Will the NHS pay for my healthcare at home or in a care home or hospice?
Do you have complicated and severe health conditions which may continue for a long time? If so, you might be able to get free healthcare.
If approved, this care will be arranged and paid for by the NHS for as long as you need it, whatever your income and savings. This is known as being eligible for NHS Continuing Healthcare.
As well as Continuing Healthcare for adults aged 18+, there is also a separate system of children’s continuing care.
Oxford Health NHS Foundation Trust (OHFT) provides the CHC assessment service for Buckinghamshire CCG. The National Framework and Standing Rules make it clear that CCGs cannot delegate their final decision-making function in relation to eligibility for NHS Continuing Healthcare. In order for this function to be discharged efficient the senior nurses at OHFT have honorary contracts in place with the CCG.
During the COVID 19 Pandemic period the Continuing Healthcare Team and The Continuing Care Team have maintained contact with patients and their families. The use of video technology has facilitated the services to undertake virtual care needs reviews and assessments. This approach has ensured that both staff and patients and their families have not exposed to any increased risk that would have occurred if these contacts had been undertaken by face-face meetings. We have been liaising with other Clinical Commissioning Groups and NHS England regarding the use of virtual technology and we are in agreement that virtual assessments will continue to be our main approach to when undertaking care needs reviews, assessments and the local appeals process.
The services will continue to engage with the individual and/or their representative to ensure they are able to participate as much as possible in the assessment process. In exceptional circumstances a face-face assessment may be required, however this will be clinically risk assessed on an individual case by case basis.
Who can receive Continuing Healthcare?
Only people with the greatest health needs get Continuing Healthcare. Just 1 in 5 people in England who apply for it actually receive it.
The needs of everyone who applies are assessed by NHS Buckinghamshire Clinical Commissioning Group. The assessment looks at:
- The nature of your condition. What treatment do you need?
- The complexity of your condition. Do you have several symptoms which make it difficult to manage or control?
- The intensity of your condition.Are your health needs so severe that regular steps need to be taken? • The unpredictability of your condition. Does it change unexpectedly? Is it difficult to manage and likely to cause you, or others, harm?
What if someone is near to end of life?
If someone has a condition that is getting rapidly worse and they are close to death, there is a fast track system to get Continuing Healthcare.
Only a doctor or nurse can apply for fast track Continuing Healthcare. Please ask them if you think it is needed
Further information about fast track Continuing Healthcare can be found here.
What if you aren’t eligible?
If you don’t get Continuing Healthcare:
- You may still receive financial help from Social Services for your personal care and accommodation. This depends on a means test, which shows whether you should get any money and, if so, how much.
- You will still get all the same free NHS services as everyone else.
What if you are refused Continuing Healthcare?
You can appeal against the decision if you are unhappy with how it was reached.
Appeal: Your right to recourse
If you are not happy with the CCG’s decision, or are concerned about the process followed by the CCG, you have the right to appeal and request a review of the CCG’s decision. There are 3 stages to this process. You can also seek independent advice from Beacon CHC.
Local resolution – The CHC team will arrange a local review of the assessment to carefully consider your grounds for appeal. We will work with you to agree the best way to resolve your concerns. This may be through another assessment or for an Appeal Panel to consider the case.
The CCG aims to complete the local resolution process within 6 months. After this, if you are still unhappy with the CCG’s decision, you will be advised of your right to request an Independent Review..
Independent Review – Requests for an Independent Review can be made in writing to: Continuing Healthcare Manager (South Region), NHS England, South West House, Blackbrook Park Avenue, Taunton, TA1 2PX. NHS England has produced a helpful leaflet which describes the Independent Review process.
Requests must be made within 6 months of local resolution being completed. You will need to tell NHS England why you believe the CCGs’ decision should be reviewed and why you believe the decision or process they followed was wrong. If the request for a review is accepted, you will be invited to a meeting to put forward your case. The Independent Panel will consider the evidence and decide whether or not the CCGs’ process and decision were robust. In all but exceptional cases, this decision will be accepted by the CCG.
Ombudsman – If you remain dissatisfied with the decision, you can write to: The Parliamentary and Health Service Ombudsman (PHSO), Millbank Tower, Millbank, London, SW1P 4QP. You can visit the Ombudsman website or call them on 0345 015 4033. The PHSO will review the case and make recommendations as appropriate.
If you want to complain
You have the right to complain to the CCG if you are unhappy with the way in which your assessment has been handled. Complaints can be sent to:
Patient Advice and Liaison Service (PALS) or The Complaints Service NHS South Central & West Commissioning Support Unit Albert House Queen Victoria Road High Wycombe HP11 1AG
Contact us – eligibility queries
For more information or to ask for an assessment of eligibility
There is more information about Continuing Healthcare and how to apply above
You can also contact the Buckinghamshire Continuing Healthcare Team at
CHC Team, Albert House, Queen Victoria Rd, High Wycombe, Bucks, HP11 1AG
Telephone: 01865 902 861
We are happy to hear from individuals, relatives, carers and their representatives.
NHS Funded Nursing Care
What is Funded Nursing Care (FNC?)
NHS-funded nursing care is care provided by a registered nurse for people who live in a care home. The NHS will pay a standard contribution directly to the care home towards the cost of this registered nursing care. There has to be a defined nursing need to be eligible for FNC.
Who is eligible for NHS-funded nursing care? You may be eligible for NHS-funded nursing care if: • You are not eligible for NHS Continuing Healthcare but have been assessed as needing care from a registered nurse • You live in a care home registered to provide nursing care
How will my needs be assessed? You will first be assessed for NHS Continuing Healthcare. Then a decision will be made about whether you are eligible for NHS-funded nursing care.
Most people don’t need a separate assessment for NHS-funded nursing care. However, if you need an assessment or haven’t already had one, Buckinghamshire Clinical Commissioning Group can ensure an assessment is arranged for you.
Outcome of the assessment
If you are eligible for NHS-funded nursing care, this will be provided by registered nurses at your care home.
A registered nurse provides services like planning, supervising and monitoring nursing and healthcare tasks. They can also give direct nursing care.
If you do not get NHS-funded nursing care after the assessment but believe you should, you can ask for a review of the decision.
What is the rate of payment for NHS-funded nursing care? NHS-funded nursing care is paid at the same rate across England. For 2019/20, the standard rate is £165.56 a week.
Personal Health Budgets (PHBs)
Adults who get Continuing Healthcare and children who get continuing care have a legal right to a personal health budget.
This amount of money can support someone’s healthcare and wellbeing needs. This is planned and agreed between the individual, or their representative, and NHS Buckinghamshire Clinical Commissioning Group. It isn’t new money but a different way of spending health funding to meet the person’s needs.
For further information on PHBs please visit the NHSE Personal health budgets in NHS Continuing Healthcare and continuing care for children webpage.
Useful Links and Documents
The Department of Health – this website covers the mandatory requirements of CCGs with regards to NHS Continuing Healthcare
Beacon CHC – Working in partnership with NHS England, they are piloting a new service to provide expert advice about NHS continuing healthcare. Their advisers can help you understand the eligibility criteria and navigate the assessment and appeal processes. Their dedicated helpline is 0345 548 0300. They offer a free consultation with a trained NHS continuing healthcare adviser (up to 90 minutes of advice)
NHS England – this website contains useful information regarding CHC