NHS Continuing Healthcare provision/funding assessment

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Hi, just wondering if anyone has any experience of the above?
I hadn’t even realised there was such a thing, strangely it seems it’s kept quite quiet….
I’d assumed post hospital it was down to the old social care means tested assessment and most people would eventually have to sell their homes etc
I’ve just completed a quick draft of the decision support tool which determines if there should be a fuller assessment and I believe my mom is ‘severe’ in at least one domain and ‘high or moderate’ in all other areas.
Was just wondering how easy it is to get the MDT to complete the initial screening tools etc from people’s experiences.

Thankyou for reading.

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Hi @Amie i can’t help with your question but this topic has been discussed before and I have copied in a couple of links below which may be of help.

@DavidHearnden is this somethin you can advise on?

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Hi, thanks for your reply, yes I had already searched the forum and saw those comments however they don’t seem to have reached any kind of conclusion unfortunately.
I’m really surprised there aren’t more posts about it, which leads me to think it really is an under used resource that maybe people aren’t aware of.
I’ll continue to explore it and feedback here as I’m sure there are many people/families here who could benefit. :slight_smile:

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Hello Amie - It is not clear how you came across this and I note you have already some research and completed the DST (Decision Support Tool).

I have heard of it and I have even applied for it on behalf of my Mum. I am trying to remember how exactly we came across it, and I could be wrong, but it may have been whilst Mum was in hospital waiting to be discharged. Her condition was severe and so somebody in the MDT (Medical Discharge Team) may have started the proceedings to fill out the form.

I don’t think we met the criteria as we now get help from the Council social care fund,

I know this is not something many people qualify for or get and it has very strict criteria that have to be met. My understanding is this is for terminally ill people or those with extreme care needs. Rather than try to second guess, I will point you in the direction of the NHS website that covers this.

NHS continuing healthcare - Social care and support guide - NHS

You may also want to contact Beacon - see below.

Information and advice

The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS continuing healthcare.

Visit the Beacon website or call the free helpline on 0345 548 0300.

Finally, here’s what AI has to say about it.

Approximately 55,000 to 60,000 adults in England are typically eligible for NHS Continuing Healthcare (CHC) funding at any given time, according to recent quarterly data. While over 100,000 people may receive it annually, only about one in five people assessed for CHC actually meet the strict criteria for this fully funded care.

Key details regarding eligibility include:

  • Definition of Need: To qualify, you must have a “primary healthcare need,” meaning your main requirement is for care to manage physical or mental health, rather than social care.
  • Standard vs. Fast Track: Roughly 35,000 people are eligible for standard CHC, while around 18,000–20,000 receive fast-track funding for end-of-life care.
  • Assessment Difficulty: The proportion of people found eligible has dropped to around 21% of those assessed, highlighting a rigorous, high-threshold assessment process.
  • Coverage: If eligible, 100% of the care fees are covered, regardless of income or savings.

Eligibility is based on the complexity, intensity, and unpredictability of needs, and can be reviewed, sometimes leading to funding being withdrawn.

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Good morning @Amie

I’m David Hearnden, a stroke survivor and a qualified social worker. My main role in the local authority I work for is carrying out Continuing Health Care (CHC) assessments with nurses (I also do Deprivation of Liberty / Best Interest Assessments).

As you have already realised, it is very difficult to get full CHC funding, where the NHS funds the full cost of someone’s care. More likely, if the person is being cared for in a nursing home, they will qualify for Funded Nursing Care (currently £254 per week) towards the cost of the nursing element of their care.

To establish eligibility for full CHC funding, an assessment of the person’s health and care needs, looking at the support s/he needs in regard to breathing, nutrition, continence, skin, mobility, communication, psychological / emotional support, cognition, behaviour and what is called altered states of consciousness, which includes stroke, is carried out. This is the Decision Support Tool (DST) assessment. Eligibility is determined by these scores, but importantly by what are called the four key indicators, which are the nature, intensity, complexity and unpredictability of the person’s health and care needs.

If the person /their representative does not agree with the assessment decision, they have a right of appeal, which needs to be made to the NHS Integrated Care Board which carried out the assessment. The local authority is part of the assessment process because statutory guidance requires it. The social worker is also there to pick up where a person may need assistance from the local authority with funding their care, and to advocate for the person to receive full NHS funding if there is enough evidence to suggest it.

If you want to appeal the decision made in your Mother’s care, or need any more information, please let me know.

Kind regards

David Hearnden

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