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NHS continuing healthcare is a package of health and social care arranged and funded solely by the NHS to meet physical and/or mental health needs that have arisen because of disability, accident or illness. Eligibility decisions for NHS continuing healthcare rest on whether someone’s need for care is primarily due to health needs. For example, people who are eligible may have long-term complex medical conditions that require highly specialised support. Around 160,000 people in England are assessed as eligible for continuing healthcare each year [click to expand]:

Sources: PQ, Continuing Care: Finance: Written Question, 1 July 2019, HL 16804; National Audit Office (NAO), Investigation into NHS continuing healthcare funding (2017), pp. 21-22.

This Commons Library briefing is intended to help Members of Parliament respond to queries from constituents about eligibility to NHS continuing healthcare in England, although equivalent provision in Scotland, Wales, and Northern Ireland are covered in the section 7 of this briefing. As services provided by the NHS are free whereas those arranged by local authority social services are means tested, the outcome of any decision as to who has responsibility for providing care can have significant financial consequences for the individual concerned. A separate Library briefing paper, Financing care home charges (SN01911), is designed to help answer constituents’ queries about the local authority means-test for care home charges.

Following concerns about the local criteria used for making decisions about eligibility for NHS continuing healthcare, and challenges to the legality of individual eligibility decisions in the courts, in 2007 the Department of Health issued a National Framework for NHS continuing healthcare. This Framework was intended to improve the consistency of approach taken by local NHS bodies by providing a common framework for decision making and the resolution of disputes. The latest version of this Framework was published in March 2018 and applies from 1 October 2018.

This briefing paper provides a summary of the key areas within the National Framework and other Department of Health and Social Care guidance. Links to these documents, and briefings from other organisations, can be found at the end of this Briefing Paper. The official guidance should be consulted for a fuller account of the rules and duties that apply to NHS bodies responsible for determining eligibility for NHS continuing healthcare.

Clinical Commissioning Groups (CCGs) are responsible for commissioning NHS continuing healthcare in England, although NHS England also has commissioning responsibilities for some specified groups of people (for example, prisoners and military personnel).

Coronavirus Act 2020

The Coronavirus Act 2020 allows NHS providers to delay assessments for NHS Continuing Healthcare (NHS CHC) until after the emergency period.

The Government has said that delaying assessments for NHS CHC will enable patients to be discharged more quickly, when clinically appropriate, to free up hospital space for those who are very ill and enable clinicians to focus on delivering care. The Impact Assessment for the Bill notes that this measure “would only be brought into operation for the shortest possible time at the peak of the coronavirus outbreak.”

During the House of Commons debate on the Coronavirus Bill, the Secretary of State for Health & Social Care Matt Hancock said that although NHS CHC assessments will be delayed until after the emergency period, the people who need this support will still receive NHS funding in the interim.[1]

NHS Trusts have been allocated emergency coronavirus funding to pay for people’s health and care needs during this emergency period. Government guidance on hospital discharge arrangements says:

  • The government has agreed the NHS will fully fund the cost of new or extended out of-hospital health and social care support packages, referred to in this guidance. This applies for people being discharged from hospital or [who] would otherwise be admitted into it, for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services.[2]

The guidance also confirms that clinicians still have a duty to assess the specific needs of highly vulnerable individuals and to commission the relevant care.[3]

[1]     HC Deb 23 March 2020 c42).

[2]     HM Government, NHS, COVID-19 Hospital Discharge Service Requirements, p3

[3]     HM Government, NHS, COVID-19 Hospital Discharge Service Requirements, p43

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