NHS Continuing Healthcare

The process usually begins with a screening assessment called a Checklist, completed The process usually begins with a screening assessment called a Checklist, completed by a trained health or social care professional. This helps determine whether you need a full assessment. A positive Checklist does not automatically mean you are eligible, but it shows that further assessment is required.

If a full assessment is needed, a multidisciplinary team (MDT) will assess your needs using a Decision Support Tool. You, and where appropriate your family member or representative, will be involved. The assessment may take place at home, in your care setting, or remotely.

The team will assess whether you have a primary health need, based on four areas:

• Nature – the type of needs and how they affect you
• Complexity – how your needs interact and require skilled care
• Intensity – the severity of your needs and level of support required
• Unpredictability – how your needs may change and the risks involved

Eligibility depends on your overall care needs, not your diagnosis or condition.

You will receive a letter confirming the outcome of your assessment.

This letter will include:

• Whether you are eligible for NHS Continuing Healthcare or Funded Nursing Care
• The reasons for the decision
• A copy of your assessment
• Information on how to appeal if you disagree with the outcome

Your referrer will also be informed of the decision.

If you are not eligible for NHS Continuing Healthcare or Funded Nursing Care, but still have some health needs, the NHS and your local authority may agree to jointly fund your care package.

In this situation:

You will not be financially assessed for the NHS-funded element of your care

The NHS and local authority share responsibility for funding your care

If you are eligible for NHS Continuing Healthcare, the next step is to arrange a care and support package to meet your assessed needs.

The All Age Continuing Care team will work with you to:

• Understand your needs and preferences
• Discuss available care options
• Consider risks, safety, and value for money

Your views will always be taken into account when planning your care.

Yes. If you receive NHS Continuing Healthcare, Funded Nursing Care, or joint funding, your care will be reviewed:

• Within three months of your care package starting
• At least once a year after that

If your needs change, you may require a new assessment to confirm whether you remain eligible.

Yes. You can request a retrospective assessment if you believe you were eligible for NHS funding for care received since 1 April 2012 but were not assessed at the time.

This assessment is usually paper-based and involves reviewing your care records to determine whether you were eligible during that period.

If you disagree with the eligibility decision, you have the right to appeal.

You must submit your appeal within six months of the decision letter. Your appeal should explain:

• Why you disagree with the decision
• Which parts of the assessment you believe should be reviewed

Send your appeal to:

NHS Appeals Team
NHS Essex Integrated Care Board
Seax House
Victoria Road South
Chelmsford
Essex
CM1 1QH

Email: [email protected]

You should include any additional evidence to support your appeal.

Yes, if you have legal authority to act on their behalf. This may include:

• Written consent from the individual
• Lasting Power of Attorney (LPA)
• Enduring Power of Attorney (EPA)
• Court Appointed Deputy documentation

If the person has died, you must provide evidence that you are managing their estate.

No. The appeals process is not a legal process, and you do not need a solicitor.

If you would like support, independent advocacy services may be available free of charge. If you choose to use a solicitor or claims company, you will be responsible for any fees.

Your appeal will be acknowledged within 10 working days.

A clinical reviewer will examine your case and may invite you to a local resolution meeting to discuss your concerns and review the assessment process.

This is an opportunity to discuss your appeal with a clinical professional. The meeting may take place in person or by telephone.

The meeting will:

• Explain how the decision was made
• Allow you to ask questions
• Review any additional evidence

Notes will be taken and shared with you.

If your appeal continues, it will be reviewed by a local appeal panel.

You may attend the panel to:

• Share your views
• Highlight any concerns
• Provide additional information

You will receive the panel’s decision in writing within 21 days.

If you remain dissatisfied, you can request an Independent Review Panel from NHS England.If you are still unhappy after this review, you can contact the Parliamentary and Health Service Ombudsman.