Continuing health care - settings of care
Find out what people said about the new draft policy for continuing health care - setting of care

This summary explains our proposals to revise the policy on providing continuing healthcare and asks for your views about these changes.

What is continuing healthcare?
Continuing healthcare is free care outside of hospital that is arranged and funded by the NHS. It is only available for people who need ongoing healthcare and meet certain criteria. Continuing healthcare can be provided in any setting, including a care home, hospice or in the person's home.

If someone in a care home gets NHS continuing healthcare, it will cover their care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS continuing healthcare is provided in a person's home, it will cover personal care and healthcare costs.

How do you make decisions about eligibility?
To be eligible for NHS continuing healthcare, a person must be assessed as having a ‘primary health need' based on a complex medical condition and substantial and ongoing care needs. Not everyone with a disability or long-term condition will be eligible.

Our assessments are carried out involving a number of professionals from health and social care. We always want the patient or their representative, family or carers, to be as fully involved in the process as possible. A decision about eligibility should usually be made within 28 days of an assessment being carried out.

There are two main stages involved. The first is to work out whether the patient requires funding for continuing healthcare. If they do, the second stage is to devise the right package of care, making sure the person has the right amount of support, in the right place. In making these decisions we will often speak to a number of agencies including social services.

Throughout all the decision-making, our local approach is based on national NHS guidelines (the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care July 2009 - revised).

Can patients choose the place where they are cared for?
We will always take into account the views of patients and their families/carers in making decisions on continuing healthcare. We accept that many patients with complex medical problems might wish for certain care options, whether in their own home or in a supported living or care home, that are more expensive. We need to consider many factors such as the appropriate level of funding and the most appropriate setting for the patient in terms of their health needs.

So what might be changing to the policy?
We need to make sure that we are being fair to everyone when people need continuing healthcare. As such we have decided to look again at our policy which guides how we make our decisions. As part of this, we need to be able to balance the money spent on an individual patient with the funding available to others.

Therefore, we are now proposing to support an eligible person with their preferred choice of continuing healthcare where this is not more than 25% (or one-quarter) above the cost of similar appropriate care available somewhere else.
We feel this is the right way forward for all concerned - but we would like to hear your views on what you think.

Why are you proposing these changes?
We want to be ‘fair to all' in the way we allocate funding. At the moment our current policy means we are covering too many additional costs for some people, spending which we do not feel is sustainable in the future. In the NHS nowadays it's more important than ever that we make the best use of every pound spent. We have to work within certain budgets and ensure that care for everyone is affordable, safe and clinically appropriate. Importantly, we must also ensure that people's ethical and moral needs are taken into account.

With the revised policy, will it still be possible to appeal against decisions on people's care?
Yes. Our decisions are always considered by a panel of professionals who will examine individual cases on their own merits. However, if the patient or their representative does not agree they can ask their primary care trust (NHS Leicester City or NHS Leicestershire County and Rutland) to review the decision. If they still do not agree, they can contact the PCT's complaints service or the Healthcare Ombudsman.

How can I have my say on the revised policy?
We are currently carrying out a questionnaire on the proposed changes to our policy on continuing healthcare and would encourage you to have your say. We always appreciate people's feedback to help improve our processes and the quality of local healthcare services.