Your NHS continuing healthcare assessment
Posted on 11th December 2023
To receive free NHS continuing healthcare you must:
have ongoing significant physical or mental health needs
require care mostly to address or prevent health problems.
Applying for NHS continuing healthcare
Sometimes a review of your community care assessment can highlight significant healthcare needs. Your physical or mental health might decline so you need additional care. People approaching the end of their life can also receive NHS continuing healthcare.
NHS staff or a member of your social work team might identify clear ongoing health needs. NHS-funded nursing in a care or nursing home might be an alternative to continuing healthcare. This could apply if your condition is unlikely to improve even after rehabilitation following a hospital stay, for example.
If you think you might qualify for continuing healthcare, speak to your healthcare provider, doctor or social worker. Alternatively, you can contact your local ICB to explain your healthcare needs. They should include your views at all stages of their assessment.
A process and tools are available to support decisions about your needs and eligibility.
Step 1: Your assessment usually starts with a checklist completed by a nurse or trained social worker. This identifies whether you need a full NHS continuing healthcare assessment. If they don’t think you need NHS continuing healthcare immediately they should record this in your notes with their reasons.
Step 2: Relevant health and social care professionals provide information about your physical, mental health and social care needs for your full assessment.
Step 3: A team including at least a health professional and social worker will review the information collected. You and if you wish, your representative, can attend and take part in the assessment meeting. The team will advise the ICB whether you qualify for continuing healthcare. To do this they use a Decision Support Tool.
Step 4: Following your assessment your ICB reviews the recommendations about your future care. The Board should then confirm its decision to you in writing with an explanation of its reasons.
Step 5: If the ICB agrees you’re eligible for NHS continuing healthcare you can agree your ongoing care and support. You can ask for a Personal Health Budget which gives you more choice over your healthcare. Reviews after three months and then at least every year will confirm the arrangements are still suitable. This doesn’t normally involve a reassessment although your funding could change.
Appealing your ICB’s decision
The letter you receive explaining your ICB’s decision should tell you how to appeal. If you’re unhappy with the outcome after the checklist step or full assessment, you can ask the ICB to reconsider. If you're still unhappy, you can ask for an independent review of your case and use the NHS complaints system.
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