NHS continuing healthcare is a package of 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 complex medical conditions that require highly specialised nursing support.
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 will be in operation from 1 October 2018.
This briefing paper provides a summary of the key areas within the National Framework and other important Department of Health and Social Care documents. Links to these documents, and briefings from other organisations, can be found at the end of this note. 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 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 recently the subject of a report authored by the National Audit Office, published in July 2017, as well as an inquiry undertaken by the Public Accounts Committee, which reported in January 2018. Both these reports were critical in particular of the difficulties experienced by individuals in accessing NHS continuing healthcare. In its response, published in March 2018, the Government accepted many of these criticisms and set out further work to improve the accessibility and efficacy of the current system and its processes. This briefing paper details the findings and recommendations of these reports, as well as the Government’s response to them.
A separate Library briefing paper, Background to the National Framework for NHS Continuing Healthcare (SN04643) provides an account of the preceding guidance and case law.