NHS Continuing Healthcare Funding
NHS Continuing Healthcare Funding
Do you qualify for NHS Funding? Then read our guide below...
If you or your loved one have a disability or long-term complex care needs, you may qualify for free NHS continuing healthcare (CHC). Many people are unaware of NHS continuing healthcare, so it’s important to check if you’re eligible and arrange an assessment. NHS continuing healthcare can be provided in a variety of settings – including in your own home.
What is NHS continuing healthcare?
In England, Wales and Northern Ireland, NHS continuing healthcare funding is available for people whose primary need is related to their health. The NHS is responsible for fully funding long-term care needs in any setting, including your own home, hospices, and care homes. In England, you have the choice of receiving continuing healthcare funding as a direct payment (known as a personal health budget), or having the NHS arrange care for you.
Continuing care funding eligibility
To find out whether you’re eligible for NHS continuing healthcare funding, you will need to be assessed by a team of healthcare professionals who will consider your needs in relation to:
- The kind of help you need
- How complex your needs are
- Any risks that might arise if you do not receive the right care at the right time
It’s important to note that the criteria for continuing healthcare funding is not dependent on a particular condition, but on your assessed needs. This means that if your needs change over time, your funding may change over time, too.
NHS continuing care assessments
The first stage of determining whether you’re eligible for NHS continuing healthcare funding is an initial assessment carried out by a healthcare professional either at hospital or in your own home. Following this initial assessment, you will be told whether you meet the criteria for continuing healthcare funding, and if you are going to be referred for a full assessment of eligibility.
Full continuing care assessments should be carried out by a multidisciplinary team made up of a minimum of two healthcare professionals from different care professions. This team will then assess your needs against the following areas:
- Mobility
- Breathing
- Continence
- Communication
- Nutrition (food and drink)
- Skin (including ulcers and wounds)
- Psychological and emotional needs
- Levels of consciousness
- Medication
- Cognition (understanding)
Once this assessment has taken place, your needs will be marked as priority, severe, high, moderate, low or no needs. You should expect to be eligible for NHS continuing healthcare funding if:
- You have at least one priority need or severe needs in at least two areas
- You have a severe need in one area plus several other needs
- If you have several high or moderate needs (depending on their nature, intensity, complexity, or unpredictability)
You should be fully involved in the process of completing your continuing care assessment, including being kept informed and having your views considered. Typically, you should receive a decision about your eligibility for a full assessment within 28 days of your initial assessment or request for a full assessment.
What happens if you’re refused continuing healthcare funding?
If you are not eligible for NHS continuing healthcare funding, you may still be entitled to other NHS services. These include:
- Palliative care
- Respite health care
- Rehabilitation and recovery
- Community health services specialist support for healthcare needs
- NHS-funded nursing care
Alternatively, there may be local authority funding to meet some of your care needs.
If I’m eligible for NHS continuing healthcare funding, what are the next steps?
If you fit the criteria for continuing healthcare funding, the next step is to arrange care that meets your assessed needs. Depending on your situation, different options may be available, including receiving support in your own home from a private live in carer.
If you’re considering care options and would prefer to remain living in the comfort of your own home, your live-in carer can provide matched, professional help and support on a long-term basis. Our live in care matching service is an affordable alternative to residential settings and is also available on a short term respite basis.
To find out more on the benefits of live-in care, or to talk through any questions, contact our team of friendly experts today.
What is a personal health budget?
A personal health budget is an amount of money to support your health and wellbeing needs, which is planned and agreed between you (or someone who represents you), and your local NHS team. It is not new money, but it may mean spending money differently so that you can get the care that you need.
A personal health budget allows you to manage your healthcare and support such as treatments, equipment, and personal care, in a way that suits you. It works in a similar way to personal budgets, which allow people to manage and pay for their social care needs.
Who can get it?
The right to have a personal health budget applies to people who are:
- adults receiving NHS continuing healthcare (NHS-funded long-term health and personal care provided outside hospital)
- children receiving NHS continuing healthcare
- people who are referred and meet the eligibility criteria of their local wheelchair service and people who are already registered with the wheelchair service when they need a new wheelchair or specialist buggy, either because of a change in clinical needs or the condition of the current chair. These people will be eligible for a personal wheelchair budget.
