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NHS continuing care

What is NHS continuing healthcare?

NHS continuing healthcare (also known as NHS continuing care and fully funded NHS care) is a package of care arranged and funded solely by the NHS. It is awarded depending on whether a person's primary need is a health need. It can be provided in a range of settings, including an NHS hospital, a care home or someone's own home.

What is the National Framework for NHS continuing healthcare?

In October 2007 the Department of Health produced new guidance that sets out a system for deciding eligibility for NHS continuing healthcare. This is called the National Framework for NHS Continuing Healthcare and NHS funded Nursing care. The Framework sets out the factors that are considered to decide whether someone meets the criteria for NHS Continuing Healthcare.

Alzheimer's Society campaigned for many years for national eligibility criteria for NHS continuing healthcare and therefore welcomed the introduction of the National Framework for NHS continuing healthcare. Since its introduction, the number of people receiving NHS continuing healthcare has increased from 27,822 at the end of September 2007 to 46,599 at the end of March 2009. It is encouraging that more people are receiving NHS continuing healthcare but it is important to note that this figure includes people with all types of illness and not just dementia.

When does the NHS pay for care?

Alzheimer's Society booklet When does the NHS pay for care? explains what NHS continuing healthcare is, how to get an assessment and how to complain if you think you have been wrongly charged for care. 

Applying for NHS continuing healthcare is not an easy process to go through or to understand. We cannot tell you whether a person with dementia is eligible for NHS continuing healthcare. The guidance applies to people in England, but much will also be applicable to people in other parts of the UK.

Changes to appeal timescales

If someone is turned down for NHS contiuing healthcare, an appeal can be made against the decision.  In March 2012 the Department of Health announced some changes to timescales for appealing NHS Continuing Care decisions.

From 1 April 2012 people will have 6 months from the date of a decision to begin an appeal with the PCT concerned.

The PCT will then have 3 months to conduct the review.
The person will then have 6 months to begin an appeal with the SHA.
The SHA will then have 3 months to conduct the review.

New deadlines for applying for a retrospective NHS Continuing Care assessment

The Department of Health also introduced new deadlines for people who have never received an assessment and think they may be eligible for NHS Continuing Healthcare for periods of care occurring between 1 April 2004 and 31 March 2011. These people had to contact their PCT before 30 September 2012.

This deadline has now passed. From 1 October 2012, only in exceptional circumstances will the local NHS take applications for NHS Continuing Healthcare for periods of care between 1 April 2004 and 31 March 2011. We are not able to advise on what constitutes exceptional circumstances. If you believe your case may be exceptional please contact the relevant Primary Care Trust (PCT) to find the staff member managing the process. You need to contact the PCT responsible for the area where the individual was living during the period you want to be considered. Call NHS Direct on 0845 4647 if you are not sure which PCT to contact.

The deadline for people who have never received an assessment and think they may be eligible for NHS Continuing Healthcare for periods of care occuring between 1 April 2011 and 31 March 2012 is 31 March 2013.

This deadline does not apply to people who have received an assessment for NHS Continuing Healthcare before 1 April 2012.

Advertising from agencies promoting 'Refunds' for care home fees

There have been advertisements over recent weeks, on television and online, regarding claiming back care home fees for people who have dementia. Companies offering these schemes encourage people to appeal the outcome of assessments for NHS Continuing Healthcare funding. 

A solicitor is not needed to make these appeal.  Alzheimer's Society provides free advice to people wishing to appeal NHS Continuing Healthcare cases, contained in the booklet 'When does the NHS Pay for Care?'.  There is also support available both through the Helpline and the NHS Continuing Care Volunteer support group. The group's Top Ten Tips on appealing NHS Continuing Care Cases are also available online. 

NHS continuing care volunteer support group

People who believe they have wrongly been denied access to NHS continuing care funding can contact the Alzheimer's Society NHS continuing care volunteer support group to help them challenge decisions.

Podcast

When does the NHS pay for care?

Guidance on eligibility for continuing NHS health care funding in England and how to appeal if it is not awarded.

NHS continuing care volunteer support group

This group can provide advice to people who are already in the process of being assessed for continuing care or are appealing decisions.

Have you been paying for care? leaflet

This leaflet encourages people to examine whether they have been wrongly charged for care and, if so, to seek redress.