Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS Continuing Healthcare.
Continuing Healthcare in North Yorkshire
A health and social care professional from Social Services, District Nursing, or other specialist health services can refer you to NHS North Yorkshire CCG's Continuing Healthcare team; please discuss your referral with them. If you do not see any professionals please get in touch.
A health or social care professional will come to visit you and complete a ‘checklist’ to see if you meet the criteria for a full referral. This checklist is a screening tool used to identify if an individual needs to be referred for full consideration of whether you qualify for NHS continuing healthcare funding.
If you are referred for a full assessment for NHS Continuing Healthcare funding the Decision Support Tool will be completed following a multidisciplinary assessment. The Decision Support Tool provides a framework to record the various needs in the 12 care domains and should result in an overall picture of an individual’s needs that captures their nature, complexity, intensity and/or unpredictability.
Eligibility recommendations made by the multidisciplinary team are verified by a senior clinician in the Continuing Healthcare team; some cases may need further ratification with the local authority. Whatever the outcome of your assessment you or the person who holds legal authority will receive formal notification of the decision in writing.
Your letter will contain the following information:-
- the date of the assessment/period under review
- the decision
- information of how to obtain reimbursement if you are found eligible
- information about your right of a review of the eligibility decision
- a contact number for you to call with any queries you might have
NHS North Yorkshire CCG will require consent from the individual in order to carry out any assessments and to gather any evidence/information required to assess eligibility for Continuing Healthcare funding and NHS-funded Nursing Care.
If an individual is unable to sign the consent form the CCG will accept a signature from a person who is legally entitled to represent the individual, i.e. a person named in the Lasting Power of Attorney document, Grant of Probate, Deputy appointed by the Court of Protection or named in the Best Interest Decision Form (see more information, follow this link.
Under all circumstances the CCG will require supporting legal evidence for any signature on the consent form other than the individual’s own. When collecting or using personal information the CCG complies with Principle 1 of the Data Protection Act 1998.
If the CCG agrees to fund your care you will be asked to provide copies of relevant invoices/receipts and corresponding bank statements in order to arrange reimbursement from the date of the eligibility decision.
The CCG will ensure that invoicing arrangements are in place to fund your care. The CCG will only meet direct care costs. Other incidental costs such as hairdressing, chiropody and newspapers will not be met.
If your needs change in the future, you may cease to be entitled to NHS Continuing Healthcare funding. If this happens and care and support is still required, the CCG will refer you to the local authority for an assessment of your community care needs.
If you're eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget.
If it's agreed that a care home is the best option for you, there could be more than one local care home that's suitable.
Your CCG should work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.
Funded Nursing Care (FNC) payments are paid to contribute towards the nursing element of your care in a care home with nursing.
You do not need to apply for FNC as the nursing home will apply for this. The manager of the care home with nursing will advise us of your admission and a Continuing Healthcare Clinical Assessor will carry out an assessment to determine if you are eligible for FNC payments. FNC assessments are undertaken on admission to a care home with nursing or in hospital prior to the admission.
You or your legal representative will be advised in writing of your eligibility. If you are dissatisfied with the outcome of a decision relating to your eligibility for NHS-funded nursing care, you are entitled to ask for a review of that decision. If you remain dissatisfied following local re-consideration you can pursue the matter through our complaints procedures.
For further information or if you have a query about Funded Nursing Care please see the Department of Health Public Information leaflet, the NHS-funded Nursing Care Practice Guide July 2013 (Revised) or contact the FNC Administration team on 0300 3038674.
If you are eligible for FNC a weekly payment of £187.60 (from April 2021) will be made directly to the care home with nursing.
Funded Nursing Care Assessment Forms, Consent Forms and the Continuing Healthcare Checklist for Assessors to complete can be downloaded on this page.
You can ask the CCG for a review of your eligibility decision. This needs to be done within six months from the date of your decision letter.
The Department of Health guidance states that if someone is determined as not eligible the 'not eligible' decision stands until the review process is completed which may or may not uphold the initial decision.
CCGs can cease funding from the date of the decision, but will give 28 days’ notice from the date of the decision letter to cease funding.
From April 2014, everyone who receives NHS continuing healthcare funding is able to request a personal health budget The local CCG offer is about supporting individuals to achieve positive health outcomes. You can read more about personal health budgets, here.