NHS Continuing Healthcare is a package of ongoing (care provided to an individual aged 18yrs plus. The package of care is required to support complex health care needs that have arisen as a result of disability, accident, or illness (not based on diagnosis). To be eligible for Continuing Healthcare funding, the individual will have been deemed to have a 'primary health need' as determined by The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2018). Where an individual is identified as having a primary health need, the NHS becomes responsible for meeting all of the individual's assessed health and social care needs. Care that is free at the point of delivery can include support in the home, respite care, supported living and residential/nursing home care; this can be commissioned by the Continuing and Complex Care Team or you can choose a Personal Health Budget to meet your assessed needs.

Please speak to your GP, District Nurse or Social worker who will be able to discuss the referral process with you.

The decision-making process, as set out in The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2012), is used to determine eligibility for Continuing Healthcare funding in adulthood (18yrs plus).

This process involves gathering information, such as assessments and care plans, to evidence the young person’s health care needs. A multi-disciplinary Team Meeting (MDT) is then held to complete the Decision Support Tool (DST) – a document that records healthcare needs and the level of need in 12 different domains.

The young person is encouraged to attend the MDT (unless this is not appropriate) alongside family/carers/ representatives and health and social care professionals involved in the young person's care. At the end of the meeting, professionals will make a recommendation regarding eligibility. This recommendation is then submitted to the CCG for ratification and the young person/parents/carers are notified of the outcome within two weeks. If a young person is deemed to have a 'primary health need', as determined by The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2018), all the young person's Health and Social Care needs will be met by NHS Continuing Healthcare funding; this will be free at the point of delivery. If the MDT recommendation cannot be accepted by the CCG, in the first instance the application will be returned to the MDT for further work or to obtain additional supporting evidence , following which the application will be resubmitted to the CCG.

If a child or young person is found eligible for NHS funded Continuing Healthcare, the CCG will write to you to confirm eligibility and advise of the date on which NHS funded Continuing Healthcare will commence.

If a child or young person is found not eligible for NHS funded Continuing Care we will write to you to explain the reasons for this decision and provide you with information regarding your right to requests a review of the eligibility decision (Appeal).

If a young person is ineligible for Continuing Healthcare funding, appropriate planning will take place to support the transition to adult services; which may be provided by Adult Social Care or universal or specialist health care services.

Sometimes it may be appropriate for care to be jointly funded between health and Social Care even though a young person does not have a primary health need.

If this is the case following a not eligible decision your Local Authority will need to submit a joint funding proposal to the CCG for consideration.

Personal Health Commissioning – NHS Dorset CCG

NHS continuing healthcare - NHS (www.nhs.uk)

If you are eligible for NHS Continuing Care or NHS Continuing Healthcare, you are entitled to request a Personal Health Budget to pay for your assessed health and/or wellbeing needs. For more information click on the links below;

Personal Health Budgets information
NHS information about Personal Health Budgets;
Video - An introduction to personal health budgets in Continuing Healthcare

If a young person is ineligible for Continuing Healthcare funding, appropriate planning will take place to support the transition to adult services; which may be provided by Adult Social Care or universal or specialist health care services.

Sometimes it may be appropriate for care to be jointly funded between health and Social Care even though a young person does not have a primary health need.

If this is the case following a not eligible decision your Local Authority will need to submit a joint funding proposal to the CCG for consideration.

Personal Health Commissioning – NHS Dorset CCG

NHS continuing healthcare - NHS (www.nhs.uk)

BCP Council Child Health and Disabilities Team