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Continuing Healthcare (CHC)

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NHS Continuing Healthcare is the name given to a package of care that is arranged and funded by the NHS for people outside of hospital who have ongoing healthcare needs. NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or a care home.

Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness and who have been found to have a ‘primary healthcare need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (revised October 2018)

The service will accept referrals for individuals who have a learning disability and/or a mental health diagnosis when a NHS Continuing Healthcare Checklist tool has been applied and the individual has positively screened in for full assessment as per the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.  

In addition referrals will be accepted for individuals under Section 117 of the Mental Health Act (1983) where it is required that the Clinical Commissioning Group and the local authority, in cooperation with voluntary agencies to, provide or arrange for the provision of aftercare to patients detained in hospital for treatment under section 3, 37, 45A, 47 or 48 of the Act who then cease to be detained. This includes patients granted leave of absence under section 17 and patients going on community treatment orders. 

Individuals will have substantial health needs which are permanent and are associated with multiple and poorly controlled health conditions and co-morbidities. Individuals are high risk, high demand service users who will require ongoing complex care case management.

 

Between 19th March and 31st August 2020 NHS Continuing Health Care (NHS CHC) assessments were suspended as part of the NHS Level 4 emergency in response to COVID -19.
The Government agreed to fully fund the cost of new or extended out-of-hospital health and social care support packages for people being discharged from hospital or who would otherwise be admitted into it. https://www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements

This funding was a temporary arrangement until a time when NHS Continuing Healthcare assessments could resume. Assessment is needed to determine long term care needs and eligibility for public funded care.

On 1st September 2020 the NHS CHC and Local Authority assessments were restarted across the whole of England. This means that in Cheshire:
• We are returning to normal business service, if we receive a Checklist or you are referred to us we will endeavour to complete your assessment within 28 days. We apologise if this is not always the case.
• We will now be conducting NHS CHC assessments for those people where temporary Government funding has been used. The Department and Health and Social Care expect us to complete all outstanding assessments by March 2021. Temporary Government funding will cease once it is clear if an individual is eligible for public funded care.
• Individual requests for a review of an eligibility decisions (i.e. Local Resolution and Independent Review) will continue.
• Three-and twelve-month reviews of NHS Continuing Healthcare packages will take place where remote technologies and Care Providers enable them to be completed.
• We will continue to consider Funded Nursing Care for those individuals who are not eligible for NHS CHC but are in Care Home with Nursing.
• We continue to work very closely with our two Local Councils to ensure that individuals are referred to discuss the support that can be provided by them. This may involve making a contribution to the cost of care depending on income and savings.

To ensure that you receive the support that you need our staff are still available for any concerns you have and will assist with any queries. Please use your normal means of contacting us or email cheshire.chc-cc@nhs.net

You can find more information about the Reintroduction of NHS Continuing Healthcare Assessments here: https://www.england.nhs.uk/healthcare/reintroduction-of-nhs-continuing-healthcare-nhs-chc-guidance/

Contact Details

To find out more please contact your Continuing Healthcare Team

Telephone: 01244 385 063

Email: cheshire.chc-cc@nhs.net

Address: Continuing Healthcare Service, 1829 Building, Countess of Chester Health Park, Liverpool Road, Chester.

Anyone over the age of 18 who has a complex medical condition and substantial and ongoing care needs may be eligible for NHS Continuing Healthcare.

Eligibility for NHS Continuing Healthcare does not depend on:

  • A specific health condition, illness or diagnosis
  • Who provides the care, or
  • Where the care is provided

Not everyone with a disability or long-term condition will be eligible.

We recognise that NHS Continuing Healthcare (CHC) can appear to be a complex & highly sensitive process, and often effects people at a very uncertain stage of their lives.

The CCG follow National Guidance to ensure that everyone has fair and consistent access to NHS Continuing Healthcare, regardless of where they live in Cheshire (CCG area).

The CCG CHC team will ensure that the process of assessment of eligibility and decision-making is person-centred. This means placing you at the heart of the assessment and care-planning process. It also means making sure that you have the opportunity to play a full role in the assessment process and receive the support to do this where needed. You could do this by asking a friend or relative to act as your representative and help explain your views.

The CCG is responsible for identifying someone to co-ordinate the assessment process and this person will be your main point of contact and will be a professional from health or social care.

The assessment will, with your permission, involve contributions from a range of professionals involved in your care to build an overall picture of your needs. This is known as an ‘assessment of needs’. Your own views should be given appropriate weight alongside professional views to help achieve an accurate picture of your needs.

Our staff pride themselves on upholding the values of the NHS Constitution and as an employer we expect them to demonstrate:

  • Working together for patients.
  • Respect and dignity.
  • Commitment to quality of care.
  • Improving lives.
  • Everyone counts.

 

NHS Cheshire CCG would like to assure you that there is no requirement to instruct a solicitor or claim firm as NHS Continuing Healthcare is not a legal process and the CCG would like to assure you that the CHC process is applied fairly & openly to all. Professionals from Health & Social Care are bound by their own Professional Code that contains the professional standards required, that must be upheld. These standards are the standards that patients and members of the public tell the regulatory bodies what they expect from health & social care professionals.

If you would like to speak to someone from the team regarding CHC, please call

Telephone number: 01244 385063

Email: cheshire.chc-cc@nhs.net

We have also included a Public Information Leaflet regarding NHS Continuing Healthcare and NHS-funded Nursing Care that can be accessed, read or downloaded here.

