If you have a disability or complex medical issue, you might qualify for free NHS Continuing Healthcare (CHC). NHS Continuing Healthcare (adults) or NHS Continuing Care (children) helps with healthcare needs resulting from disability, accident or illness.

Eligibility

Eligible people can see the full costs of care, including care at home, in a nursing home or hospice met by the NHS. However, eligibility criteria are very strict and even people with long-term care needs don’t always qualify. There’s no specific list of health conditions or illnesses that qualify for funding, but, for example, simply being frail, does not automatically mean that somebody is eligible.

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The best way to ascertain a person’s eligibility is to ask a GP or social worker for an assessment (even if you know somebody with similar needs who has been turned down, it is still worth investigating).

The following, non-exhaustive list of ‘eligible’ health needs represent a few that might be considered:

  • Complex medical conditions that need additional care and support.
  • Long-term medical conditions.
  • Physical or mental disabilities.
  • Terminal illnesses.
  • Rapidly deteriorating health.
  • Mobility problems.
  • Behavioural or cognitive disorders.

Assessment process

An initial screening by a nurse, doctor, social worker or other healthcare professional will be used to establish if you’re eligible for funding. The assessment will cover your general health and care needs including:

  • Behaviour.
  • Cognition (everyday understanding of what’s going on around you).
  • Communication.
  • Psychological and emotional needs.
  • Mobility.
  • Nutrition (food and drink).
  • Continence.
  • Skin (including wounds and ulcers).
  • Breathing.
  • Symptom control through drug therapies and medication.
  • Altered states of consciousness.
  • Other significant care needs.

(In cases where health is deteriorating quickly, a fast track assessment can be arranged to bypass the initial screening.)

If the screening shows that you may be eligible to receive NHS Continuing Care, you’ll have a further assessment by health and social care professionals involved in your care using broadly the same list of needs but this time marking them as: priority, severe, high, moderate or low. (One priority need or two severe needs will usually mean that you are eligible for funding.)

Costs

NHS continuing healthcare or continuing care covers personal care and healthcare costs, such as paying for specialist therapy or help with bathing or dressing. It may also include accommodation if your care is provided in a care home, or support for carers if you’re being looked after at home.

Appealing against an assessment

If you disagree with the outcome of an assessment, you should consider asking your local Clinical Commissioning Group, Health Board or Health and Social Care Trust for a review of their decision (via your social worker or healthcare professional). You should be given an opportunity to contribute to the review and to see all the evidence that was taken into account. (If their decision was only based on an initial screening, ask for a full assessment.)

You should certainly ask for a fresh assessment if your circumstances change. (Even if you don’t qualify for NHS support, you may still be eligible for local authority funding to meet some of your care needs.)

Regional differences

Funding varies by region, so you’ll need to check with your local Clinical Commissioning Group, Health Board or Health and Social Care Trust to see what’s covered.

Budgets and spending

If you qualify and live in England, the NHS can arrange care for you or you can choose to receive funding for your care as a direct payment, known as a personal health budget. A personal health budget gives you more choice and control over how you plan and pay for your healthcare and wellbeing needs.

Personal health budgets are not currently available in Wales, Scotland or Northern Ireland.

A Cap On Care Costs?

As you may already know, the cap regarding the amount of money you need to pay for care has been set at £72,000, as pledged by The Care Act 2014. It is worth noting however, that even once you have spent £72,000 it is unlikely that the state will pay for the rest.

Just to keep the maths simple, say you find a care home that costs £720 a week. It would seem at first glance that after 100 weeks – just under two years – you will have spent £72,000 and then it will be free but this is not the case.

Council rate

The cap actually represents the amount of care you could buy at the rate your local authority would pay.  So if your local council is prepared to pay only up to £650 a week for a care home it would take 111 weeks to reach £72,000, by which time you would have paid £79,920 – and even so, the cap would not have been reached because the portion of fees building towards the cap is just for actual care costs (not ‘hotel fees’ for board and lodgings).

Once the cap is reached, the state will continue to pay only the £420 a week local authority cost of care, leaving you to find the balance of £300 a week in this illustration.

At the moment, in England, anyone with more than £17,000 in savings (and total assets below the value of £118,000) is expected to pay something towards the cost of their care.

The changes to the Care Act 2014 apply only to England. The rules are different in Scotland, Wales and Northern Ireland. (In Scotland some changes to paying for the cost of nursing care in later life began in April 2015.)