NHS Continuing Healthcare

NHS Continuing Healthcare is the provision of care over an extended period of time for individuals aged 18 years or over, to meet a physical or mental health need that has arisen as the result of disability, accident or illness.

NHS Continuing Healthcare means a package of NHS Continuing Healthcare arranged and funded solely by the NHS to meet an individual’s health needs within the resources available.

Anyone over 18 years old registered with a GP in Cambridgeshire and Peterborough may be eligible for NHS Continuing Healthcare (CHC) funded support if they have ongoing complex healthcare needs and a Primary Health Need is established through assessment. Everyone is different and people do change so ongoing reviews are completed to ensure the correct support is in place to meet their needs at the right time.  If you do not meet the criteria for CHC and live in a nursing home, NHS-funded Nursing Care may be available to you

For greater choice over how their health and care needs are met, people receiving continuing healthcare may like to consider a Personal Health Budget (PHB). 

The Q&A below provides further detail about these services and how to apply. NHS Cambridgeshire & Peterborough hosts these services.

What is NHS continuing healthcare?

NHS continuing healthcare is a package of ongoing care that is arranged and funded solely by the NHS. It is designed to support people aged 18 or over who are found to have a primary health need which have arisen as a result of disability, accident or illness.
The national framework for NHS continuing healthcare and NHS funded nursing care explains how it works and how eligibility is decided. The framework ensures that those assessing and delivering NHS continuing healthcare, do so in the same way.
Please note: NHS Cambridgeshire & Peterborough can only accept the following documentation when applying for continuing healthcare:  
•    CHC Checklist
•    Decision Support Tool
•    Fast Track Tool

These tools and all relevant and updated documents regarding NHS continuing healthcare and NHS funded healthcare can all be found under the 'Useful CHC documents' heading at the top right of this page.

How is eligibility for NHS continuing healthcare assessed?

The first step is to have a screening tool completed with a health or social care professional (a checklist). Health and social care staff use the checklist to help judge whether a full assessment for NHS Continuing Healthcare should happen. 

The second step is a full assessment of eligibility. This involves a multi-disciplinary team applying the ‘Decision Support Tool’. The tool will be completed by health and social care professionals. This looks at twelve different types of need, for example, mobility, nutrition, and behaviour. The tool helps decide on the nature, complexity, intensity and unpredictability of your needs known as 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 to do this.

In some cases, an urgent decision is needed, for example those who are terminally ill, and this can be assessed via use of the fast Track Tool to provide timely NHS continuing healthcare for those rapidly deteriorating and entering a terminal phase.

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 Cambridgeshire & Peterborough 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. As this is a health funded service it is not dependent on savings or income.

What is 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 who have registered nursing needs and are receiving their care in a care home with nursing. Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for FNC.

If you are eligible for FNC, it will be paid to 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 self-funding your care at the nursing home, these funds should be reflected in your care home fees.

Please talk to the manager of the home to discuss how FNC affects your fees. If your placement is funded by social services, the FNC payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

What if social services currently provide my care?

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.

How do I apply for NHS Continuing Healthcare or funded nursing care?

If you feel you may be eligible for either NHS continuing healthcare or NHS funded nursing care and you are registered with a GP within the NHS Cambridgeshire & Peterborough area then please speak to your social worker, GP or other health or social care professional and request a CHC checklist 

You can also contact the Complex cases team on: 0330 057 1022 
Email us: capccg.complexcases-chc@nhs.net 

Cambridgeshire area: 0345 045 5202 or email careinfo@cambridgeshire.gov.uk
Peterborough area: 01733 747474 (option 5) 

What is a personal health budget?

A personal health budget is an amount of money that can be spent on meeting someone’s long-term health and wellbeing needs they have been found eligible for CHC. Patients will be able to receive their personal health budget payments direct, so they can make their own arrangements to purchase the services they need. Or they could have their budget managed by another organisation such as a charity or the NHS will commission the service direct if they prefer.

The allocation of this budget is agreed between the individual and their continuing healthcare team, based upon a detailed care and support plan which identifies both healthcare and wellbeing outcomes.

We believe everything we do should focus on people’s individual health and wellbeing needs. That’s why wherever possible, we are trying to personalise the things we do.

Many people have said that by using a personal health budget, they have more flexibility, choice and control over how money gets spent on their care and support and makes them feel more involved and more positive. A personal health budget enables you to work with a healthcare professional to prioritise the care needs that are important to you and create a care plan that reflects your own personal health and social goals.

Who can have a personal health budget?

If you are registered to a GP within the NHS Cambridgeshire & and Peterborough area, are eligible for NHS Continuing Healthcare and are receiving your care at home, you can ask for a personal health budget.

I'm eligible, so how do I get a personal health budget?

