How continuing healthcare works
NHS continuing healthcare (CHC) is a package of care arranged and paid for by the NHS. You might receive it in your own home, a care home or somewhere else that is not a hospital. It's for some adults with long-term complex health needs.
If you think you or someone you care for might be eligible for continuing healthcare funding, you have the right to ask for an assessment. The process has two stages.
Stage one: checklist assessment
The first stage is a checklist completed by a health or social care professional. This helps them decide if you need a full assessment.
Sometimes the NHS will skip the checklist stage and go straight to doing a full assessment. For example, if you need urgent care or have a diagnosis of a terminal illness.
Find out more about the checklist assessment on the NHS website.
If you’re unhappy with the checklist decision, you can complain to the NHS.
Stage two: full assessment
The second stage is a full assessment where the NHS decides if you're eligible for funding. At least two healthcare professionals do the assessment.
Integrated care boards (ICBs are the NHS organisations that plan local health services) make this decision. If the NHS decides you're not eligible, you or your family can ask NHS England for an independent review of this decision.
How to complain about continuing healthcare
We make final decisions on complaints about the NHS. You can ask us to look into your complaint about continuing healthcare if:
- you're unhappy with the checklist decision, have complained to the NHS and are unhappy with its response
- you've had a full assessment by the NHS, have been turned down for funding and have already been through the independent review process
- you've been given funding but are unhappy with the amount and have made a complaint to the NHS about this.
If you want to complain to us about continuing healthcare, use our complaint checker to see if we can help.
What we can and cannot do
When we investigate continuing healthcare complaints, we check whether the NHS followed the National Framework. This is the nationally agreed guidance for deciding who is eligible for continuing healthcare funding. It's designed to make sure decisions are consistent across the country.
If we investigate, we'll look for a specific fault in how the NHS reached its decision. These decisions are based on clinical judgement. Someone having a different opinion does not mean there was a fault in the process.
If we do find a fault and uphold your complaint, we'll usually ask the NHS to take action. For example, we might ask it to explain how it reached its decision or to look at it again.
We cannot make the NHS change its decision, and we cannot decide whether you're eligible for funding ourselves. But we'll say what we think the NHS should do to put things right.
Help making your complaint
If you want to make a complaint to the NHS or ask for an independent review, you can do this yourself. You can also get help from an organisation called Beacon. Visit the Beacon website or call the helpline on 0345 548 0300.
Many people use paid representatives like solicitors or claims companies, but this is rarely necessary. We do not usually recommend that the NHS reimburses fees you’ve paid to a representative.
Complaining to us after an independent review
If you bring a complaint to us after an independent review, you need to tell us how you think the process was unreasonable or unfair. You'll have had the chance to raise concerns with the independent review panel. Our investigation will look at how the panel addressed those concerns. We'll usually only investigate issues you've already raised with the independent review.
Here are some examples of what you ask us to investigate.
- Did the independent review find any failings in the assessment and have these been addressed?
- Were all the right people involved in the assessment, including family, clinical staff, and representatives from the NHS and local authority?
- Did the independent review consider all the relevant information, including evidence from you and your family?
- Was the independent review decision explained clearly?
Claims for past periods of care
You can claim continuing healthcare funding for a past period of care, or on behalf of someone who has died.
If you're unhappy with the decision the NHS has made about your claim, you can challenge this through the NHS complaints and appeals process. After that, if you're still unhappy, you can ask us to look into your complaint.
We expect the NHS to prioritise current cases (where the person is still alive and needs ongoing care) over past cases where there is no longer a need for financial help with care needs.
But we would also expect NHS organisations to keep people informed about the progress of their claim. If your claim is approved, the guidance on redress requires interest to be paid for all of the time since the period of care concerned.