NHS continuing healthcare (CHC) is a package of care arranged and funded solely by the NHS for individuals who are not in hospital but who have an on-going complex, intense or unpredictable healthcare need. You can receive CHC services in any setting including your own home.
If you are eligible for NHS continuing healthcare, NHS Kernow will fund the care needed to meet your identified care needs.
Eligibility does not depend on a particular disease, condition or diagnosis, where the care is provided or by whom. If an assessment determines that you have a primary health need, you may be eligible.
You need to be 18 years or over and be assessed as having a certain level of care need to be entitled to NHS continuing healthcare. Assessments for eligibility will be made in accordance with the Department of Health National Framework.
You can find out more about the CHC process here.
Children and young people (aged under 18) with complex health needs may be eligible for NHS continuing care funding. You can find more information of children continuing healthcare by clicking here.
What happens if I am not eligible for fully funded NHS continuing healthcare?
Funded nursing care
In cases where individuals are in a nursing home and it has been deemed that they do not meet the eligibility criteria for continuing healthcare funding, they may well be eligible for NHS funded nursing care. This is because the nursing fee includes an additional cost for the employment of Registered Nurses. The decision as to whether you are eligible for funded nursing care will be given to you at the same time that a decision is made regarding your eligibility of fully funded NHS continuing healthcare. The public information leaflet explains this in more detail.
Other health and social care services
If you have a medical need for then, please be assured that you will continue to receive health support through universal health services such as your GP or community health staff. In addition, if you have social needs you might be able to apply for help from the local authority Department of Health and Social Care.
The following directory of services might also help to signpost you to services that could assist you further.
Appealing a CHC decision
If the result of your assessment is that you are not eligible for NHS continuing healthcare and you are not happy with this decision, then in the first instance we would ask that you get in contact with the team manager for your area who will be able to discuss the concerns with you. If you wish to make contact you should do so within six months of receipt of the written decision regarding eligibility.
If the team manager has been unable to satisfactorily resolve your concerns, your details will be passed to our appeals team and our local resolution process will be started.
Independent review panel
If we have been unable to resolve the case for you at a local level, you may wish to consider contacting NHS England regarding an independent review panel. Full details of this process can be found in the Review Panel Leaflet.
Previously Unassessed Periods of Care (PUPC)
The previously unassessed periods of care (PUPoC) group of clients were based on the Department of Health (DOH) guidelines for periods between 1 April 2014 and 31 March 2012. NHS Kernow has met the deadline imposed by NHS England of giving “Yes” or “No” answers to the 574 cases that they have investigated. There are a cohort of patients who are appealing these decisions.
The decision of a PUPoC two phase is currently with the DOH for consultation for the period after March 2012.