This House of Commons Library briefing paper is intended to help Members respond to queries from constituents about eligibility to NHS continuing healthcare in England. Equivalent provision in Scotland, Wales, and Northern Ireland is covered in the final section.

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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).

NHS continuing healthcare in England was the subject of a report by the National Audit Office (NAO), published in July 2017. This was followed by an inquiry by the Public Accounts Committee (PAC), which reported in January 2018.  Both these reports were critical of the difficulties experienced by individuals in accessing NHS continuing healthcare.  The Government response to the PAC, published in March 2018, accepted many of these findings and set out further work to improve the accessibility and efficacy of the current system. The NAO report also found that continuing healthcare accounts for 4% of CCG’s total spending, noting NHS England estimates that spending in this area will increase from £3,607 million in in 2015/16 to £5,247 million in 2020/21. At the same time, NHS England’s efficiency plans include a requirement for CCGs to make £855 million of savings on continuing healthcare and NHS-funded nursing care by 2020-21.

A separate Library briefing paper, Background to the National Framework for NHS Continuing Healthcare (SN04643) provides an account of some of the preceding guidance and case law.

  • Commons Research Briefing SN06128
  • Authors: Andrew Mackley, Philip Loft, Tom Powell
  • Topics: Health services

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