Applying for NHS funding to pay for your care

NHS Continuing Healthcare

If the NHS agrees you have a ‘primary health need’ your care costs will be met through Continuing Healthcare funding. This means you typically need to have a long-term, complex health need that goes beyond the needs of basic personal care. The funding could cover care home fees or the cost of care in your own home.

Your eligibility isn’t based on you having a particular type of medical condition. It’s about whether a major part of your care is to support your health needs or prevent them from getting worse. Being frail, for example, isn’t enough on its own to qualify for Continuing Healthcare.

If in England

You can get an assessment for NHS Continuing Healthcare funding by asking your GP or contacting your local Integrated Care Board (ICB).

If in Scotland

In Scotland, NHS Continuing Healthcare has been replaced with Hospital Based Complex Clinical Care. This fund only covers care in a hospital environment. If you need care at home or in a care home, you’ll need to contact your local authority to explore funding options.

Read more on the Scottish Government website.

If in Wales

In Wales, you’ll need to ask your local NHS Health Board for a Continuing Healthcare assessment.

If in Northern Ireland

If you live in Northern Ireland, it’s your Local Commissioning Group that you will need to contact for an assessment.

How the NHS decides whether to pay for your care
How the NHS pays for care
Funding for Nursing Care

The first part of the assessment is an interview with a health or social care professional from your local Integrated Care Board (ICB). They’ll ask you some questions to understand how much help you need across 12 areas of care:

Breathing**

Nutrition*

Continence

Skin Integrity*

Mobility*

Communication

Psychological and emotional needs

Cognition*

Behaviour**

Drug Therapies and medication**

Altered states of consciousness**

Other significant care needs*

For each area, you can be scored as having No need, Low, Moderate or High need. To get through to the second stage of the assessment, you’ll need to show you have the right level of need.

To pass step one, you’ll need to show that you have:

Two or more areas rated as high need, or

Five or more rated as moderate, or

One area rated as high and four rated as moderate, or

A High need in one of these four areas of care: Breathing, Behaviour, Drug Therapies and medication, and altered states of consciousness.
In this second stage, the ICB will consider the same 12 areas as the checklist in more depth. For this part, your needs can be scored beyond ‘high’ to ‘severe’ in the areas marked with a * and ‘priority’ for areas labelled **.

After this step, you should be recommended as eligible for NHS Continuing Healthcare if you have:

a priority level of need in any of the four areas you can be scored as having priority needs

two or more scores of severe needs across all care areas.

It’s also a sign that you’re likely to be eligible if you have:

a severe score in one area, together with needs in a number of other areas, or

high and moderate needs across a number of areas.
If your health has deteriorated and you’re receiving end-of-life, sometimes called palliative care, you can ask your local health authority to fast-track your application. This is to help you get the care you need in place as soon as possible, so your assessment should be done and you should hear a decision within 48 hours.

If you don’t agree with the funding decision, your local health authority will explain how you can ask them to reconsider. You’ll need to do this within six months of hearing the outcome of your assessment.

They’ll then look at your case again, and if you’re not happy with the result of the Local Review, you can ask for an Independent Review.

If you need help with the assessment or to challenge a decision, you can talk Beacon, who are a specialist service supported by NHS England and operating across the UK that offers free telephone support.

Find out more
How the NHS pays for care

If you need care in a care home

Your local NHS authority will pay your care home directly, so there’s nothing you need to do.

If you need care at home

You’re likely to be given a Personal Health Budget so you can arrange for care yourself. It’s designed to give you enough money to pay for the care your assessment suggests you need. You’ll have the flexibility to decide how you’re cared for and which providers you use.
Funding for Nursing Care

If you’re staying in a nursing home and getting care from the on-site registered nurse, you’re entitled to some NHS funding, even if you’re not eligible for Continuing Healthcare. You should get a weekly payment to cover the nursing part of your care, paid directly to the nursing home. This means any nursing costs will be taken off your nursing home bill, saving you money.

Table

Part of the UK Weekly payment

England £235.88

Wales £201.74

Scotland £111.90

Northern Ireland £100.00

How to apply

Contact your local health authority to apply for NHS Continuing Healthcare. If you’re not eligible for this funding, they’ll automatically consider whether you’re entitled to nursing payments.

Find out more about NHS Continuing Healthcare

Table
Part of the UK	Weekly payment
England	£235.88
Wales	£201.74
Scotland	£111.90
Northern Ireland	£100.00

Care Cost Calculator

Many people needing care find they’ll have to cover some or all of the costs themselves, and it can be daunting. But knowing all your options could help to save you money. Our Care Costs Calculator can help you to understand the cost of care in your area and fully explore your funding options.

Calculate your care costs

Understanding your options

While they’re the most well known, care homes aren’t your only option. Find out about other potential options, such as home adaptations.

Home care

Finding care

Whether you need some help at home or want to find out more about Care Homes in your area, we have information on where to search and what questions to ask.

Finding the right care

Avoiding care costs

Our mythbusting guide can help you make sense of gifting rules.

Ways to avoid paying for care

Applying for NHS funding to pay for your care

If you need help because you have certain medical needs as well as personal care needs, some or all of your care costs could be paid for by the NHS.