helps those in the community that need continuing healthcare by covering the costs, including care home fees. Funding of care costs comes from the local authority health budget, provided you give permission and pass the assessment exercise. 

Below, we give guidance for those wanting a better picture of what continuing healthcare could do for them. 

What is NHS continuing health care?

NHS continuing healthcare gives health and social care to people that are not in a hospital setting. This package of care is delivered in your own home, care home, or other non-hospital environment. 

NHS continuing healthcare funding is provisioned by the government. To figure out if you are eligible for NHS continuing healthcare you will need to undergo assessment procedures. This healthcare assessment determines your care needs and helps the panel make their decisions.

Here is a short video that explains more about NHS funding.

What is considered a primary health need?

Care and support is offered under NHS continuing healthcare if members of your clinical commissioning group decide you have a primary health need. 

A primary health need is one that requires care in the area of healthcare, rather than the area of social or personal care needs. Simply having a diagnosis of a condition does not make you eligible. 

Ultimately, whether you get the NHS CHC support package depends on the two-step assessment by members of your NHS clinical commissioning group (ccg) . The procedure follows a national framework. 

If it is personal care you require support with, seek information and advice to find out what other options are out there. Remember, your CCG wont start the care until you can leave hospital.

What does CHC funding pay for?

Continuing healthcare funding will cover all your health needs. This includes any care home fees, or the cost of health and social care professionals that come to your home. 

However, it does not cover a social or personal healthcare need.  

What is the criteria for NHS continuing healthcare?

Generally, it is a care package with long term healthcare as its main purpose. You must be an adult to apply (for children an alternative service known as a continuing care package is available).  Your accommodation must also be in England, Wales, or Northern Ireland. 

The eligibility for nhs continuing healthcare funding is decided by a multidisciplinary team. They come to your accommodation and conduct an independent review of your health problems. Your health issue can be a physical or mental health problem. 

In the care assessment, the multidisciplinary team from your local health board consider four main things:

  1. What aspects of your health and wellbeing you need support with 
  2. The complexity of your needs
  3. The intensity of these needs 
  4. The unpredictability of your needs (in other words, the level of risk that arises if you do not get support exactly when you need it)

Does dementia qualify for NHS continuing healthcare?

This will depend on the results of your healthcare assessment. Simply having a diagnosis of a  health condition does not mean you are eligible. This is because the assessment exercise considers your healthcare needs, in other words your personal health and ability to cope. 

Whilst the impact on memory can be significant, adults often wrongly assume that their relative will be eligible for the scheme. The patient will still need to undergo the two stage process to see if they can access the scheme. 

"Continuing healthcare funding will cover all your health needs. This includes any care home fees, or the cost of health and social care professionals that come to your home. "

Where can CHC through the NHS be administered?

If, after your assessment, you are eligible to get NHS continuing care you will then need to decide where this is going to be administered. 

There are different options available, and each might require its own different arrangements. 

Generally, NHS continuing care and nursing will be given in an individuals home, care home, hospice, or nursing home. 

You can apply for NHS funded nursing care and an NHS continuing healthcare assessment whilst in hospital. However, the nursing care is given to you when you move home.

Can I access NHS CHC?

Your eligibility is something that depends on the exact nature of your individual problems. There is not a strict set of illnesses that are eligible/not eligible. Instead, eligibility depends on your specific health needs and care needs. 

You will have an initial assessment, and if you pass a specialist will come to you (in your care home if necessary) to assess your circumstances. They will take into consideration the level of support for tasks you require and how complex a support package you might need. 

Then, the experts will decide if you are eligible for NHS continuing healthcare funding.This will only occur with your consent. 

What is a CHC checklist?

This is one part of the two stage assessment for allocation of NHS continuing healthcare. 

It is a screening device used by the clinical commissioning group (ccg) to see who might need NHS continuing healthcare. 

Should evidence from the checklist suggest someone is in need, the health and social care professionals will make a recommendation that they undergo the second stage of review. 

nhs continuing

What options do I have if I am not eligible?

This depends on why you don’t qualify /were not granted assistance.

If you are under 18 and require support with healthcare, nhs continuing healthcare will not be given due to your age. However, children that suffer a disability, illness, or accident, may be eligible for a continuing care package. 

This is only if their health needs can not be met by either the universal care and support on offer or the specialist health services provided by NHS England/Wales/ Northern Ireland. Assessment is conducted by a clinical commissioning group using the decision support tool, which you can view here

Other examples for those with concerns include paying for a private service. For instance, a therapist or carer to help with things such as keeping track of medicines. You could even pay for a room in a private care home if you are happy to change homes. 

Another option is seeing what other health budgets and support are available as an alternative to chc funding. These may be means tested, and might require you get a social worker. 

Family members might also be able to help you out with health care if you cannot get continuing healthcare from your CCG. This can be a helpful option if cost is an issue in your current setting.

continuing healthcare funding

Can I make an appeal?

If you are unhappy with the result of your meeting, it is not the final say. You can start an appeal. This can be a complex and timely process, so you might want guidance from a friend/family member, or advice from an expert. 

You have 6 months after being told you don’t qualify to seek advice and send it to the relevant department.  The board then have 3 months to respond. Make sure you keep all notes from each section of the process, in case you need them later.

Will NHS CHC affect my benefit entitlement?

Whether NHS continuing healthcare will affect your current benefits depends on the benefits you as an individual are currently claiming, and other elements of your individual situation.

For example, if you’re eligible and your place of residence is your home then your Personal Independence Payment will not end. Neither will your Attendance Allowance, nor your Disability Living Allowance (DLA).

