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 residential or nursing care 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 Framework. Since its introduction, the number of people receiving NHS continuing healthcare has increased from 27,822 at the end of September 2007 to around 59,000 at the end of March 2016. It is encouraging that more people are receiving NHS continuing healthcare but this figure fluctuates and it is important to note that it 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 appeal 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. Eligibility is based on an individual’s healthcare need not a diagnosis and we cannot tell you whether a person with dementia will be eligible for NHS Continuing Healthcare.
The guidance applies to people in England. Wales has its own guidance which is very similar 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 continuing 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 were given 6 months from the date of a decision to begin an appeal with the clinical commissioning group (CCG) concerned.
New deadlines for applying for a retrospective NHS continuing healthcare 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 CCG before 30 September 2012. The deadline for people who have never received an assessment and think they may be eligible between 1 April 2011 and 31 March 2012 was 31 March 2013.
These deadlines have now passed. From 1 October 2012, only in exceptional circumstances can 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 what constitutes exceptional circumstances.
If you believe your case may be exceptional please contact the relevant CCG to find the staff member managing the process. You need to contact the CCG responsible for the area where the individual was living during the period you want to be considered.
Advertising from agencies promoting 'refunds' for care home fees
There are often advertisements 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 at a cost.
A solicitor is not needed to make an appeal. Alzheimer's Society provides free information and 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 through the National Dementia Helpline.