The assessment process for NHS Continuing Healthcare is person-centred; this means putting you, your views about your needs and the care and support you require at the centre of the process.

For most individuals there is an initial Checklist assessment. This is the screening tool used by health and social care staff to identify those people who may be eligible to undertake a full assessment for NHS Continuing Healthcare. The Checklist does not indicate whether the individual is eligible for NHS Continuing Healthcare, only whether they require full assessment of eligibility for NHS Continuing Healthcare.

If the Checklist has been completed and indicates that there is a need to carry out a full assessment of eligibility for NHS Continuing Healthcare the Clinical Commissioning Group will arrange for a multidisciplinary team to carry out an assessment of your needs. 

A multidisciplinary team is made up of two or more health or social care professionals who may already be involved in your care.

The multidisciplinary team will share the information they hold about you or your relative's care needs and jointly complete a Decision Support Tool. The team will look at all your care needs and relate them to:

  • What help you need
  • How complex your needs are
  • How intense your needs can be
  • How unpredictable they are; including any risks to your health if the right care isn’t provided at the right time 

Your eligibility for NHS Continuing Healthcare depends on your assessed needs, and not on any particular diagnosis or condition. 

The multidisciplinary team will also take into account your views and together with all of this information a recommendation is then put forward to your local Clinical Commissioning Group who ultimately decides whether or not you or your relative is eligible for funding.

If your needs change then your eligibility for NHS Continuing Healthcare may also change. 

Fast Track Tool

There are times when a person is in need of an urgent package of care due to a rapidly deteriorating condition which may be entering a terminal phase; in these situations an appropriate clinician will complete the Fast Track Tool. Your local NHS Continuing Healthcare Team will then process this and arrange for a package of care as quickly as possible.

A review of your care needs will be undertaken at regular intervals.

If following any review it is decided that you no longer meet the eligibility criteria for NHS Continuing Healthcare, social services may carry out an assessment to determine if you are eligible for support from them.

If you are not eligible for NHS Continuing Healthcare, the local authority will discuss with you whether you may be eligible for support from them. 

If you are not eligible for NHS Continuing Healthcare but are assessed as having healthcare or nursing needs, you still may receive some care from the NHS.

If you live in your own home, this could be provided as part of a joint package of care, where some services come from the NHS and some from social services.

If you live in a care home with nursing you may be eligible for NHS Funded Nursing Care (FNC).This type of funding is available for people that have registered nursing needs and are receiving their care in a care home with nursing. Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for FNC

If you think this affects you or someone you care for and you are already receiving care services from health or social care e.g. GP, Community Nurse or Social Worker you may wish to discuss this with them in the first instance.  

If you are in hospital and have been assessed as requiring care on discharge then the hospital discharge team will discuss this with you.

Some children and young people may have very complex health needs requiring additional health support that is not routinely available. This additional health support is called continuing care. The Clinical Commissioning Group is responsible for assessing children and young people to see if they are eligible for continuing care.

A continuing care package of support may be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone (GP practices, hospitals or in the community). The Cheshire and Wirral children’s complex care service is guided by the National Framework for Children and Young People’s Continuing Care (Department of Health 2016) and will work alongside social care and education to provide the most appropriate support at home, in school and in the community.

Who is Eligible?

Any child or young person up to their 18th birthday who has a complex health need or disability may be eligible.

When a child reaches 18, adult NHS Continuing Healthcare arrangements may apply however there are significant differences between Children and Young People’s Continuing Care and NHS Continuing Healthcare for adults. Although a child or young person may be in receipt of Children’s Continuing Care they may not be eligible for NHS Continuing Healthcare as an adult.

All children and young people in receipt of children’s continuing care will be assessed aged 17 to see if they are likely to be eligible for NHS Continuing Healthcare.

How can you access Continuing Care for Children and Young People?

A referral can be made by any healthcare, social care professional or carer who feels a continuing care package may be required. A referral form should be submitted to complexcare.admin@nhs.net along with signed consent from the child, young person or person with parental responsibility.

Further Information

What is a personal health budget?

A personal health budget is an amount of money to support someone’s health and wellbeing needs, which is planned and agreed between the individual or their representative, and the local clinical commissioning group (CCG). It isn’t new money, but a different way of spending health funding to meet the needs of an individual.

Personal health budgets are a way of personalising care, based around what matters to people and their individual strengths and needs. They give people more choice, control and flexibility over the care and support they receive.

A personal health budget may be used for a range of things to meet agreed health and wellbeing outcomes. This can include therapies, personal care and equipment. There are some restrictions in how the budget can be spent.

Who is entitled to a personal health budget?

Adults eligible for NHS Continuing Healthcare and children in receipt of continuing care have had a right to have a personal health budget since October 2014 and personal health budgets should be the default option for these groups.

People who become eligible for NHS Continuing Healthcare funding under the Fast Track Pathway also have a legal right to have a personal health budget. People may choose to receive their end of life care and support as a personal health budget, however there is no expectation from NHS England and NHS Improvement that this should be the case for everyone in receipt of Fast Track funding.

For further information on personal health budgets please click here: Personal health budgets in Continuing Healthcare

NHS England has published guidance on issues CCGs should consider when determining claims from individuals for retrospective funding of Continuing Healthcare needs. For more information on this please visit https://www.england.nhs.uk/wp-content/uploads/2015/04/nhs-cont-hlthcr-rdress-guid-fin.pdf