Getting help with care fees from the NHS

 

The NHS is responsible for meeting your care needs when your need is mainly for healthcare rather than social care. The NHS can meet your care needs if you have:

  • A high level of healthcare needs – in this scenario you may qualify for NHS continuing healthcare.
  • Been assessed as needing nursing care and live in a care home. This means you’re likely to qualify for NHS funded nursing care payments.
  • Entered a hospital as a voluntary patient or are detained under the Mental Health Act. If this is the case, this cost is paid by the NHS.

NHS continuing healthcare

Continuing healthcare is fully-funded NHS care for adults who are severely ill and need care over an extended period.

You may have a disability, injury or illness and need help with physical or mental health needs. If you qualify for NHS continuing healthcare, all your care fees are funded by the NHS. This includes any care provided:

  • at home
  • in a nursing home, or
  • in a hospice.

NHS continuing healthcare is not available if you live in Scotland. Instead Scotland has a different arrangement called ‘hospital-based complex clinical care’.

If you have a high level of healthcare needs, ask for a NHS continuing healthcare assessment. In the future, you can request a reassessment for NHS continuing healthcare if your health deteriorates.

Your NHS continuing healthcare assessment

To qualify for NHS continuing healthcare, you’re first assessed by two (or more) nurses from your primary care trust. They do this using a ‘decision support tool’ to make an assessment of each area of need.

Continuing healthcare assessments are strict. For example, if you’re frail but don’t have any medical issues, you’re not likely to qualify for NHS continuing healthcare. This can be the case in spite of you having long-term care needs.

If you are eligible for NHS continuing healthcare, the financial benefit is very high. This is because all your care fees will be paid for by the NHS.

Unlike social care, there’s no financial means test for NHS continuing healthcare. And you won’t have to make any personal contribution.

Primary health need

To be eligible for NHS continuing healthcare your assessment must determine that you have a ‘primary health need’. This primary health need must have arisen because of disability, accident or illness.

Establishing eligibility

There’s no clear-cut list of health conditions or illnesses that qualify for funding. However, national guidance on eligibility helps make sure there’s a consistent approach. Your care needs will be assessed against 12 areas of care (also known as ‘domains’ – see the table below).

NHS continuing healthcare checklist

The NHS continuing healthcare checklist can help you see if you should have a full assessment to determine your eligibility.

This initial checklist will assess your care needs against 11 of the 12 care domains. Other significant care needs are only taken into account in the final assessment.

NHS continuing care assessment checklist - care domains
Behaviour Priority need Severe need High need Medium need Low need No need
Cognition   Y Y Y Y Y
Psychological/Emotional needs     Y Y Y Y
Communication     Y Y Y Y
Mobility   Y Y Y Y Y
Nutrition - food and drink   Y Y Y Y Y
Continence     Y Y Y Y
Skin (including tissue viability)   Y Y Y Y Y
Breathing Y Y Y Y Y Y
Drug therapist and medication Y Y Y Y Y Y
Altered state of consciousness Y   Y Y Y Y
Other significant care needs   Y Y Y Y Y


Your NHS continuing healthcare assessment will take into account your:

  • overall need
  • interactions between all your needs, and
  • evidence from risk assessments.

You should be eligible for NHS continuing healthcare if you have:

  • at least one priority need, or
  • severe needs in at least two areas.

You may also qualify if you have:

  • a severe need in one area, and
  • a number of other needs (or a number of high or moderate needs) which are intense, complex or unpredictable.

Your views and the views of any carers you may have are also considered with the assessment. You’ll get a copy of the decision documents, along with clear reasons for the decision.

Full assessment

Once a trained health/social care professional has completed your checklist, you may get a full assessment. This will be carried out by a multidisciplinary team, using a decision support tool. They’ll do this assessment to establish if you’re eligible for NHS continuing healthcare.

The decision support tool isn’t an assessment in itself. It’s a way of bringing together and applying evidence in a single practical format. This evidence is then used to provide an overview of the levels chosen.

The decision support tool provides a summary of your needs. The multidisciplinary team uses this summary to make a recommendation to your local Clinical Commissioning Group about eligibility or ineligibility.

Your local Clinical Commissioning Group should send you a letter confirming whether or not you’re eligible and explaining the decision.

The fast-track pathway tool

The fast-track pathway tool is used if you have a rapidly deteriorating condition and may be entering a terminal phase.

It can only be used by an ‘appropriate clinician’ - and they gather evidence to work out your eligibility. Using the fast-track pathway tool replaces the need to do a checklist and decision support tool.

