NHS continuing healthcare

NHS Continuing Healthcare (also known as CHC), is the name given to a package of ongoing care which is arranged and funded entirely by the NHS for individuals outside of hospital who have ongoing health care needs. You can receive NHS Continuing Healthcare in any setting outside of hospital, including your own home or in a care home. NHS Continuing Healthcare covers all your identified care costs and is not means tested. This means it is not based on what you earn, or your savings. The NHS Continuing Healthcare process is set out in the National Framework for NHS Continuing Healthcare.

Anyone over 18 years of age, assessed as having a ‘primary health need’, should be eligible for NHS Continuing Healthcare. It is not dependent on a particular disease, diagnosis, or condition. If you are eligible for NHS Continuing Healthcare, your care will be funded by the NHS. This is subject to regular reviews, and should your needs change, the funding arrangements may also change. Your eligibility for NHS CHC is based on evidence of a ‘primary health care need’.

A ‘primary health need’ is not about the reason why you require care or support, nor is it based on your condition and diagnosis; it is about your overall actual day-to-day care needs taken in their totality.

A primary health need would be indicated by the nature, complexity, intensity or unpredictability of health needs, or a combination of these.

To find out if you are eligible for NHS Continuing Healthcare a two-stage assessment process is followed:

• Stage 1: Screening via the Checklist tool
• Stage 2: Full assessment of eligibility via a multi-disciplinary team meeting.

To help correctly identify if you require a full assessment of eligibility for NHS continuing healthcare, a health or social care professional involved in your care will complete a screening tool called a NHS Continuing Healthcare Checklist. They may also speak to your family or others who support you to build up a picture of your needs.

The checklist is a national tool and the threshold at this stage of the process has intentionally been set low, to ensure that all those who require a full assessment of eligibility have this opportunity. If your checklist indicates further assessment is required, this does not mean that you will be eligible to receive NHS continuing healthcare.

Once completed, if the checklist indicates that you require a full assessment of eligibility we will arrange for a ‘multi-disciplinary team’ meeting to take place. A ‘multi-disciplinary team’ means a team drawn from a number of professionals such as nurses, therapists, and social workers. You may hear the term shortened to ‘MDT’. The multi-disciplinary team will be made up of two or more professionals who understand your care needs. They may be from health or social care services.

At the full assessment, NHS Continuing Healthcare staff from Hampshire and Isle of Wight Integrated Care Board (HIOWICB) will make sure that you, your chosen representative, as appropriate, and whoever cares for you are invited to be involved.

A member of the NHS Continuing Healthcare team will contact you or your chosen representative before your assessment takes place to talk you through the process and answer any questions you may have. Your assessment can take place either in person or online. If it happens online the multi-disciplinary team will still have access to all the relevant information about your needs.

Members of the multi-disciplinary team will meet with you to undertake the assessment and complete a ‘decision support tool’. You may hear this term shortened to a DST. This decision support tool allows the multi-disciplinary team to gather a full picture of your health and care needs.

Whilst there may be a number of professionals, along with you and/or your chosen representative at the meeting, the two decision makers will be the NHS Continuing Healthcare nurse and typically a social worker. They will listen and record everyone’s views and put forward their recommendation with regards to your eligibility for NHS Continuing Healthcare. A registered professional within HIOWICB will look at the recommendation made by the multi-disciplinary team, alongside the supportive evidence collected, and finalise or “ratify” the decision. This will usually be in line with the recommendation made unless there are exceptional circumstances.

Once we have made a decision, we will send you a letter confirming the outcome. This letter will also include a copy of the decision support tool.

In most cases the NHS Continuing Healthcare assessment process and eligibility decision should be completed within 28 days.

Fast Track tool

If you need an urgent package of care due to a rapidly deteriorating condition, which may be entering a terminal phase, then the fast-track tool may be used to confirm eligibility for NHS Continuing Healthcare funding. If this is the case, an appropriate clinician will complete the fast-track tool and send it directly to us at HIOWICB, who will arrange for care and support to be provided as quickly as possible.

If you receive a letter saying you are “not eligible” for NHS Continuing Healthcare funding and you feel that the appropriate procedures have not been followed, for example, that our team at HIOWICB have not applied the National Framework appropriately in making this decision, or your needs have been misrepresented, you have a right to appeal. You cannot appeal solely on the basis that you do not agree with the outcome of the assessment. In these circumstances you can ask us to undertake a review within six months of the decision. Once we receive your request, we then will aim to complete the appeals process within 90 days. All the information you need about the appeal process can be found on the letter where we confirm the outcome of the assessment.

Review of your care package will be completed within three months of being found eligible. Afterwards you should have further reviews at least once a year. These reviews should focus on whether your care plan, and care arrangements continue to meet your needs. If your care plan no longer meets your needs, we will work with you to make amendments to ensure all your care needs are safely met.

If your needs have changed to such an extent that they may impact on your eligibility for NHS Continuing Healthcare, then we may arrange a full reassessment of eligibility. This is called a Review DST. If you have any queries or need to discuss your care needs in between review dates, please contact your case worker.

Whether or not you are eligible for NHS Continuing Healthcare, you are still able to make use of all the other services from the NHS in your area in the same way as any other NHS patient.

If you are not eligible for NHS Continuing Healthcare and you live in a care home that is registered to provide nursing care, you may be eligible to receive NHS-funded nursing care. This will be considered during your CHC assessment. If you or those caring for you feel your own/your relative’s health has got worse, you can ask for a re-assessment of their eligibility for NHS Continuing Healthcare.

NHS Continuing Healthcare is not based on a specific diagnosis, but on the level of health care needs which considers the nature, intensity, complexity, and unpredictability of the health needs.