Continuing healthcare for adults

Anyone over 18 years of age, who is assessed as having a ‘primary health need’, may be eligible for NHS Continuing Healthcare. It is not dependent on a particular disease, diagnosis, or condition.

A primary health need means your main need is for healthcare rather than social care (ie. help with daily activities such as feeding, washing and dressing, and using the toilet). 

If you are eligible for NHS Continuing Healthcare, your care will be funded by the NHS. This is subject to regular reviews, and should your care needs change, the funding arrangements may also change.

If you do not meet the criteria for NHS Continuing Healthcare and live in a nursing home, NHS-funded Nursing Care may be available to you.

The principles and processes of NHS Continuing Healthcare is set out in a national framework. You can find the NHS Continuing Healthcare Framework on the GOV.UK website: National framework for NHS continuing healthcare and NHS-funded nursing care

Assessments for NHS Continuing Healthcare

There is a two-stage assessment process to find out if you are eligible for NHS Continuing Healthcare:

Stage 1: An initial screening assessment measures your eligibility against a national checklist. 

If you think you may be eligible speak to your GP, social worker, care worker, or another healthcare. You can ask them to complete the Continuing Healthcare checklist and submit it to the Integrated Care Board on your behalf.

Stage 2: A multi-disciplinary team (made of different professionals such as doctors, nurses, therapists, and social workers) will meet to carry out a full assessment of your eligibility. You will be invited to join in and to bring someone with you, such as a family member or representative.

A member of the ICB’s Continuing Healthcare team will contact you or your chosen representative beforehand to talk you through the process and answer any questions. They can also arrange an advocate to support you through the assessment process, if you need one. 

The NHS website has more detailed information about NHS continuing healthcare assessments including who is eligible and what happens at each stage of the assessment.

Find information about continuing healthcare eligibility assessments on the NHS website

Do I have to agree to an assessment before it can be carried out?

Yes. You, or a relative with Power of Attorney for Health and Welfare must agree to the assessment before the process begins and before any decisions are made. This is called ‘consent’. If Power of Attorney is required but not in place, a responsible professional can also complete a mental capacity assessment and sign the consent form as a ‘Best Interests’ decision.

To be sure that you have the full information to agree to the assessment, the professional referring you should explain the process and make sure you have enough information to make your decision. Once you have given your consent, a record will be made to say that you have agreed to the assessment being undertaken. 

How the final decision is made

The assessment meeting will listen to everyone’s views and look at all the information about your health needs and then make a recommendation about your eligibility for NHS Continuing Healthcare (CHC):

A registered professional from Central East ICB will verify this recommendation and the evidence. They will then make the final decision. They will usually support the recommendation from the assessment meeting unless there are exceptional reasons not to.

We will send you a letter explaining the decision. 

How long the process takes

Most NHS Continuing Healthcare assessments and decisions are completed within 28 days. However, if someone’s health is rapidly deteriorating or are entering a terminal phase a clinician can complete a Fast Track tool to confirm immediate eligibility for CHC.

If you are eligible for NHS Continuing Healthcare

Someone from the Central East ICB Continuing Healthcare team will work with you and your family representative to agree a care and support plan. This will cover

• your health and wellbeing goals
• the care and support you need each day
• how your needs will be managed
• where your care will take place, which may be in your own home or a care home.

Everyone eligible for CHC can have a Personal Health Budget. This is money allocated for your care needs, giving you more choice and control.

If you receive NHS Continuing Healthcare at home, adult social care services may still provide some support for you or your carers. This is known as a mixed package of care, where some services come from the NHS and some from adult social care. If adult social care provides support, they will usually carry out a financial assessment to decide if you need to contribute.

If you are told you are not eligible for NHS Continuing Healthcare 

If you receive a letter saying you are not eligible and you believe the correct process was not followed, or your needs were not described accurately you can make an Appeal. You must do this within six months of the decision.

You cannot appeal only because you disagree with the outcome. There must be a concern about how the decision was made.

Once we receive your request, we aim to complete the review within three to six months. 

Can funding be agreed in the future?

If your health gets worse, you or the people caring for you can ask for a new CHC assessment.

Other support if are you not eligible for NHS Continuing Healthcare

If you are not eligible for NHS Continuing Healthcare you can still use all other NHS services in your area.

You may also be eligible for:

• NHS‑funded nursing care if you live in a nursing home
• a shared package of care if you have both health and social care needs, where the NHS pays for part of your care

NHS-funded Nursing Care

If you do not qualify for NHS continuing healthcare and you live in a care home that provides nursing care, you may still get help from the NHS to pay for the nursing part of your care. This is called NHS-funded Nursing care (FNC).

NHS-funded Nursing Care is for people who need a registered nurse to be involved in their care. Living in a nursing home does not automatically mean you will get FNC. You must meet the eligibility criteria.

If you are eligible for NHS-funded Nursing Care, the ICB Continuing Healthcare team can work with you and your family to find a nursing home that can meet your needs.

If you receive funded nursing care, the payment goes directly to the care home. It covers care that is provided, planned or supervised by registered nurses employed by the home. If you pay for your own care, your care home fees should show clearly what you are paying for, including any healthcare costs.

If your care home placement is funded by adult social care, the NHS-funded Nursing Care payment is included in the fees paid to the home. It does not change the amount you pay from your pension or any third‑party top‑up fees.

If you have questions about how funded nursing care affects your fees, speak to the care home manager.

Reviewing your care

Your care needs may change over time. If you receive NHS Continuing Healthcare or NHS-funded Nursing Care, your first review will take place after three months. After that, reviews will happen at least once a year.

Reviews check whether your current care and support plan still meets your needs. If your needs have changed, we will update your care plan with you.

If your needs have changed, the review will look at whether your funding should change too.

If you receive NHS-funded Nursing Care and your needs have increased, the review may recommend a full reassessment for NHS Continuing Healthcare.

If your needs have changed a lot, we may arrange a full reassessment of your CHC eligibility. 

If you have questions between reviews, you can contact the ICB Continuing Healthcare team. 

Contact information

If you are registered with a GP in Bedfordshire, Cambridgeshire, Hertfordshire, Milton Keynes or Peterborough have questions about NHS Continuing Healthcare or NHS-funded Nursing Care you can contact your local NHS Continuing Healthcare team for advice and information.