However, if the care is not NHS funded, then the patient has to fund much of the care themselves or it is funded by social services with the patient expected to contribute according to their means.

How do I know if I am eligible for continuing healthcare?

There’s no clear list of health conditions or illnesses that qualify for funding.

Most people with long-term care needs don’t qualify for NHS continuing healthcare or NHS continuing care because the assessment is quite stringent.

But don’t let that put you off.  Free healthcare could be worth thousands of pounds each year, so it’s important to find out where you stand and if you qualify.

What are eligible health needs?

As a guide, ‘eligible’ health needs might include:

  • Mobility problems
  • Terminal illnesses
  • Rapidly deteriorating health
  • Long-term medical conditions

But the only sure way to know if you’re eligible is to ask your GP or social worker to arrange an assessment.

How do I apply for continuing healthcare?

The assessment process usually takes place when you are ready for discharge from hospital and require a package of care, or you live in the community or a care home and your health needs have increased significantly.

What can I expect from the process?

  • An initial checklist – the aim is to get a general indication of your level of health needs. You should note that threshold for passing to the next stage is quite low.
  • Full assessment – a ‘Decision Support Tool’ document is filled in at a meeting involving family members and health/ social care professionals.

What happens at the Assessment?

The decision support tool meeting will be held and should include the following people:

  • a nurse from the Clinical Commissioning Group (the local NHS provider)
  • social worker
  • and a member of your care team

You will be invited to attend and you can bring along someone to represent you. 

At the assessment, you will work through a decision support tool. This document looks at your health needs under twelve ‘domains’ which include areas such as mobility, behaviour and psychological needs.  A score, ranging from ‘no needs’ to ‘severe’ is awarded for each domain.  The higher the score awarded, the more likely it is that you will have a ‘primary health need’ and therefore be eligible. 

The professionals at the meeting make a recommendation of eligible/not eligible, which is then presented to a local panel for ratification.

What happens if I am found to be eligible?

Your care package will be funded from the 29th day after the checklist was received. Your eligibility will be reviewed after three months and if you are still eligible will be reviewed every year after this. It is important to remember that you can lose this funding and have to make a significant contribution to your care.

Can I appeal if I have been told that I am not eligible?

You can appeal the decision if you believe the eligibility criterion has not been applied properly or the meeting has not been properly conducted.

How can we help you?

At Keoghs, Nicholls Lindsell & Harris LLP we have a specialist team with a wealth of experience offering tailored and comprehensive support to clients and their loved ones who are going through this complex assessment process.

If you have a query relating to continuing healthcare, please contact us today, we are here to help.