NHS Continuing Healthcare is the name given to a package of care arranged and funded completely by the NHS. It is only available to those who have been assessed by the NHS as having a primary health need. Funding can apply to any setting, including the home or care home.
Continuing healthcare funding is completely free for anyone eligible. This is different to support from local authorities which arises from a care needs assessment, the results of which may mean people have to make contributions to social care based on income and savings.
NHS Continuing Care Funding arrangements are subject to regular reviews and may change as someone’s primary healthcare need changes. Eligibility is determined by a detailed assessment with several stages. The process in Berkshire is outlined below.
For more information on continuing healthcare, you may want to listen to our podcast with expert Jason Butler or read our guide to NHS Funded Care. The charity Beacon also provide useful resources and free advice for each stage of the process.
For transportation to and from medical appointments, your elderly relative may be eligible for patient transport services in Berkshire. Our guide to home adaptations in Berkshire may prove useful for making the home environment more accessible.
How to Apply for NHS continuing healthcare funding in Berkshire:
A clinical commissioning group (CCG) is a group of GP practices that organise the delivery of NHS services for the local population. In Berkshire there are two CCGs:
- East Berkshire (including Ascot, Bracknell, Maidenhead, Slough and Windsor)
- West Berkshire (including Reading, Newbury and Wokingham). Each CCG follow the same protocol in assessing eligibility for continuing healthcare funding.
Each CCG has their own contact for referral for an NHS continuing healthcare assessment. Referrals can be made by anyone who feels an individual may benefit from continuing healthcare funding. This includes carers, family members and healthcare professionals.
East Berkshire CCG
Address: Continuing Healthcare Team, NHS East Berkshire CCG, King Edward VII Hospital, St. Leonards Rd, Windsor, SL4 3DP
Telephone: 01753 636 302
West Berkshire CCG
Address: Continuing Healthcare Team, NHS Berkshire West CCG, 57-59 Bath Road, Reading, RG30 2BA
Telephone: 0118 982 2900
Part 1: Initial Checklist Assessment
The first part of the process is an initial checklist assessment. This can take place in a range of settings including in hospital or in someone’s home. Staff will use a NHS checklist to assess health needs in line with eligibility for continuing healthcare funding.
Part 2: Decision Support Tool
If eligibility is met from part one of the assessment, a full review using a decision support toolkit is then carried out. This calls for a multi-disciplinary team of health care and social care workers in Berkshire. All aspects of care surrounding someone’s condition are considered. This revolves around four key indicators: nature, complexity, intensity and unpredictability.
The process should take less than a month to complete. Those found to be eligible for NHS continuing healthcare funding will be subject to review. This will take place every three months for the first year, and every year thereafter.
Appealing a NHS Continuing Healthcare Decision in Berkshire
First of all, you can seek independent advice from Beacon CHC at any stage in the application and assessment process, which includes appeals. If you decide that you are not happy that the outcome of a NHS Continuing Healthcare assessment is accurate, you have a right to an appeal. The appeal process takes place in three stages; Local Resolution, Independent Review, and Ombudsman.
At this stage you talk to your contact within the Continuing Healthcare assessment, stating that you have an issue and would like to appeal the decision. Locally, they will review the assessment and work out the best way to resolve the concerns whether it be an independent review, reassessment or consideration by an Appeal panel. If you are unhappy with the outcome of a local resolution the next step is to ask for an independent review.
To request an independent review you will need to contact Eileen Roberts, Continuing Healthcare Manager (South Region), NHS England, South West House, Blackbrook Park Avenue, Taunton, TA1 2PX. State exactly what you feel has been wrong with the process and why you think it warrants an independent review. You must ask for an independent review within 6 months of a local resolution being completed.
If you are still unhappy with the decision you can contact The Parliamentary and Health Service Ombudsman (PHSO) at Millbank Tower, Millbank, London, SW1P 4QP.