Fully funded NHS care

Some people who have primarily health care needs may meet the criteria to have their care provided completely free by the NHS. This will depend on the quality or quantity of health care needed. This is referred to as continuing NHS health care.

You should automatically be assessed for continuing NHS health care before you move into a care home that provides nursing care, or when you are being discharged from hospital. If you are being assessed for help with nursing care costs you should first be properly assessed for fully-funded NHS care.

Following two very significant court cases – the Coughlan case in 1999 and the Grogan case in January 2006, which caused much discussion about who is entitled to fully-funded care, national eligibility criteria for continuing NHS health care were introduced in October 2007. These criteria look at eleven different ‘care domains’: for example, behaviour, continence and mobility, and, depending on the level of care needed in each of these areas, fully-funded care may be awarded.

If you feel that you have been refused continuing NHS health care unreasonably you should use the NHS complaints procedure to ask your Primary Care Trust (PCT) to reassess your case against the national criteria.

If you do qualify for an NHS fully-funded care home placement, the NHS will decide which home you will move into. You can ask to move into a particular home and your wishes should be taken into account, but the NHS has the final say. Your state pension and benefits will be affected in the same way as if you were in hospital – see our information sheets no.14, Going into Hospital, and no. 22, Coming out of Hospital.

Free care in a care home under the Mental Health Act

Some people in England, Wales and Northern Ireland who have been detained in hospital under certain sections of the 'Mental Health Act 1983' ('Mental Health Order 1986' in Northern Ireland), will be entitled to receive free 'after-care services'. This can include care home accommodation.

A local branch of the organisation MIND can advise people in this position. Phone 0845 766 0163 for details of your local group.