Continuing Care Advice

What Is Continuing Care?

People who are old and frail, those with chronic or degenerative diseases, or perhaps with other complex health needs, may require specialist care, regular treatment or other support on a long-term basis. This is known as Continuing Care, a package of care and support offered by the NHS - working with a range of different agencies - to meet a patient's assessed needs, whether they are physical, mental or involve personal care.

Continuing Care enables people to regain their independence following a stay in hospital or in response to an illness, accident or disability, giving them the support they need to maintain or improve their quality of life.

If someone in a care home gets NHS Continuing Healthcare, it will cover their care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS Continuing Healthcare is provided in the home of the person you look after, it will cover personal care and healthcare costs. It may also include support for you as a carer.

NHS Continuing Healthcare is provided free of charge for people aged 18 or over who require the service and are assessed as being eligible. It can be provided in a variety of settings, including your own home, a hospital, hospice or care home.

Continuing Healthcare may be offered for prolonged periods but not necessarily for life, so a patient's entitlement will be reviewed at regular intervals. Children and young people under 18 may be eligible for a similar type of care but it is organised differently. See Children and Young People's Continuing Care national framework at www.gov.uk.

A revised version of the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care was published by the Department of Health in May 2022 and it was implemented on the 1st of July 2022. NHS Continuing Healthcare best practice guidance was issued in March 2018. The guidance is part of the Department of Health's continuing care policy in England.

In 2021 the Welsh government updated the National Framework which came into force on April 1st 2022. This replaced the 2014 Framework is to provide a consistent foundation of assessing, commissioning and providing CHC for adults, over the age of 18, across Wales.

The Framework covers the criteria used to assess if you're eligible for continuing care or NHS-funded Nursing Care, as well as the procedure for investigating cases where people may have been wrongly denied continuing care. National tools are in place, including a Checklist, Decision Support Tool and Fast Tracking Tool, to help define who is eligible for NHS Continuing Healthcare. Under the Framework, there is also one single band or rate of payment for NHS-funded Nursing Care in a nursing home, so that the NHS provides the same contribution to everyone receiving this type of care.

Who is eligible for NHS Continuing Healthcare?

You must be over 18 and have a complex medical condition and substantial and ongoing care needs. After a stay in hospital, most people would benefit from some kind of convalescence, or from on-going monitoring of their recovery. However, the Continuing Care Programme is designed to support people whose primary need is a 'health' rather than 'social' care need and, as such, have conditions that stay with them after they leave hospital.

Such conditions may be short term - such as recovering from a hip replacement operation - to longer-term illnesses and disabilities.

NHS Continuing Healthcare is free of charge to qualifying patients, but some additional aspects of care that are not NHS-funded may be provided at the expense of the patient. It is important to seek clear and detailed information before any decision is made. In England, there are clear guidelines on what local authorities should charge for community care services such as home help, respite care, etc.

Who decides about NHS Continuing Healthcare?

Prior to your discharge from hospital, the decision about whether you qualify for NHS Continuing Healthcare is taken by a multi-disciplinary team of healthcare professionals. Among these may be your GP, nursing staff, physiotherapists and members of the social services.

This team will discuss with you and your family how any eligibility decisions have been reached as well as how, when and where the Continuing Care is to be provided. In the first instance, the hospital will explain the procedure for discharge and for ongoing healthcare thereafter.

Second, the local authority social services staff will outline the details of any Continuing Care arranged for you, the patient. They should clearly state those aspects of the care that will be funded by the NHS, and those which may be at your expense as the patient. Where the costs may be shared, this is sometimes called a joint package of care.

They should also discuss the availability of social security benefits, mobility allowances, and so on. A decision about eligibility should usually be made within 28 days of an assessment being carried out. It is worth noting that under the scheme, patients have the right to ask for a review of any decision made by the team - especially about discharge from hospital. All hospital and Clinical Commissioning Groups (CCGs) also have a Patient Advice and Liaison Service (PALS) to help sort out problems or give you advice.