Continuing Care Advice

What Is Continuing Care?

People who are old and frail, those with chronic or degenerative diseases, or perhaps with other complex health needs, may require specialist care, regular treatment or other support on a long-term basis. This is known as Continuing Care, a package of care and support offered by the NHS - working with a range of different agencies - to meet a patient's assessed needs, whether they are physical, mental or involve personal care.

Continuing Care enables people to regain their independence following a stay in hospital or in response to an illness, accident or disability, giving them the support they need to maintain or improve their quality of life.

NHS Continuing Healthcare is provided free of charge for people aged 18 or over who require the service and are assessed as being eligible. It can be provided in a variety of settings, including your own home, a hospital, hospice or care home.

If someone in a care home gets NHS Continuing Healthcare, it will cover their care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS Continuing Healthcare is provided in the home of the person you look after, it will cover personal care and healthcare costs. It may also include support for you as a carer.

Continuing Healthcare may be offered for prolonged periods but not necessarily for life, so a patient's entitlement will be reviewed at regular intervals. Children and young people under 18 may be eligible for a similar type of care but it is organised differently. See Children and Young People's Continuing Care national framework at www.gov.uk.

A revised version of the 2022 National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care was published by the Department of Health in May 2022 and it was implemented on the 1st of July 2022.

The Framework covers the criteria used to assess if you're eligible for continuing care or NHS-funded Nursing Care, as well as the procedure for investigating cases where people may have been wrongly denied continuing care. National tools are in place, including a Checklist, Decision Support Tool and Fast Tracking Tool, to help define who is eligible for NHS Continuing Healthcare. Under the Framework, there is also one single band or rate of payment for NHS-funded Nursing Care in a nursing home, so that the NHS provides the same contribution to everyone receiving this type of care.

Who is eligible for NHS Continuing Healthcare?

You must be over 18 and have a complex medical condition and substantial and ongoing care needs. After a stay in hospital, most people would benefit from some kind of convalescence, or from on-going monitoring of their recovery. However, the Continuing Care Programme is designed to support people whose primary need is a 'health' rather than 'social' care need and, as such, have conditions that stay with them after they leave hospital.

Such conditions may be short term - such as recovering from a hip replacement operation - to longer-term illnesses and disabilities.

NHS Continuing Healthcare is free of charge to qualifying patients, but some additional aspects of care that are not NHS-funded may be provided at the expense of the patient. It is important to seek clear and detailed information before any decision is made. In England, there are clear guidelines on what local authorities should charge for community care services such as home help, respite care, etc.

Who decides about NHS Continuing Healthcare?

Prior to your discharge from hospital, the decision about whether you qualify for NHS Continuing Healthcare is taken by a multi-disciplinary team of healthcare professionals. Among these may be your GP, nursing staff, physiotherapists and members of the social services.

This team will discuss with you and your family how any eligibility decisions have been reached as well as how, when and where the Continuing Care is to be provided. In the first instance, the hospital will explain the procedure for discharge and for ongoing healthcare thereafter.

Second, the local authority social services staff will outline the details of any Continuing Care arranged for you, the patient. They should clearly state those aspects of the care that will be funded by the NHS, and those which may be at your expense as the patient. Where the costs may be shared, this is sometimes called a joint package of care.

They should also discuss the availability of social security benefits, mobility allowances, and so on. A decision about eligibility should usually be made within 28 days of an assessment being carried out. It is worth noting that under the scheme, patients have the right to ask for a review of any decision made by the team - especially about discharge from hospital. All hospitals and Integrated Care Boards also have a Patient Advice and Liaison Service (PALS) to help sort out problems or give you advice.

While you are in Hospital

The prospect of a stay in hospital can be daunting if you are not used to it. To help allay any fears that you may have, it is wise to make sure that you understand your illness.

They say knowledge is power and, in these terms, a better understanding of your condition will help you feel more in control and less anxious.

When in doubt, ask questions and you will find that your consultant, doctor or nurse will take the trouble to explain the reasons for their diagnosis. Likewise, be sure you understand why you are receiving certain medication or what undergoing a particular treatment will entail.

Discharge from Hospital

Where it has been assessed that you do not require In-Patient Continuing Care, you do not have the right to occupy an NHS hospital bed indefinitely. However, you do have the right to request a review of decisions made about your discharge from hospital and you cannot be discharged into a care home against your will.

If you do have some concerns about being discharged from hospital and your right to Continuing Care, you may wish to seek support and advice from the Patient Advice and Liaison Service (PALS) – ask a member of staff in the hospital for details of the local PALS office; there should be one in the hospital itself.

Discharge to a Care Home

Where you have been assessed as needing care in a care home – either arranged by your local authority or privately – you are at liberty to choose the home you wish to go to, subject to certain conditions.

In England all care homes are registered and regulated by The Care Quality Commissions (CQC), different care standards authorities apply in Wales and Scotland.

Ongoing Support for Mental Health and Learning Disabilities

In England, approximately 1.3 million people are defined as having learning disabilities including 950,000 adults aged 18 and over.

As many as one in four of us are likely to experience mental health issues, such as depression or anxiety each year and a further one in every 100 experience severe mental illness, which may include a temporary period where they lose touch with reality.

Under the framework for NHS Continuing Healthcare, your mental, emotional and psychological needs will be assessed alongside the assessment of your physical or nursing care needs before you are discharged from hospital. If you do have learning disabilities or mental health needs, a care plan should be drawn up and overseen by a care co-ordinator who will help you access support from within your local community and various services.

There are a number of agencies throughout the UK that specialise in providing home help for people with primary health needs related to mental health or learning disability. You should ask your local authority what is available in your area. As ever, the Internet is an excellent source of information.