NHS Continuing Healthcare
Gaining NHS Continuing Healthcare eligibility can be difficult. To qualify, you must demonstrate your needs are:
- Complex, intense or unpredictable;
- Not incidental or ancillary to the accommodation your local authority is under a duty to provide; and
- Not of a nature typically provided for by a social services department.
There are two key stages when applying for NHS Continuing Healthcare eligibility:
- Checklist assessment:
This is a screening tool which determines whether an individual’s needs warrant completing the Decision Support Tool.
- Completion of a Decision Support Tool (DST):
This is an assessment tool which is conducted to investigate whether an individual’s needs are primarily healthcare needs that would qualify for NHS Continuing Healthcare. The assessment looks at the full range of care needs, but focuses on 12 care domains which include cognition, behaviour, nutrition and mobility.
As part of the DST, the individual in question will be given a level of need in each of the 12 care domains. There are six levels, ranging from no needs to priority.
If a patient’s level of need is assessed as being priority in any area, eligibility for full funding is automatic (however you should note that the priority level of need is only applicable to four of the 12 care domains). If a patient’s level of need is assessed as being severe in any two areas, eligibility for full funding is also automatic.
It is still possible to be found eligible without a priority or two severe measurements, however the rules are open to interpretation. The higher the level of need, the more likely it is that an individual will be found eligible for NHS Continuing healthcare.
To claim retrospective eligibility, we need to show that an individual’s health and nursing care needs were more than what a social services department could provide. If that’s the case, then their primary need would be for health and they would have been entitled to full NHS funding.