NHS Continuing Healthcare (CHC) is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a ‘primary health need’.
You can receive CHC in any setting, including your own home or in a care home. CHC is free, unlike support provided by local authorities for which a financial charge may be made depending on your income and savings. If you are found to be eligible for CHC in your own home, this means that the CCG will pay for healthcare (e.g. services from a community nurse or specialist therapist) and associated social care needs (e.g. personal care, help with bathing, dressing and food preparation). In a care home, the CCG also pays for your care home fees, including board and accommodation.
Anyone 18 years of age and over who is assessed as having a certain level of care needs may be entitled to CHC. It is not dependent on a particular disease, diagnosis or condition, or on who provides the care or where that care is provided. If your overall assessment of care needs shows that you have a ‘primary health need’, you should be eligible for CHC. Once eligible for CHC, your care will be funded by the CCG.
What is NHS Funded Nursing Care?
This is the name given to a contribution from the NHS to meeting the nursing element of your care if your needs are such that they have to be met in a nursing home, but you are not assessed as having a ‘primary health need’.
How is eligibility for NHS Continuing Healthcare or Funded Nursing Care decided?
You can be referred for an assessment for CHC eligibility by a health or social care professional. You can also refer yourself or someone can request an assessment on your behalf. Usually the process starts with a ‘Checklist’ completed by a trained social worker or healthcare professional. The ‘Checklist’ is a screening assessment that gives an indication that your needs require further assessment for CHC. A positive Checklist outcome does not in itself indicate that you have a primary health need. If you have a positive Checklist, your needs are then assessed by a ‘multi-disciplinary team’ of team of health and social care professionals using a ‘Decision Support Tool’ (DST). You (and where appropriate, a family member or representative) will be involved in the assessment process. The assessment may take place in your own home or usual place of residence.
The assessment team uses a Framework for NHS Continuing Healthcare which is defined by NHS England. To be eligible for NHS Continuing Healthcare, you must be assessed as having a ‘primary health need’ in line with the domains included in the NHS Framework. It does not relate to any particular diagnosis or condition.
Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:
- Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs.
- Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care.
- Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/ongoing care.
- Unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.
After your assessment
Following your assessment you will be notified in writing of the outcome. If you are not eligible for NHS Continuing Healthcare, the reasons will be explained in the letter. A copy of the assessment will be provided with that letter. The letter will also tell you how to appeal if you feel the decision is wrong. The professional who referred you for the assessment will also be informed of the outcome of the decision.
Care and support planning.
If you are eligible for fully funded NHS Continuing Healthcare, the next stage is to arrange a care and support package which meets your assessed needs. Depending on your situation, different options could be suitable. NHS Mid Essex CCG’s CHC team will work with you to discuss your needs and consider your views about what support might best meet those needs. Other factors such as the cost and value for money of different options will also be taken into account.
If you are eligible for NHS Funded Nursing Care, the Brokerage Team will work with you and your family and the Continuing Healthcare Specialist Nurses to find a nursing home that can meet your needs.
If you are eligible for NHS Continuing Healthcare, or NHS Funded Nursing Care, your needs and support package will be reviewed within three months and thereafter at least once a year. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, you may require a further full assessment to consider whether you are still eligible for fully funded NHS Continuing Healthcare.
Personal Health Budgets
If you are eligible for fully funded NHS Continuing Healthcare and are receiving care in your own home, you will be offered a Personal Health Budget (PHB). Find out more about Personal Health Budgets.
To find out more about NHS Continuing Healthcare visit NHS.uk, or the Department of Health website for detailed information on the National Framework for NHS Continuing Healthcare and NHS Funded Nursing care.