How does the assessment for NHS continuing healthcare work?
There is a process staff must follow to decide your eligibility for NHS continuing healthcare.
1. If you have ongoing significant health needs, there are times when NHS staff or a member of the social work team should consider whether you may be eligible for NHS continuing healthcare.
These situations include:
- when you are ready to be discharged from hospital and your long-term needs are clear
- once a period of rehabilitation following a hospital stay has finished and it’s agreed your condition is unlikely to improve
- whenever your health or social care needs are being reviewed as part of a community care assessment
- if your physical or mental health deteriorates significantly and your current level of care seems inadequate
- when your nursing needs are being reviewed; this should happen annually if you live in a nursing home
- if you have a rapidly deteriorating condition and may be approaching the end of your life.
Important things to know about all stages of the assessment process:
- You should be fully involved and your views should be considered.
- You can ask a relative or carer to help and support you.
2. The assessment process starts with the completion of a checklist by a nurse or a social worker trained to complete it. The checklist identifies what your needs are and shows whether you need to have a full NHS continuing healthcare assessment.
If your condition is deteriorating quickly and you may be approaching the end of life, you may have a Fast Track assessment instead, which is a quicker process.
3. If you’re referred for a full assessment, evidence will be collected from all relevant health and social care professionals about your physical, mental health and social care needs.
4. A team of health and social care professionals will meet to look at this evidence and make their recommendations as to whether or not you’re eligible. You and/or your representative can attend and participate at this meeting.
5. Their recommendation is given to the Clinical Commissioning Group (CCG), which is responsible for funding your care. Except in exceptional circumstances, the CCG confirms their recommendation.
6. The CCG should write to you with the decision and explain the reasons for it.
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