NHS Continuing Healthcare eligibility

NHS Continuing Healthcare eligibility falls despite unchanged rules

Thousands of people with serious health conditions may be missing out on NHS-funded care, according to new analysis from The King’s Fund.

The health think tank has found that eligibility rates for NHS Continuing Healthcare (CHC) have fallen significantly over recent years, despite there being no change to the official criteria used to determine who qualifies.

NHS Continuing Healthcare is a package of care arranged and funded entirely by the NHS for people whose primary need is related to their health. It can cover care provided in a person’s own home, a care home or another setting and is not means tested.

A particular area of concern is Fast Track NHS Continuing Healthcare, which is intended for people with a rapidly deteriorating condition that may be entering a terminal phase. The King’s Fund found that the proportion of Fast Track recipients later judged no longer eligible for NHS funding has increased by almost 30 per cent since 2017/18.

The findings raise questions about whether access to NHS-funded care is becoming more restrictive in practice, even though the legal framework and eligibility rules have remained the same.

Major financial consequences

The issue is particularly significant because of the high cost of social care.

Care home fees can easily exceed £6,000 per month, meaning that people who are not awarded NHS Continuing Healthcare may have to fund their own care through savings, pensions or the sale of property.

Campaigners and legal specialists say some families only discover that their relative may have been entitled to NHS funding after spending substantial sums on care. In some cases, decisions are later overturned following appeals.

For older and disabled people with complex needs, the difference between qualifying for CHC and being assessed as ineligible can have life-changing financial consequences.

Calls for closer scrutiny

The King’s Fund is calling for a review of how Continuing Healthcare operates as part of a wider examination of the relationship between the NHS and social care.

The organisation argues that the current system can be confusing for patients and families, with decisions often involving complex assessments of whether a person’s needs are primarily health-related or social care-related.

As governments continue to explore ways of improving integration between health and social care services, the report suggests that NHS Continuing Healthcare should receive greater attention to ensure people with the highest levels of need receive the support to which they are entitled.

Understanding NHS Continuing Healthcare

Many people are unaware that NHS Continuing Healthcare exists until a relative requires long-term care.

Eligibility is not based on a diagnosis, disability or financial circumstances. Instead, assessors consider the nature, intensity, complexity and unpredictability of a person’s needs to determine whether they have a “primary health need”.

People who believe they may be entitled to NHS Continuing Healthcare can request an assessment through their local NHS services.

With demand for both health and social care continuing to grow, the new findings are likely to renew debate about whether the current system is consistently identifying those who qualify for NHS-funded support.

What about Scotland?

Scotland does not operate NHS Continuing Healthcare in the same way as England and Wales. Instead, people aged 65 and over who are assessed as needing personal care are entitled to receive free personal and nursing care, regardless of their income or savings. However, they may still be expected to contribute towards accommodation, food and other living costs if they live in a care home.

For younger disabled adults, local authority charging policies and NHS responsibilities can be more complex. While Scotland’s system generally provides broader support than the Continuing Healthcare arrangements in England, concerns remain about variations in access to services, waiting times for assessments and the overall funding pressures facing health and social care.

We have more information about NHS Continuing Healthcare in Scotland here
 

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