What is 'Continuing Care'?
NHS Continuing Healthcare and NHS Funded Nursing Care is a package of care arranged and funded solely by the NHS, provided over an extended period of time to meet physical or mental health needs that are a result of disability, accident or illness.
Anyone can qualify for Continuing Healthcare regardless of location or diagnosis provided they have a certain level of care. It is not dependent on the individual’s disease, diagnosis or condition, or on who provides the care or where it is provided. Eligibility is not dependent upon finances or budgets.
Who provides NHS Continuing Care?
If you require Continuing Healthcare you may need health services from the NHS which are given through Primary Care Trusts, NHS Trusts and Mental Health Trusts. These services are provided in various places e.g. care home, nursing home, your own home or a hospice. If provided in a care home the funding covers the care home fees. If NHS Continuing Healthcare is provided in the home of the person you are looking after it will cover personal care and health care costs.
To be eligible your primary need must relate to your health. Your needs will be assessed by your local Primary Care Trust to decide if you are eligible.
Key Indicators of a Primary Health Need
- Nature – the type of condition or treatment required, and the quality and quantity of condition or treatment
- Complexity – one or more needs or symptoms which interact, making overall needs difficult to manage or control
- Intensity – needs which are so severe that they require regular interventions to manage risk
- Unpredictability – unexpected changes in condition that are difficult to manage and cause significant risk
If you have a disability, or have been diagnosed with a long term condition, it does not necessarily mean that you will be eligible for NHS Continuing Healthcare.
An assessment should be carried out by a PCT when:
- Patients are discharged from hospital, carried out before referring the patient to social services for help with social care needs
- The health of the person you are caring for deteriorates significantly
- A decision is to be made by the NHS to contribute to Registered Nursing Care when someone goes into a care home that provides nursing care
Family and Patient Communication
- The PCT is responsible for ensuring that all patients and their carers are kept informed throughout the process
- All decisions should be communicated in writing, with a clear rationale of why the decision was made
- PCT’s are responsible for promoting national rules and access to the NHS funding and should give details of what the NHS can and cannot provide
Difficulty Getting Continuing Healthcare
If Continuing Healthcare funding has been awarded by your local PCT but you are dissatisfied with the location or type of care then you can use the normal NHS complaints procedure. Your complaint should be submitted in writing to the healthcare professionals involved in the decision making process. This is known as local resolution. You can ask to liaise with your local Patient and Liaison service (PALs) who can advise you about the Independent Complaints and Advocacy Service (ICAS) that could offer you support. Always try to resolve your complaint locally first as this is likely to be the fastest way.
If you are unable to resolve your complaint locally with the PCT you can ask for a review of the eligibility decision by your regional Strategic Health Authority (SHA). They will assign your complaint to a Lay Person who is independent of the SHA who will convene a panel to consider whether the PCT has correctly applied the guidance in the National Framework when making their decision.
Complaints that are not resolved at this stage can then referred directly to the Parliamentary and Health Service Ombudsman.
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