NHS continuing care in Scotland: Hospital Based Complex Clinical Care

Scotland no longer has NHS continuing healthcare. Since 1 June 2015 it has used Hospital Based Complex Clinical Care (HBCCC), which asks a single question: can this person’s care needs be properly met in any setting other than a hospital? If the answer is no, the NHS provides long-term care in hospital and pays for everything, including food and accommodation. If the answer is yes, the person is discharged and normal council charging rules apply, although personal and nursing care remain free.

In short

• HBCCC replaced NHS continuing healthcare in Scotland on 1 June 2015, under Scottish Government guidance DL (2015) 11.
• There is no checklist, scoring tool or “primary health need” test. A consultant, informed by the multidisciplinary team, decides whether hospital is the only suitable setting.
• HBCCC is provided in NHS-run inpatient settings. For new cases, there is no NHS-funded care home place as there is in England.
• Eligibility should be reaffirmed three months after admission and then every three months as needed. It is not for life.
• Outside hospital, the council pays £260.30 a week for personal care and £117.10 a week for nursing care in a care home in 2026/27. Personal care at home is free.
• Families can ask for a second opinion and use the NHS complaints procedure. The final step is the Scottish Public Services Ombudsman, normally within 12 months.

How HBCCC differs from England’s continuing healthcare

Many families have read about NHS continuing healthcare (CHC) in England and expect the same in Scotland. The two systems work very differently:

If your parent lives in England, read our guides to NHS continuing healthcare at home and fast-track CHC instead.

Who decides, and how

The decision belongs to the responsible consultant or an equivalent specialist. In a community hospital, a GP may lead. The guidance expects the consultant to use the views of the whole multidisciplinary team, which may include nurses, physiotherapists, occupational therapists and social workers. They should consider every option and explain the outcome to the patient, family and carers.

Boards should give families written information on discharge, appeals and complaints, and record each step. Ask for a copy of that record.

If your parent cannot make decisions, the Adults with Incapacity (Scotland) Act 2000 applies. Staff must consult any welfare attorney or guardian. Our guide to power of attorney in Scotland explains why having one in place makes these conversations easier.

What “hospital” means

The guidance defines a hospital as an inpatient facility fully funded and managed by NHS Scotland. In practice, HBCCC beds are often in community hospitals or specialist wards for older people or people with dementia. If someone is in a care home, they are not receiving HBCCC, however complex their needs are.

Reviews: HBCCC is not permanent

Eligibility is subject to regular review. The independent review behind the guidance recommended that a clinician and another team member confirm the need for HBCCC three months after admission, then every three months as needed. If your parent’s condition stabilises and the team decides a care home could now meet their needs, they will be discharged.

People who had NHS continuing healthcare before 1 June 2015 kept it “without detriment” for as long as they still need that level of care. That eligibility can also be reviewed and is not necessarily for life.

If the answer is no: leaving hospital

When the team decides hospital care is no longer needed, discharge follows. The Scottish Government’s guidance on choosing a care home on discharge (refreshed February 2023) says:

• Discharge depends on clinical need. It should not wait for a choice of home or for money to be sorted out.
• If the preferred home has no vacancy, your parent may need to move to another suitable home while they wait.
• Nobody has the right to stay in hospital once inpatient care is no longer needed.
• Long-term decisions should not normally be made in an acute hospital. Rehabilitation and reablement should come first, with a return home as the aim where possible.

DL (2015) 11 notes that intermediate care in a step-down bed is normally free for a limited period, usually four to six weeks. Our hospital discharge checklist helps you prepare, and care after hospital discharge explains the options.

What the NHS and council still pay for outside hospital

Losing HBCCC does not mean losing all help. The NHS still provides GP care, district and community nursing, palliative care at home and many items of equipment. In a care home, the council pays the free personal and nursing care payments if your parent is assessed as needing them. The council’s means test then decides who pays the rest.

Worked example (illustrative fee)

Robert has advanced dementia and has been in a specialist NHS ward for five months. At his review, the team decides a nursing home can now meet his needs. The home charges £1,350 a week, and Robert has £120,000 in savings.

He pays this until his capital falls to the £36,750 upper limit, when the council’s financial assessment begins. Our hub guide to paying for care in Scotland explains that means test. If his home might have to be sold, see selling a house to pay for care in Scotland.

