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), 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.
If you are eligible for CHC a personal health budget can allow you to manage your healthcare and support such as treatments, equipment and personal care, in a way that suits you.
The CHC Checklist
The National Screening Continuing Healthcare Checklist can be used in a community or a hospital setting and helps to identify people who should have a full assessment to determine their eligibility.
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
A full assessment for NHS Continuing Healthcare is required if there are:
- two or more domains selected in column A;
- five or more domains selected in column B, or one selected in A and four in B; or
- one domain selected in column A in one of the boxes marked with an asterisk (i.e. those domains that carry a priority level in the Decision Support Tool), with any number of selections in the other two columns.
If you are screened out from full consideration following use of the Checklist, you may ask the CCG to reconsider its decision and agree to a full assessment of eligibility
Full Assessment – Decision Support Tool (DST)
Following a positive checklist, a full assessment should be carried out by a Multi- Disciplinary Team (MDT) using the Decision Support Tool (DST) to establish eligibility to CHC.
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.
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
Challenging a decision
Challenging a Checklist outcome
If you have received a ‘negative’ checklist outcome person you may ask the CCG to reconsider its decision and agree to a full assessment of eligibility.
Challenging an assessment decision
If you do not agree with the decision made following recommendations made by a Multi Disciplinary Meeting using the Decision Support Tool (or by use of the Fast Track Pathway Tool), challenging that decision should be addressed through the local resolution procedure, initially.
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. The Funded Nursing Care Payment is a weekly payment of £187. 60 (2021/22) and is provided by the NHS to homes providing nursing care, to support the provision of nursing care by a registered nurse.
Some people who have been kept in Hospital under the Mental Health Act 1983 are entitled to FREE AFTERCARE under Section 117 of the Mental Health Act 1983. This care and support provided by both Health and Social Care is to try and prevent mental health issues getting worse and avoid the need to go back into hospital.
Discharge to Assess
Discharge to assess (D2A) provides free short term care to support people to leave hospital quickly, it should still be safe and appropriate to do so, and the purpose is to allow time for care needs assessment out of hospital.
If you would like to help to understand whether you may be eligible for Continuing Healthcare or to understand how care is paid for and the help available please call us 0800 999 2 27 or get in touch.