Skip to main content

NHS-funded Nursing Care Procedure (FNC)

1. The NHS-funded Nursing Care Practice Guide

The NHS-funded Nursing Care Practice Guide is a document that sets out the process for the consideration of NHS-funded Nursing Care (FNC).

The practice guide is supplementary to the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, and practitioners carrying out any action in relation to NHS-funded Nursing Care funding must have regard for both documents.

Click here to access the NHS-funded Nursing Care Practice Guide.

Click here to access the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

2. An Introduction to Funded Nursing Care

Defining NHS-funded Nursing Care

NHS-funded Nursing Care (sometimes called Funded Nursing Care or FNC) is a weekly financial contribution made by the NHS towards the cost of registered nursing care provided in a care home setting.

FNC is available for people who:

  1. Live in a nursing placement; or
  2. Stay short term in a nursing placement (for example respite).

Eligibility for NHS-funded Nursing Care

NHS-funded Nursing Care is only available for people:

  1. From the age of 18; who
  2. Are not eligible for NHS Continuing Healthcare; but
  3. Who have eligible nursing needs; and
  4. Those needs are most appropriately met by a Registered nurse in a care home environment.

The local Clinical Commissioning Group (CCG) must determine if a person is eligible for NHS-funded Nursing Care.

Eligible nursing needs

Eligible nursing needs are those needs with interventions that have to be:

  1. Carried by a Registered nurse;
  2. Planned and reviewed by a Registered nurse;
  3. Monitored by a Registered nurse; or
  4. Supervised by a Registered nurse.

Only a Registered nurse can carry out the assessment to determine whether the person has eligible nursing needs.

The Funded Nursing Care contribution

The FNC contribution is provided at a flat rate set by central government. It does not change depending on the cost of the nursing home, or the complexity of the person's eligible nursing needs.

The FNC contribution is paid directly by the CCG to the care home providing the registered nursing care.

The FNC contribution and will not cover the total cost of a nursing home and the remaining costs will need to be paid by:

  1. The person (if they are self funding); or
  2. The Local Authority.

3. Funded Nursing Care and NHS Continuing Healthcare

A person cannot be found eligible for NHS-funded Nursing Care until they have been found to be ineligible for NHS Continuing Healthcare unless:

  1. They will be staying short term in a nursing home; and
  2. Eligibility for NHS Continuing Healthcare has not been considered; but
  3. They have nursing needs that have been assessed by a Registered nurse; and
  4. That Registered nurse has made a recommendation that the person is eligible.

Note: Eligibility for NHS Continuing Healthcare can be considered without a full assessment process having been carried out.

4. Roles and Responsibilities

The role of Case Managers

Through any assessment or review process practitioners should:

  1. Identify when a person may be eligible for NHS-funded Nursing Care; and
  2. Provide information to the person (and their family) about NHS-funded Nursing Care; (whenever it is requested or would be beneficial); and
  3. Obtain the person's consent to request a nursing needs assessment is completed.

For existing nursing placements and those being arranged from community settings a nursing needs assessment should then be requested via ComplexCare@swindon.gov.uk.

If the person is on an acute hospital ward and will be discharged to a nursing home a ward nurse should complete a nursing needs assessment and submit this directly to the CCG Continuing Healthcare Team.

The role of the Complex Care Team

The Complex Care Team is part of the Integrated Services Complex Care Hub. The Hub also comprises of the Swindon CCG Continuing Healthcare Team, who are ultimately responsible for funding decisions.

Upon receiving a request from a Local Authority practitioner the Complex Care Team should liaise with the CCG Continuing Healthcare Team to arrange allocation of a registered nurse to complete a nursing needs assessment.

The role of the Registered nurse

The Registered nurse appointed by the CCG is required to:

  1. Complete a nursing needs assessment; and
  2. Consider whether or not a nursing home placement is required (see below); and
  3. If so, develop a Care Plan setting out how nursing needs will be met; unless
  4. This information has already been provided as part of the NHS Continuing Healthcare assessment process.

When completing a nursing needs assessment and Care Plan the Registered nurse should ensure they only consider interventions that are (or would be):

  1. Planned and reviewed by a Registered nurse;
  2. Monitored by a Registered nurse; or
  3. Supervised by a Registered nurse.

The Registered nurse should consider the following questions:

  1. Could the person's eligible nursing needs be met by a community nurse in their own home?
  2. Does the level or nature of the eligible nursing needs require a nursing home placement, or could a non-nursing home placement meet the need?
  3. Does the person want to be in a residential setting?
  4. Are there any safeguarding concerns relating to the person, or to any proposed placement that must be considered.

Note:  If a nursing home placement is not required the nurse cannot recommend NHS-funded Nursing Care

The role of the Clinical Commissioning Group

After the assessment process is completed and the registered nurse has made their recommendation the CCG must then make a decision about whether or not the person is eligible for NHS-funded nursing care.

