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NHS Funding

IMPORTANT CHANGES – CORONOVIRUS

The Coronavirus Act 2020 may impact on care assessment and funding by a Local Authority or Clinical Commissioning Group.

WHAT IS CONTINUING HEALTHCARE?

NHS Continuing Healthcare (CHC) is a package of care arranged and funded solely by the NHS in England for a person who is aged 18 or over and has been found to have a ‘primary health need’ that has arisen because of disability, accident or illness. This is regardless of where the care is to be provided and includes: care at home, residential or nursing homes.

WHO ADMINISTERS CHC?

Clinical Commissioning Groups (CCGs), replaced Primary Care Trusts (PCT) as NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. The Clinical Commissioning Group (CCG) that holds the contract with the GP practice responsible for care at the time of application is responsible for deciding eligibility to Continuing Healthcare.

THE CHC CHECKLIST

The National Screening Continuing Healthcare Checklist can be used in a community or a hospital setting and aims to help trained health/social care professionals identify people who should have a full assessment to determine their eligibility.

Following the checklist, if appropriate, a full assessment will be carried out by a Multi- Disciplinary Team (MDT) and the Decision Support Tool (DST) used to establish eligibility to CHC.

The checklist is based on 11 out of 12 care domains (areas of care need) used in the decision support tool. The domain ‘other significant needs’ is not used in a checklist

CARE DOMAINS

CHC care domains

CHALLENGING A DECISION NOT TO PROCEED TO FULL ASSESSMENT

If a person has been screened out from full consideration following use of the Checklist, they may ask the CCG to reconsider its decision and agree to a full assessment of eligibility

FULL ASSESSMENT AND THE DECISION SUPPORT TOOL (DST)

Where appropriate the Decision Support Tool should be used following a comprehensive multi-disciplinary assessment (often called a Multi-Disciplinary Team Meeting – MDT) of a person’s health and social care needs.

The primary health need should be assessed by looking at all of the care needs and relating them to twelve care domains (below) AND four key indicators; nature, intensity, complexity and unpredictability.

The Decision Support Tool is not an assessment in itself but a way of bringing together and applying evidence in a single practical format to provide an overview of the levels chosen and a summary of the person’s needs.

Challenging an assessment decision

Where a full assessment has been undertaken of potential eligibility using the Decision Support Tool (or by use of the Fast Track Pathway Tool), and a decision has been reached, challenging that decision should be addressed through the local resolution procedure, initially.

The Fast Track Tool

The Fast Track pathway tool is used when a person has a rapidly deteriorating condition and may be entering a terminal phase. It can only be completed by an ‘appropriate clinician’ and is sufficient evidence to establish eligibility. Where it is appropriate to use the Fast Track Pathway Tool, this replaces the need for a Checklist and DST to be completed

Funded Nursing Care Payment

NHS continuing healthcare must be considered, and a decision made prior to any consideration of eligibility for NHS-funded nursing care. From 1st April 2020 the Funded Nursing Care Payment is a weekly payment is a weekly payment of £183. 92 (2019/20 £180.31) and is provided by the NHS to homes providing nursing care, to support the provision of nursing care by a registered nurse.

The National Framework for NHS Continuing Healthcare and NHS funded nursing care, sets out the principles and processes for determining eligibility

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