How to arrange an assessment

You can ask your GP, social worker or care home manager to arrange your assessment for NHS continuing healthcare. If you’ve already had an assessment for NHS continuing healthcare then you won’t need another one.

What if I'm not eligible for NHS continuing healthcare?

Your NHS continuing care assessment also looks at eligibility for NHS funded nursing care payment. So, if you don’t qualify for continuing care, you could qualify for funded nursing care instead.

If you’re not considered eligible for NHS continuing healthcare, you can request a review or make an appeal. The decision letter you’re sent will explain how to appeal if you’re not happy with the decision.

 

NHS funded nursing care payments

NHS funded nursing care is provided by a registered nurse and paid for by the NHS. It’s sometimes referred to as the Registered Nursing Contribution (RNCC).

If you’re eligible, the NHS makes a fixed payment to your care home to fund care provided by registered nurses. These nurses are usually employed by the care home.

This NHS payment to the care home is:

  • tax-free
  • not means tested, and
  • is available to all (including those paying for their own care).

The payment is intended to cover:

  • direct nursing tasks
  • planning and supervising, and
  • monitoring of nursing and healthcare tasks.

NHS funded nursing care assessment and eligibility

Your needs will be assessed to decide if you're eligible for NHS funded nursing care. You should receive it if:

  • you've been assessed as needing care from a registered nurse, and
  • you live in a care home or nursing home but don't qualify for NHS continuing healthcare.

To be eligible, individuals must need nursing care and be staying in a care home registered to provide nursing care.

How much are NHS funded nursing care payments?

NHS funded nursing care payments vary depending on where in the UK you live.

Region NHS funded nursing care payments 2018/19 (weekly)
England £158.16
 Scotland £253.00 
Wales £149.67
Northern Ireland £100.00


The weekly payment shown for Scotland is made up of:

  • the personal care contribution of £174, and
  • the nursing care contribution of £79.

Funded nursing care payments are made directly to your care home or nursing home. Always check that the care home fees you’re paying exclude the nursing care fee being paid by the NHS.

Free healthcare from the NHS could be worth thousands of pounds each year. That’s why it’s always worth establishing your eligibility and reviewing it if you develop nursing care needs.

How to arrange an assessment

You can ask your GP, social worker or care home manager to arrange an assessment for NHS funded nursing care payments. If you’ve had an assessment for NHS continuing healthcare then you won’t need a separate assessment.

 

 

Hospital-based complex clinical care (Scotland only)

In Scotland, NHS continuing healthcare has been replaced by hospital-based complex clinical care.

This change was made to:

  • help people stay in their home
  • help people receive home care for as long as possible, and
  • make a hospital stay a last resort.

A prolonged hospital stay can result in:

  • a sense of separation from family and friends
  • bordeom, loneliness, loss of confidence and depression
  • catching a hospital infection such as MRSA, and
  • stress and financial distress for relatives making frequent visits to a hospital (especially if it's not close to home).

Local authorities and health boards have together developed services supporting people with high-level needs at home or in care homes. This is to help make sure they don’t have to stay in hospital longer than necessary.

If you currently receive NHS continuing healthcare in Scotland, you’ll receive that level of care as long as you remain eligible. This applies whether you’re at home, in a hospital or living in a care home or nursing home.

Assessing eligibility for hospital-based complex care

Your assessment for hospital-based complex care is carried out by a consultant (or equivalent specialist). They’re helped by the multidisciplinary team - in partnership with you, your family and any carers. This means that your views and wishes should be taken into account.

The assessment will establish the best place for you to have your medical healthcare needs met. All options should be considered. The outcome of the process will be explained to you, and your family and/or carer.

If your care needs can be properly met anywhere other than a hospital, you’ll be discharged from NHS care. You’ll then move to a suitable community setting such as:

  • your own home - with support
  • a care home or nursing home, or
  • supported accommodation.

At this point, your local authority’s charging policies will apply. You may also have to contribute towards the cost of your care.

Your local authority will carry out a financial assessment to work out how you need to contribute towards care costs. The NHS will remain responsible for meeting any medical needs after discharge from hospital.

Planning for discharge

Health and social care staff will start planning your hospital discharge when you're admitted – or soon after. This planning process will make sure appropriate support is available to help you when you leave hospital.

Your assessment may identify that your long-term care needs can only be met in a care home or nursing home. If this happens, social care staff will help you, your family, carers or advocate to choose a care home. They’ll make sure they help you chose a care home that can meet your assessed needs.

Hospital-based care

Unless you’re receiving private healthcare services, the NHS will pay for your medical care. This is regardless of whether you’re:

  • there voluntarily, or
  • you've been detained (also known as 'sectioned') under the Mental Health Act (1983) and treated without your agreement.