Maximising participation of the person

A core value and principle of the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care is to maximise the involvement and participation of the person at all stages of the process, from completing the checklist to the point where a decision is made about eligibility and beyond.

As a minimum the MDT should:

  1. Ensure that the person and/or their representative is fully and directly involved in the process and any decision making;
  2. Take full account of the person's own views and wishes, ensuring that their perspective is the starting point of every part of the process;
  3. Address communication and language needs;
  4. Obtain consent to assessment and sharing of records;
  5. Deal openly with issues of risk; and
  6. Keep the person (and/or their representative) fully informed.

Practitioner skills and knowledge

The Framework requires that practitioners involved in the process have received the necessary training to fulfil their role and meet their responsibilities.

You should speak with a line manager if you are concerned about your skills or knowledge around the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

5. Identifying a Possible Eligible Nursing Need

Why it is important to identify possible eligible nursing needs

As a social care practitioner it is important that you understand when a person may have eligible nursing needs, for both person centred and statutory reasons.

Person centred benefits

It is unlikely that practitioners based in the Local Authority will:

  1. Understand how best to meet nursing needs; or
  2. Be able to assess the appropriateness of a placement to meet the person's nursing needs.

Statutory implications

Under Section 22 of the Care Act the Local Authority is not permitted to provide services and support to people when it is the legal duty of the NHS to provide them unless:

  1. The support being provided by a health professional is merely incidental or ancillary (secondary) to doing something else to meet Care and Support needs; or
  2. The support is of a nature that the Local Authority could be expected to provide.

People that may have an eligible nursing need

It is important that no assumptions or generalisations are ever made about a person's possible eligible nursing need. However people with the following health conditions that may require (or already live in) a nursing home placement may have needs that are complex enough to require the care of a Registered nurse.

  1. Advanced Dementia;
  2. Parkinson's Disease;
  3. Cancers;
  4. Acquired brain injury;
  5. Severe learning disability;
  6. Complex personality disorders; or
  7. Enduring mental health illness
  8. Needs that are complex, intense and unpredictable.

Identifying when a person may have eligible nursing needs

The Care and Support Planning process

Consideration of possible eligible nursing needs should, wherever possible take place as part of the Care and Support planning process, as a way to:

  1. Confirm a person's need for a nursing placement; and
  2. Support the Local Authority to identify the most appropriate placement to meet their specific nursing needs.

Consideration should only take place after a person has moved into a nursing home when:

  1. They arranged their own placement; or
  2. Their needs have changed and you feel they may now be eligible (when previously they were not).

How to identify possible eligible needs

Possible eligible nursing needs can be identified by considering the person's needs in the context of their:

  1. Nature;
  2. Intensity;
  3. Complexity; and
  4. Unpredictability.
Nature This describes the particular characteristics of an individual's needs (which can be physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the individual, including the type ('quality') of interventions required to manage them.
Intensity This relates both to the extent ('quantity') and severity ('degree') of the needs and to the support required to meet them, including the need for sustained/ongoing care ('continuity').
Complexity This is concerned with how the needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/or manage the care. This may arise with a single condition, or it could include the presence of multiple conditions or the interaction between two or more conditions. It may also include situations where a person's response to their own condition has an impact on their overall needs, such as where a physical health need results in the person developing a mental health need.
Unpredictability This describes the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the person's health if adequate and timely care is not provided. Someone with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.


If you are not sure of a person's possible eligible nursing need you should seek the support and advice of your line manager or the Complex Care Team.

6. Providing Information and Advice

You are expected to be able to provide accessible information and advice about NHS-funded Nursing Care whenever:

  1. A person/carer asks for it; or
  2. You have identified that a person may have an eligible nursing need.

The following is a list of all the information that you should be able to provide:

  1. What NHS-funded Nursing Care is;
  2. What factors might make a person eligible for Funded Nursing Care;
  3. Who is responsible for making decisions about eligibility;
  4. How decisions about eligibility are made;
  5. The implications of an 'eligible' decision; and
  6. The implications of an 'ineligible' decision.

You should speak with a line manager if you are concerned about your skills or knowledge around the NHS-funded Nursing Care process before providing advice about it.

7. Obtaining Consent

It is important to obtain informed consent from the person prior to requesting a nursing needs assessment.

Consent should be:

  1. Explicit;
  2. Specific;
  3. Informed; and
  4. Freely given.

For further information about consent please refer to the Framework.

The nature of the consent given must be clearly recorded on the CHC Consent Form.

Click here to access it.

8. Making a Request for a Nursing Needs Assessment

All requests from Local Authority practitioners for NHS-funded Nursing Care to be considered should be sent to ComplexCare@swindon.gov.uk.

The Complex Care Team will then liaise with the CCG Continuing Healthcare Team to arrange for a registered nurse to complete a nursing needs assessment.