How to challenge an HBCCC decision

There is no separate HBCCC appeal panel. The route is:

1. Ask for the decision and reasons in writing, including who took part and what evidence they used.
2. Ask for a second opinion. The guidance says the patient is entitled to one.
3. Ask for the disagreement to go to the NHS board’s Medical Director (or deputy), who has the final say on clinical disagreements about discharge.
4. Make a formal complaint under the NHS Scotland complaints procedure. Complain within six months of the event or of finding out about it. Stage 1 aims for a decision within five working days, and stage 2 for a full response within 20 working days.
5. Go to the Scottish Public Services Ombudsman (SPSO) once the complaints process is finished, normally within 12 months of becoming aware of the problem.

The Patient Advice and Support Service, run through Citizens Advice Scotland, can help you write the complaint. People with dementia or another mental disorder also have a right to independent advocacy under section 259 of the Mental Health (Care and Treatment) (Scotland) Act 2003.

Evidence that carries weight

Because the test is about where care can safely be given, focus on why a care home could not manage. Useful evidence includes:

• how often skilled nursing or medical interventions are needed, especially unpredictable ones overnight;
• care homes that have assessed your parent and declined, with their reasons in writing;
• falls, choking episodes, seizures or distressed behaviour recorded on the ward, with dates;
• treatments or equipment that care homes in your area cannot provide.

Moving between England and Scotland

CHC eligibility in England does not carry over to Scotland. If a parent with CHC is thinking of moving to a Scottish care home to be near family, check in writing with the English integrated care board and with the Scottish council before the move. Otherwise the family could face full fees, less free personal and nursing care.

Mistakes to avoid

• Asking for “continuing healthcare” by name. Ask the HBCCC question directly instead.
• Refusing every care home offered. This will not keep your parent in hospital, and an interim move may happen anyway.
• Forgetting free personal and nursing care. Ask the council to assess before or straight after the move so the £377.40 a week in total starts as soon as possible.

See also choosing a dementia care home and residential or nursing home.

Frequently asked questions

Is there NHS continuing healthcare in Scotland?

No, not since 1 June 2015. Scotland replaced it with Hospital Based Complex Clinical Care. HBCCC is only provided in NHS-run inpatient settings, for people whose needs can only be properly met in hospital. For them, the NHS pays everything, including food and accommodation. Everyone else is discharged, and council charging rules apply.

Who qualifies for Hospital Based Complex Clinical Care?

Anyone whose care needs cannot be properly met in any setting other than a hospital. There is no scoring tool or list of conditions. The responsible consultant decides, informed by the multidisciplinary team. The decision should be reviewed three months after admission and then every three months as needed.

Does the NHS pay for nursing homes in Scotland?

Not in full for new cases. The council pays a free nursing care payment of £117.10 a week and a free personal care payment of £260.30 a week in 2026/27 if your parent is assessed as needing them. The rest of the fee is means-tested, with an upper capital limit of £36,750.

Can you appeal an HBCCC decision in Scotland?

There is no separate appeal panel, but you can ask for a second opinion. Disputes can go to the NHS board’s Medical Director. You can also use the NHS complaints procedure, raising the complaint within six months. After that, you can go to the Scottish Public Services Ombudsman, normally within 12 months of becoming aware of the problem.

What happened to people on NHS continuing healthcare before 2015?

People who were already receiving NHS continuing healthcare before 1 June 2015 remained eligible, with their funding continuing “without detriment” for as long as they need that level of care. Their eligibility can still be reviewed, so it is not guaranteed for life.

Can my parent stay in hospital until a care home place is free?

Usually not. Scottish Government guidance says discharge should not be delayed by the choice of home or by money matters. If the preferred home has no vacancy, an interim move to another suitable home is expected. Nobody has a right to remain in hospital once inpatient care is no longer needed.

Sources

• Scottish Government: Hospital Based Complex Clinical Care, DL (2015) 11
• Scottish Government: choosing a care home on discharge from hospital (2023)
• The Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2026
• The National Assistance (Assessment of Resources) Amendment (Scotland) Regulations 2026
• NHS Scotland model complaints handling procedure (public guide)
• Scottish Public Services Ombudsman Act 2002, section 10 (time limit)
• Mental Health (Care and Treatment) (Scotland) Act 2003, section 259 (advocacy)

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.