05. What if I am coming out of hospital?

If you are in an NHS hospital, you should be assessed before you are discharged to work out what support or services you might need.

This assesment looks at whether:

• your needs are such that the NHS should remain responsible (even if you go into a care home or return to live in your own home usually called 'continuing care') ; or 
• you need to do into a care home with social services support and get some nursing care there; or
• you can go home and get health care you need as an outpatient, in your own home or at a local centre.

After you've been assessed you should be given written details of:

• how much you are likely to have to pay for care after you leave hospital;
• any benefits you might be able to get; and
• which parts of your care will be arranged and paid for by the NHS.

Local NHS authorities, like councils, have limited budgets. They can decide, within limits, what services they can afford and who will get them. Strategic Health authorities, Primary Care Trusts (in England) and Local Health Boards (in Wales) must publish a 'continuing care statement' describing the services they will give to patients who have 'non-acute' needs (people who are in longer-term or respite care, for example). This statement should contain an explanation of how the authority decides which patients will qualify for NHS support.

This means that, for example, if you are in hospital and are assessed as needing to be discharged to a nursing home, you could ask your local Trust or Board to pay for this care because you come within its 'continuing care eligibility criteria'. If it agrees to this, it will pay all the nursing home's fees and you will pay nothing.

If your assessment shows you need some nursing care in a nursing home, but not of the kind that qualifies as 'continuing care', you will get some NHS help with the fees if you want it, but only to cover those parts of nursing care that require a registered nurse (see 'What if I need nursing care?').

If you qualify for other specialist NHS ongoing healthcare services as an outpatient (such as diabetic advice, physiotherapy or chiropody), these will be free whether you get them in your own home, at a day centre or in a residential or nursing home.

What if I don't agree with what has been decided for me?

If your assessment says you don't qualify for NHS continuing care and you don't agree with it, you may have a 'right to a review' of the decision by an independent panel of people. But this panel will not look at whether the policies are fair, only at whether the rules have been applied properly to your case.

You should not have to leave NHS care while your review is taking place, which should be within 2 weeks of your request. You should receive the result of the review in writing. If you're not happy with its findings - or if you think the continuing care rules themselves are the problem - you can complain using the NHS complaints procedure (see 'What if I have a problem with NHS care?').

You can also normally refuse to be discharged from NHS care into a nursing or residential home if the NHS will not pay for your care. You cannot generally stay in an NHS hospital forever, though, so all the organisations involved should try to come up with suitable alternatives. These could be, for example, a package of services that mean you could go back to your own home.

You can ask to be reassessed by if your situation changes and you think you may now meet the rules for NHS continuing support.