NHS Continuing Healthcare
Explaining the
NHS Continuing
Healthcare
Process
September 2014
Explaining the NHS Continuing Healthcare Process
The following notes are intended to assist health and social care practitioners when they first
explain NHS Continuing Healthcare to individual members of the public, in particular when seeking
consent to the completion of a Checklist.
What is NHS Continuing Healthcare?
Give the individual/their representative a copy of the Public Information Leaflet (found at
https://www.gov.uk/government/publications/nhs-continuing-healthcare-and-nhs-funded-nursingcare-public-information-leaflet).
Explain that, of the many people in England who have ongoing care needs as a result of disability,
accident or illness, the vast majority get help and support which they have to pay something
towards - either through social services charges or because they have enough money to buy the
care themselves.
However, for some people in England the need for ongoing nursing and/or healthcare support is of
such a level or type that they qualify for all their assessed care needs to be met by the NHS,
including those personal and social care needs which might otherwise be met by social services or
funded by themselves. This is ‘NHS Continuing Healthcare’ (NHS CHC) and is care for adults
aged 18 or over which is arranged and funded solely by the NHS, and is therefore free at point of
delivery to the individuals concerned. NHS CHC can be delivered in a care home, or as a package
of care in the individual’s own home or elsewhere. To qualify for NHS CHC the individual has to be
assessed and found to have a 'primary health need'. The term 'primary health need' has a very
specific meaning which requires careful explanation. It is not about whether the individual has a
particular disability or illness, it is about whether their day to day nursing/healthcare needs are,
taken as whole, beyond local authority powers to meet. This is judged by looking at the nature,
intensity, complexity and unpredictability of their needs. Any one, or any combination, of these four
characteristics of need might mean that they are judged to have a 'primary health need'.
Context - Assessing and Meeting Needs
To some members of the public it might seem that the professionals involved in the NHS CHC
decision-making process are only interested in who is going to pay for care. Whilst NHS CHC is
about who funds care, it is not only about this. People with high level care and support need require
a good quality assessment whether or not NHS CHC has to be considered - otherwise it will not be
possible to ensure that their needs are identified and appropriately addressed.
Good quality assessment is therefore essential and is at the heart of the NHS CHC decision-making
process. When embarking on this process, individuals should be reassured that their views and
wishes will be heard, their questions answered, and that they will receive appropriate care and
support, whatever the outcome in relation to NHS CHC.
What is the NHS Continuing Healthcare Checklist?
Explain that the NHS Continuing Healthcare Checklist is a nationally prescribed tool which is used
by health and/or social care staff to work out whether an individual needs a full assessment for NHS
CHC. It contains descriptions of levels of need under 11 headings (domains) and has three options
under each domain: A, B, or C. The professional(s) completing the form will use the information that
they already have about the individual to make a judgement about the level of need under each of
2 the domains. It is not an exact science but the professionals involved will try to find the closest fit
between the person's needs and the descriptions in the Checklist. This will produce a 'score' - so
many As, Bs and Cs. Depending on the score the individual either will or will not 'screen in', i.e.
require a full assessment for NHS CHC. If the individual does not 'screen in' then they will not get a
full assessment for NHS CHC (unless there are very exceptional circumstances).
Remember to explain that:
• if the individual screens in as needing a full assessment for NHS CHC, this does not mean
that they are eligible for NHS CHC - it only means that they require a full assessment for
this. The Checklist has been deliberately designed to have a low 'threshold' - in other words
it is expected that many people will 'screen in' for a full assessment of NHS CHC but then be
correctly found not to have a 'primary health need' and therefore not to be eligible for full
NHS funding. The whole idea is to make sure anyone who might be eligible for NHS CHC is
fully considered for this
• if the individual does not screen in for a full assessment for NHS CHC this does not mean
that they won't get any help - it just means that it will not be through NHS CHC funding
• the individual can choose, if they wish, to have a family member, friend or other advocate
present when the Checklist is completed
• they will be given a copy of the Checklist once it is completed and if they are not happy with
the outcome they can say so and will be asked to explain why. They can ask for the
Checklist to be reconsidered and, if after this they remain dissatisfied, can make a complaint
to the Clinical Commissioning Group (CCG)
• Whether or not the individual crosses the Checklist threshold their circumstances and needs
might change, so they may need to be reconsidered at a later stage. However, there is no
automatic requirement to review a Checklist unless needs change or the individual
specifically seeks a review of the outcome
Consent and sharing information
Ask the individual for their permission to complete the Checklist and make a record of this. At the
same time, having explained what the Checklist is, ask them for permission to:
• go ahead with the full assessment for NHS CHC if they 'screen in'
• share information with and between any professional involved in their assessment
throughout the process in order to ensure that all the relevant facts are considered
There should be a standard consent form to use for the above purpose but if not make a clear
record in the individual's case notes.
If the individual lacks the capacity to consent to the process and to sharing information, there should
be consultation with family/friends and a 'best interest' decision made under the provisions of the
Mental Capacity Act about whether to undertake the Checklist and (where relevant) the full
assessment for NHS CHC. Remember that only a court appointed deputy or someone with Lasting
Power of Attorney (welfare) can actually make a decision on behalf the individual about this otherwise a ‘best interest’ decision should be made.
What other implications should the individual be aware of?
• If the individual 'screens in' using the Checklist then their needs will be considered in more
detail using the Decision Support Tool (DST). This will be done by at least two professionals
(from different professional backgrounds) involved in their care who are referred to as the
'multi-disciplinary team' or MDT. The individual and/or their representative will be fully
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involved in the process, so long as they wish this. The process takes time and may well
involve one or more meetings. It will consider the individual's current and ongoing care
needs in depth.
The DST is used to record needs under 12 'domains' - effectively the same headings as in
the Checklist but with another domain to capture any other significant care needs that do not
fit elsewhere.
It can be quite upsetting for the individual/family going through this process because the
DST is focused on the detail of the person's needs, which can include quite sensitive
information
Having completed the DST the MDT will make a recommendation as to whether or not the
individual has a 'primary health need'. This is then checked and signed off by the CCG and if
they are found to have a primary health need they will be eligible for NHS CHC.
Despite the name, NHS Continuing Healthcare does not necessarily continue. If needs
change then at some point the individual may be assessed as no longer being eligible for
NHS CHC.
If the individual is found to be eligible for NHS CHC then:
o the CCG will be responsible for arranging the care and support - it will make the
decisions on what is possible and appropriate but will respect the individual's choices
and wishes wherever possible
o the individual can ask for this care and support to be provided by way of a Personal
Health Budget which is a specified sum of money that the individual helps decide
how to spend. Indeed the money might be handed over to the individual in order for
him or her to buy the care and support themselves (with help if necessary)
o if the individual is receiving NHS CHC in a care home placement their entitlement to
some benefits will change
o if the individual remains in his/her own home then their entitlement to benefits won't
change (unless they are one of the few people currently receiving help from the
Independent Living Fund).
If the individual is not found to be eligible for NHS CHC then the professionals working with
them will discuss with them how health and social services can support them to meet their
care needs. The normal range of support and services from the NHS and local authority will
be available to them, as appropriate.
If the individual is found not to be eligible for NHS CHC and wishes to challenge this decision
they will be advised of the appeals process.
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