However, those in care homes using authority funding will see some benefits change 28 days after NHS continuing healthcare commences. Specifically, you will lose the cost of:

  • The care aspect of your DLA
  • The daily living element of your Personal Independence Payment, and Attendance Allowance 

The good thing is that continuing healthcare will never affect your pension assets. 

nhs continuing healthcare funding

How long should I expect to have to wait for CHC?

Understandably, many people are concerned about the wait time for continuing healthcare funding. The assessment process can take a while, as can a decision. 

Luckily, if your health need is urgent or you are coming to the end of life, you can apply for a fast track priority evaluation. For example, fast track applications are available for those that are in late stages of a terminal illness.

With this process, healthcare packages are normally put in place within 48 hours. Most patients, however, do not meet this criteria since there is not such a tight time limit. Then, the process has a number of stages:

1 – Initial assessment 

The first step of the process is a checklist assessment. It can be carried out by a number of different people, for example a doctor, nurse, GP, or any other staff member that is a medical professional. 

You will have to give consent, and may wish to have a loved one there with you for the assessment. At the end of the checklist evaluation the nurse, GP, or other NHS worker from your CCG will let you know the decision. 

Every decision, and the reasons behind the decision, is recorded in writing by the professionals. The worker should also give every patient their own individual copy of the complete form. 

Remember, the decision solely depends on the checklist and is not under the direct control of the professionals. You can view the framework for assessments here.

The checklist is a standard tool. It does not guarantee that you will be granted any funding. It simply means you have the opportunity to have a full assessment to assess whether you are eligible for NHS continuing healthcare. 

2 – Full assessment

If the outcome of the initial assessment suggests you might be eligible for NHS continuing healthcare  arrangements will be made for a full assessment. This does not guarantee you funding, though. 

During a full assessment a multidisciplinary team (mdt) will visit you in your home, nursing home, or in hospital. The team will have at least 2 different professionals from 2 different healthcare professionals for your assessment. 

You will be informed exactly who is conducting your assessments beforehand, and they generally include a healthcare worker or carer that has experience with you, and already provides you with care and support. 

Again, you should get your own copy of the statement of decision after the continuing healthcare assessment. This report will detail the reasons why a recommendation for funding has or has not been made.  

3 – Planning of the personal health support package 

The final step before receiving your NHS CHC after being told you’re eligible is to meet with the health and social care professionals. Based on your health needs, your continuing healthcare provision will be decided. 

In some cases, conditions mean provision can continue in your own home. In other circumstances, you may need to move to a care home. This is to increase your proximity to the healthcare professional. 

Whilst there is a health budget for care costs, that your local authority will need to stick to, there are often different options available if you need to move. The will give you information and advice, that considers your preferences as well as the cost. 

Ultimately, carers should work with you to help you find the kind of treatment you need and make the choice that is best for you. 

commissioning group

What does the full assessment consider?

The full assessment is used to determine whether you do or don’t qualify for nhs continuing healthcare funding. Each individual patient is considered with regard to their unique situation and support needs. 

There are a number of health needs that assessments consider. For example the main areas of assessment are: breathing, mobility, nutrition, cognition, behaviour, medication, skin (such as ulcers and wounds), communication, and other care needs. 

Assessments rank needs of patients as one of the following: ‘priority’, ‘severe’, ‘high’, ‘moderate’, ‘low’ ,’no needs’. 

Ultimately, the decision  depends on the overall picture the carers and assessment team get, as they decide who is eligible for NHS continuing healthcare

Generally, though, cases where a patient has at least one priority or two severe care needs on their assessment document are granted funding. If you don’t have these rankings though, it doesn’t instantly mean you don’t qualify.

For example,  if you have many high risk factors you might still be eligible for NHS continuing healthcare. It all really depends on their nature, complexity, and your capacity to cope. 

Can I have a mixture of NHS and private CHC ?

With local authority care matters , the council gives you the option to top up your care by paying top up fees. However, you cannot make a top up contribution to your NHS CHC. 

You can, however, pay privately for extra services on top of what the NHS CHC states you are entitled to. For example, you could choose to pay for some help with recovery and rehabilitation. 

eligible for nhs

More information related to paying for care

Paying For Care

If you feel that you need extra support around the house, or that you need to move into a residential care home,  then you may be worried about how you are going to pay for care. Unfortunately, social care is not cheap. While the exact cost of your care will depend on your personal care needs, care fees can easily run in excess of £100,000.

Care Home Costs

Most people are responsible for paying for the full cost of their social care. You will be considered responsible for paying for care home fees if the valuation of your personal assets exceeds the national threshold. The savings threshold is different in England and Northern Ireland than it is in Wales or Scotland. Therefore, the are costs can also differ.

Home Care Costs

If you are thinking about receiving care and support at home, then you may be worried about how much your home care is going to cost. While it is true that the cost of home care is generally far less than the cost of residential care, home care can still amount to a considerable sum. Indeed, it is very common for the cost of in home care to run in excess of £13,000 per year.

Avoiding Care Home Fees

It may come as surprising news to learn that many people are responsible for paying their full care home costs. A person is responsible for funding their own care if the valuation of their personal assets exceeds the national threshold. 

Immediate Needs Care Annuity

An immediate care annuity is an option that can give you peace of mind. Essentially, it is an insurance policy that covers your care fees for the rest of your life by providing you with a guaranteed lifetime income. 

CHC Funding

NHS CHC stands for NHS continuing healthcare, with continuing meaning long term life care. Health and social care can be expensive, especially if you have no savings, income, or other finances. 

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