Eligibility for NHS continuing healthcare

For most people, the assessment process involves an initial screening and then a full assessment. After the full assessment, a recommendation will be made to NHS Birmingham and Solihul about whether the patient is eligible.

The initial screening is usually carried out by a health or social care professional who knows the person and uses a checklist to decide whether people need a full assessment. The person who completes the checklist will send it to the continuing healthcare (CHC) team.

The full assessment is usually undertaken by a group of health and social care professionals who have been involved in the patient’s care. They are known as a multidisciplinary team (MDT). The MDT works together to collate and review the relevant information on the individual’s health and social care needs. The MDT uses this information to help clarify individual needs through the completion of the DST, and then works collectively to make a professional judgement about eligibility for NHS continuing healthcare, which will be reflected in its recommendation. This process is known as a multidisciplinary assessment of eligibility for NHS Continuing Healthcare.

The CHC assesment and MDT recommendation is presented to NHS Birmingham and Solihull, the ICB will make the final decision regarding eligibility and care provision.

NHS continuing healthcare (CHC) assessments can take place at home or in a care or nursing home.

In some instances, assessments may be conducted in hospital. However, the hospital discharge policy is in the first instance to discharge to assess via Pathway 1 or Pathway 2, which the local authority, such Birmingham City Council or Solihull Metropolitan Borough Council, will lead and arrange from hospital.

Where there is a need to complete a CHC assessment, this will be assessed on an individual basis by the complex discharge team within the hospital, who will referrer into the CHC team. The hospital is not usually the best place for the assessment to be completed. Once you are medically fit for discharge and at your optimum health and wellbeing, the local authority will arrange for you to be allocated to a Discharge to Assess or Enhanced Assessment bed, within a care home. The Discharge to Assess or Enhanced Assessment bed location aims to provide a calmer environment than an acute ward.

If your preferred destination is home, either your own or a family members' home, the hospital discharge team will provide a short-term package of care before undertaking your CHC assessment. This will reduce the amount of time you spend in hospital. The assessment will be undertaken within an agreed time frame by the local authority of your move from hospital.

NHS Birmingham and Solihull actively promotes and supports discharging patients back to their own (or a relatives) home with a package of care providing quality and safe care. Leaving hospital to return home depends on the complexity of your care needs and the availability of domiciliary care providers suited to meeting your needs at home.

Financial issues are not part of the decision about an individual’s eligibility for continuing healthcare (CHC). NHS Birmingham and Solihull can, however, take account of comparative costs and value for money when arranging care and should ensure the services provided reflect the person’s preference as far as possible.

Health and social care professionals must use their professional judgement at both the screening and full assessment stages. They will consider the person’s combined healthcare needs across 11 domains (areas of need) to complete an initial checklist and across 12 domains to undertake the full assessment.

People will be assessed three months after their successful assessment and then annually.  This is to ensure the care provided is still relevant and providing the right support, as well as ensuring that CHC is still needed.

If you are not eligible for NHS CHC, you may appeal. To find out more about the appeals process, please refer to the CHC Appeals Section.

Either you or your representative will be contacted to arrange a mutually suitable date and time for the assessment. You will receive written confirmation of the agreed arrangements.

You will be visited by one or two qualified nurses. Depending on your individual needs this may be a Registered General Nurse (RGN), Mental Health Nurse (RMN), Learning Disability Nurse (RNLD).

A social worker will also be invited to attend, and you can have family/friends present to support you.

First, the nurse leading the assessment will gain consent from you to undertake the assessment. The nurse will then put you at ease by explaining the process and documents used. During the assessment the nurse will consider evidence provided by you and your representative(s).

After the assessment the nurse will advise you of the recommendation regarding your eligibility forcontinuing healthcare (CHC) or funded nursing care. The nurse will also explain what happens once the recommendation is submitted to NHS Birmingham and Solihull.

You should be fully involved in the assessment process and kept informed and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate.

A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment. You will receive a letter confirming your eligibility within five working days of a decision being made by NHS Birmingham and Solihull.

If you are not eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.
If you still have some health needs, then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.

The route to appeal a decision will be available.

For people in a nursing home who do not meet the funding criteria, they may be eligible for NHS-funded nursing care (FNC). This is because the nursing fee includes an additional cost for the employment of registered nurses. The decision on whether you are eligible will be provided at the same time that a decision is made regarding your eligibility for NHS continuing healthcare.

FNC is a weekly payment made by the NHS to cover nursing care provided by a Registered Nurse. FNC is only provided if you need nursing care within a care home setting.

The nursing care contribution is paid directly to the care home by the NHS. If you pay your own care fees, this amount should be deducted from your bill. If you are funded by the local authority, this amount will be deducted from the fees paid to the care home.

NHS-funded nursing care is paid at the same rate across England. In April 2023, the rate was set at £219.71 a week (standard rate).

We will:

• Ensure you know who everyone at the meeting is.
• Treat you as an individual.
• Involve you in every decision about your care – if professionals use jargon or words you don’t understand, please ask them to explain
• Be respectful and value your privacy and dignity.
• Be polite and helpful.
• Keep your personal information secure (with your consent, we may need to share some information with other professionals involved in your care)
• Show you our ID badge. If we forget, it’s ok to ask.

If a patient or their carer is unhappy with the outcome of their continuing healthcare (CHC) assessment, they can ask NHS Birmingham and Solihull to review their case. There are three stages to this process:

1. The patient or their representative should contact the CHC team in the first instance for a local review meeting. This will be an opportunity to outline the reasons for the appeal and to have a discussion regarding this. Telephone 0121 203 3300.

Once the local review stage has been completed, if necessary, NHS Birmingham and Solihull will provide you with information about how to refer your case for an Independent Review Panel (IRP).

2. The regional team will send you a formal IRP request form. This will ask you to explain your reasons for requesting an IRP in more detail and will encourage you to specify any complaints you have about the assessment process. The Regional CHC Team can be contacted by email.

3. If a patient is unhappy with the outcome of the independent review, they can complain to the Parliamentary and Health Service Ombudsman. The Ombudsman’s role is to decide whether decisions made by the NHS are in line with the national framework; it does not generally make judgements about whether the NHS has made the right decision.​​​​​​

NHS Birmingham and Solihull's all ages continuing healthcare (CHC) team works Monday to Friday between the hours of 8:30am and 5:00pm and can be contacted on 0121 203 3300

During busy times you can leave an answerphone message with your details and we will get back to you.  

If you have a designated case manager, they should be your first point of contact. Your case manager should provide you with a direct contact number.