- people with mental health problems who are eligible for section 117 after-care as a result of being detained under certain sections of the Mental Health Act (this does not include detention under section 2 of the Act).
If you are not in a group that has a right to a personal health budget, but you are interested in receiving one, speak to your local integrated care board (ICB). ICBs make the arrangements for personal health budgets and are encouraged to offer them to other patient groups.
Find your local integrated care board (ICB)
How is a personal health budget worked out?
If you are able to have a personal health budget, then together with your NHS team you will develop a personalised care and support plan. The plan sets out your personal health and wellbeing needs, the health outcomes you want to achieve, the amount of money in the budget and how you are going to spend it.
A care co-ordinator, who will be your first point of contact in case you have any concerns, should be identified in the planning process.
Visit the people hub website, where people with a personal health budget and their families and carers share their experiences.
A personal health budget will not be right for everyone, and it will not always be the best way to receive support. You are not allowed to spend the money on gambling, debt repayment, alcohol, tobacco, or anything illegal. Emergency care, medicines, and the care you get from a GP is separate and will not need to be paid for from your budget.
Monitoring and review
Once you have a personal health budget, your NHS team will periodically review your care plan with you. You can also ask your NHS team to review and update your plan because your health needs have changed, or you feel the current plan is not working for you.
You can give up your personal health budget at any point if you wish to; you will still be able to receive care and support in another way.
Can I have a personal health budget as well as a personal budget?
Yes. If you already have a personal budget for care and support from social care services and your NHS team agrees, you can also have a personal health budget and ask for both to be paid into the same bank account.
What is the difference between a personal health budget, a personal budget, an integrated personal budget, and a direct payment?
- A personal health budget is for your NHS healthcare and support needs.
- A personal budget is for your social care and support needs.
- An integrated personal budget is for both your healthcare and support needs and social care needs.
- A direct payment is one way of managing these budgets. It’s when you get the money directly to buy the agreed care and support you need rather than the council arranging it for you.
What happens if I disagree with the amount I’m offered?
The discussion around your plan should include what to do if you disagree with something, or if something goes wrong. If you’re not sure what to do, speak to your NHS team. If you’re still not happy, you can follow the NHS complaints procedure.
What if my request for a personal health budget is turned down?
If your request for a personal health budget is turned down, you should be told why. If you wish to appeal, your local ICB should explain what to do. If you’re still not happy, you can follow the NHS complaints procedure.
Managing your personal health budget
A personal health budget can be managed in 3 ways, or a combination of these.
- Notional budget
No money changes hands. You find out how much money is available for your assessed needs and together with your NHS team you decide on how to spend that money. They will then arrange the agreed care and support for you.
- Third party budget
An organisation legally independent of both you and the NHS (for example, an independent user trust or a voluntary organisation) holds the money for you, and also pays for and arranges the care and support agreed in your care plan
- Direct payment for healthcare
You get the money to buy the care and support you and your NHS team agree you need. You must show what you have spent it on, but you, or your representative, buy and manage services yourself.
Managing your personal wheelchair budget
There are 4 different options for managing a personal wheelchair budget.
- Notional personal wheelchair budget
This is where no money changes hands. The NHS purchases and provides your chair, but you can contribute to the budget with money from other sources to get a higher specification wheelchair. This was previously known as a partnership voucher.
- Third party personal wheelchair budget
You can use your personal wheelchair budget to purchase equipment outside of the NHS. You can also contribute additional money from other sources. This was previously known as an independent voucher.
- Traditional third party personal health budget
If you have a wheelchair as part of a wider package of care and support, an independent organisation could help you manage the budget you receive and pay for the chair.
- Direct payment
This is where you get the money to pay for the equipment you need. This option is not usually available at the moment for personal wheelchair budgets.
Find out more about personal wheelchair budgets from NHS England.
What happens if I underspend, or overspend, my budget?
There are likely to be times when your healthcare needs change and this may affect your budget.
If you have underspent, your NHS team will discuss with you what happens to the money that is left. It may be kept for your future healthcare needs or returned to the ICB and allocated to other budget holders.
If you have overspent, contact your NHS team as soon as possible. No-one with a personal health budget will be denied healthcare. If you feel you need additional support than is agreed in your care plan, then those arrangements should be reviewed.
You can request a review of your needs and care plan at any time. If you have spent your budget in ways that have not been agreed with your NHS team, you may be asked to repay it.