9. Agreeing Eligibility for NHS-funded Nursing Care

It is the responsibility to the CCG, based on the recommendations of the Registered nurse, to make a decision about eligibility for NHS-funded Nursing Care.

It is also the responsibility of the CCG to notify the person of the outcome, the Local Authority and any service providers.

If the person is not eligible for NHS-funded Nursing Care the Local Authority must provide a Personal Budget that is sufficient to meet all of the person's eligible needs for Care and Support, which can include support provided by a health professional when:

  1. It is merely incidental or ancillary (secondary) to doing something else to meet Care and Support needs; or
  2. It is of a nature that the Local Authority could be expected to provide.

Complaints and challenges to the decision

Challenges to the decision

If you are concerned about the decision of the CCG you should discuss any action that may (or may not) be needed to challenge the decision with your line manager.

Complaints about the decision

If the person (or their representative) is unhappy with the decision they should complain about it directly to the CCG, and the CCG is required to review their decision.

The Local Authority is not able to manage any complaints relating NHS-funded Nursing Care.

10. Arranging Services and Recording NHS-funded Nursing Care Contributions

Arranging services

When arranging a nursing home placement (either permanently or for respite) you must:

  1. Use any available nursing needs assessment to understand the nursing needs that the person has; and
  2. Work jointly as required with the Registered nurse that completed the assessment in order to ensure that an appropriate placement is identified.

Guidance about effective joint working can be found in the Joint Work procedure by clicking here.

When the person moves into the placement

When the person who is eligible for NHS-funded Nursing Care moves into a nursing placement the Registered nurse responsible for reviewing the FNC must ensure that they have access to all of the health services that they require when they move. This can include:

  1. Tissue viability services;
  2. Occupational Therapy;
  3. Speech and Language Therapy;
  4. Physiotherapy; and
  5. Palliative Care.

Self Funders

The Local Authority should consider the benefit in arranging and manage services for a self funder if they are eligible for NHS-funded Nursing Care.

This is because their needs are likely to be:

  1. Complex;
  2. Likely to change; or
  3. Unstable (or at risk of becoming unstable).

Recording NHS-funded Nursing Care contributions

NHS-funded Nursing Care contributions should be recorded in line with local requirements.

11. Reviewing Eligibility

The Clinical Commissioning Group

The CCG have a statutory responsibility to review how the nursing placement is meeting the person's eligible nursing needs 3 months after NHS-funded Nursing Care was first agreed, and then every 12 months after that.

If there is any evidence to suggest that the person may no longer be eligible for NHS-funded Nursing Care the CCG must carry out an appropriate reassessment of the person's nursing needs to confirm this to be the case.

The Local Authority

The Local Authority should consider making a further request or completing a NHS Continuing Healthcare checklist if they believe there to be a change in the person's needs or circumstances in the future, and that they:

  1. May now be eligible for NHS-funded Nursing Care; or
  2. May now be eligible for NHS Continuing Healthcare.

Joint reviews

Wherever possible statutory Care and Support Plan reviews should be carried out at the same time as the CCG carries out its review of the NHS-funded Nursing Care to:

  1. Prevent duplication for the person; and
  2. To ensure a multidisciplinary approach to agreeing the response to any change in need or circumstances of the person.

Guidance about effective joint working can be found in the Joint Work procedure by clicking here.

If a joint review is not possible the Local Authority practitioner and the Registered nurse must make arrangements to share relevant information, having regard for confidentiality and consent.

Withdrawing NHS-funded Nursing Care

NHS-funded Nursing Care can be withdrawn by the CCG if:

  1. The person no longer has eligible nursing needs; or
  2. The person no longer require a nursing home placement; or
  3. The person no longer requires respite in a nursing home.

If the CCG intends to withdraw NHS-funded Nursing Care the Local Authority should be informed in writing of:

  1. Their intention to do so;
  2. The date that they intend to stop providing funding; and
  3. The rationale for the decision.

If the Local Authority is managing the placement they should:

  1. Consider whether the nursing placement remains the most appropriate way to meet the person's eligible Care and Support needs; and
  2. If so arrange to increase the person's Personal Budget accordingly so that the full cost of the placement is met; and
  3. If not, agree and make alternative arrangements for Care and Support.

If the Local Authority is not managing the placement because the person is self funding, the person must make suitable arrangements to pay the full cost of the placement.

12. Hospital Admissions

The CCG is not permitted to continue paying NHS-funded Nursing Care contributions to a nursing home if the person is receiving registered nursing care in an acute hospital (or other NHS setting).

However, the CCG is permitted to pay a retainer fee to the nursing home at the FNC rate in order to hold the placement.

Where available local NHS-funded Nursing Care policy should set out:

  1. The circumstances when the CCG will/will not pay the nursing home a retainer fee to cover the shortfall;
  2. The circumstances when the Local Authority must pay the difference in cost in order to retain the placement; and
  3. The circumstances when the person must make suitable arrangements to pay (if self funding).

tri.x adults procedures