There are six basic steps to organising a personal health budget:

1. Getting clear information
Start by talking to the NHS team who currently look after you to find out if you would be eligible for a personal health budget. If you have been referred to our Complex Cases Team, we can tell you how personal health budgets work for people who receive continuing healthcare.
If you have recently received confirmation that you are eligible for continuing healthcare funding, a package of care and support will be put in place for you. Your care and support needs will be reviewed after three months, if your needs have changed, the review will also consider whether you remain eligible for CHC if you are still eligible for continuing healthcare funding at this time, the continuing healthcare nurse will talk to you about the potential benefits of a personal health budget and whether you would be interested in having one.

2. Understanding your health and wellbeing needs
Your health and wellbeing needs will be assessed by your multi-disciplinary team (which may include a community nurse, social worker, and other health professionals). The team, supported by a continuing healthcare nurse, will discuss with you how the personal health budget may work. An important part of setting a personal health budget is agreeing how the care you receive will benefit your health – your team will talk this through with you.

3. Working out the amount of money that may be available
As soon as continuing healthcare funding is confirmed, at three months your nurse can work out the amount of money that will be available to you in your personal health budget. The amount of money will be based on your health and wellbeing needs and what a conventional package of care would look like. Have a chat with your continuing healthcare nurse if you have any questions or concerns.

4. Making a personalised care and support plan
If you choose to have a personal health budget, you will need to have a personalised care and support plan (sometimes called a Health Support Plan). This is developed by you and your support planner – together you will design a plan that meets your needs and meets NHS funding rules. 

5. Organising care and support
As soon as your Health Support Plan has been approved, your personal health budget will need to be “activated” – this can be organised in a number of different ways:
•    Notional personal health budget – this means the continuing healthcare team will buy the services you need directly from the service provider (for example– a care agency, or if you are in permanent residential accommodation).
•    Third party personal health budget – this means we pass on the money to someone you know, who then organises your care for you (as agreed and described in your Health Support Plan).
•    Direct payment – this means we pass on the money directly to you, and you can organise your own care (as agreed and described in your Health Support Plan).

You can also choose to receive your budget as a combination of the three options above.

6. Making sure the money is working for you
Your continuing healthcare nurse is responsible for making sure the help and support you are receiving is meeting your needs. As your needs change, so might your personal health budget, to make sure it is giving you the most appropriate support. Eligibility for continuing healthcare funding is also reviewed regularly.


How will my personal health budget care support plan be reviewed?

In order to ensure that your care support plan provides you with increased flexibility and choice, is safe, and that public funds will be spent appropriately, all care support plans will be reviewed by the personal health budget lead and the senior management team. It is important that the use of personal health budgets is fair and equitable to all. 

Who do I contact for more information about personal health budgets?

If you want to know more or you have any questions about personal health budgets, you can call and speak to a member of our continuing healthcare team on 0330 057 1022.

Who do I contact for more information about the Children’s Complex Cases Team?

NHS continuing care is provided to a small group of children and young people with complex health needs up to the age of 18, who need a tailored package of community support.
You can contact the Children’s Complex Cases Team by calling them on 01733 847380 or emailing them capccg.childrenscomplexcases@nhs.net

How do I appeal a funded healthcare decision?

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 to put you in touch with agencies that can offer support and advice.
We will help and guide you through our established appeals process. It is not necessary to engage legal counsel to pursue an appeal.

If you would like to make an appeal, or speak to someone about an ongoing appeal please contact:
Complex Cases Team
Gemini House
Cambridgeshire Business Park
Angel Drove
Tel: 0330 057 1022
Email: capccg.complexcases-chc@nhs.net

Useful links and other websites

The following trusted organisations also provide a wealth of useful information on NHS Continuing Healthcare:
Age UK 
Alzheimer’s Society 
Beacon – If you would like more information on NHS Continuing Healthcare, you can contact Beacon who will provide 90 minutes of free impartial advice, (NB after the initial 90 minutes there is a financial charge which they will inform you of). Beacon can be contacted on 0345 548 0300 or via their website which has free resources and information. 
Healthwatch Cambridgeshire and Healthwatch Peterborough – Are the independent champions for people who use health and social care services in the Cambridgeshire and Peterborough area. Their job is to make sure that those who run local health and care services understand and act on what really matters to people. They listen to what people like about services and what could be improved. They share what people tell them with those with the power to make change happen. They encourage services to involve people in decisions that affect them. They also help people find the information they need about services in their area. For more information visit their websites.

Public information leaflet: NHS continuing healthcare and NHS-funded nursing care - GOV.UK (www.gov.uk)
National framework for NHS funded healthcare 
National guidance on personal health budgets 

Contact us

Call us: 0330 057 1022 
Email us: capccg.complexcases-chc@nhs.net 
Write to us: Complex Cases Team, 
Gemini House, 
Cambridgeshire Business Park, 
Angel Drove, 
Ely CB7 4EA