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
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 2018 the Funded Nursing Care Payment is a weekly payment of £165.56 (from April 2019/20) and is provided by the NHS to homes providing nursing care, to support the provision of nursing care by a registered nurse.