NHS Continuing Healthcare (CHC)

What is Continuing Health Care (CHC)?

"NHS Continuing Healthcare (CHC) means a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a ‘primary health need’ as set out in this National Framework. 

Such care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen as a result of disability, accident or illness. 

The actual services provided as part of the package should be seen in the wider context of best practice and service development for each client group. 

Eligibility for NHS Continuing Healthcare is not determined by the setting in which the package of support can be offered or by the type of service delivery. 

NHS-funded Nursing Care is the funding provided by the NHS to care homes with nursing to support the provision of nursing care by a registered nurse. "

National Framework for Continuing Healthcare July2022

Watch

Below is a link to a video explaining the CHC process. This video was produced before the changes in July 2022 and does discuss CCG's, however the discussion of the process remains the same. The sub pages from this page go into more detail of the specific elements of the process.

Core Values and Principles of NHS CHC 

The core value of NHS CHC is Person-centred approach  

The  professionals must understand and adhere to the below elements of the person centred sore value of NHS CHC 

Element 1: Involvement of the individual

• Individuals should have the process fully explained to them and/or their Representatives at the start of the process.

• Offering the Individual, a point of contact within the ICB at the beginning of process.

Element 2: The individual's views and wishes

• The individual's own views of their needs and their preferences as to how they should be met should be documented at each stage. They should be given as much choice as possible, particularly in the care and support -planning process.  

• Where care/support options are limited due to the individual's needs and associated risks, these should be fully discussed with the individual including the resources or services to meet them 

• It is important that the person's own view of their needs is carefully noted and given due weight alongside professional views. 

Element 3: Communication and language needs

• It is important to establish at the outset whether the individual has any particular communication needs and if so how these can be addressed.  

• Preferred methods of communication should be checked with the person and/or their relatives, friends or representatives in advance. 

Element 4: Consent

• Before assessing for NHS CHC, it is important to consider the need for consent.  Consent is not required to undertake an NHS CHC assessment (unless sharing of information with third parties including family is involved) but it is good practice to seek consent for sharing information with third parties at this point 

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• In the event that the individual is unable to provide this consent then a ‘best interests’ decision in accordance with the Mental Capacity Act 2005 should be undertaken 

Element 5: Risk

• Assessment of risk is central to a holistic multidisciplinary assessment of need. 

• A good risk assessment will include listening and observation, talking to the individual and their carers to identify what risks they see and their proposed response to them, talking to other agencies and providers of services and then listing the key risk factors 

Element 6: Keeping the individual informed

• The ICB should identify a person to co-ordinate the process for each individual being fully assessed

The key stages in assessing whether an individual is eligible for CHC are as follows 

1.Checklist completed

An individual is identified as in need of assessment for NHS CHC, usually through use of the nationally prescribed Checklist screening tool. All reasonable steps should be taken to ensure that an assessment of eligibility for CHC is carried out in all cases where it appears that there may be a need for such care.

2.Co-ordinator appointed

A co-ordinator should be identified to oversee the MDT assessment process. An MDT, in this context, is at least two professionals, preferably one from healthcare and one from social care, but otherwise from two different healthcare professions.

3.MDT assessment undertaken

All relevant assessment reports are gathered to inform the decision-making process. Where necessary, additional or new assessments are undertaken.

4.DST completed and recommendation made

The MDT team uses the assessment information to complete the DST. This has 12 domains and records the individual's needs. The individual's needs are then considered with reference to the 4 key characteristics (Nature, Intensity, Complexity and Unpredictability). The MDT uses this information and its professional judgment to make a recommendation as to whether the individual has a 'primary health need' (i.e., whether or not they are eligible for NHS CHC).

5.Recommendation verified

The MDT's recommendation is checked and ratified / verified. Only in exceptional circumstances, and for clearly articulated reasons, should the recommendation not be followed. If the individual (or the person representing the individual) does not agree with the eligibility decision, they can request a review of the decision.

he National Framework states (Paragraph 162):"The overall assessment and eligibility decision-making process should, in most cases, not exceed 28 calendar days from the date that the CCG receives the positive Checklist (or, where a Checklist is not used, other notice of potential eligibility) to the eligibility decision being made."

6.Care package/placement arranged

If the individual is eligible for NHS CHC, the CCG arranges and funds the care placement, home support package or personal health budget to meet all the assessed health and social care needs.

7.Situation regularly reviewed

The CCG is responsible for ensuring that there is ongoing case management and that the care arrangements are regularly reviewed. A review should take place within 3 months of the eligibility decision and thereafter at least annually.

The primary focus of these reviews should be whether the care plan or arrangements remain appropriate to meet the individual's needs. It is expected the most recently completed DST will normally be available at the review and should be used as a point of reference for any potential changes in need. Where there is clear evidence of a change in needs to such an extent that it may impact on the individuals eligibility for NHS Continuing Healthcare, then CCG should arrange for a full reassessment of eligibility for NHS Continuing healthcare.

Key points 

• NHS Continuing Healthcare (NHS CHC) is care for adults aged 18 or over which is arranged and funded solely by the NHS, and is therefore free at point of delivery to the individual concerned.

• NHS-Funded Nursing Care (FNC) is a contribution by the NHS towards the cost of registered nursing care in a care home.

• There is an upper limit to the amount and type of general nursing/healthcare that local authorities can lawfully provide and the policy in relation to this has been developed through case law, informed by Ombudsman enquiries and confirmed in Statute.

• Clinical Commissioning Groups (CCGs) have a range of statutory responsibilities in relation to CHC and these are set out in Standing Rules Regulations.

• There are three key national tools in relation to NHS CHC: the Checklist, the DST and the Fast Track.

• Assessment of eligibility for CHC is a process involving completion of the Checklist, appointment of a co-ordinator, MDT assessment, completion of the DST with a recommendation, ratification of the recommendation, arrangement of the care package/placement and subsequent regular review of the situation (within 3 months and then at least annually)

• Assessment and decision-making in relation to NHS Continuing Healthcare should always be person-centred, placing the individual, their perception of their support needs, and their preferred models of support at the heart of the assessment and care-planning process.

• If the individual lacks capacity in relation to decisions in the NHS Continuing Healthcare process, then the principles of the Mental Capacity Act 2005 should be applied to decision making on the individual's behalf.

• An Independent Mental Capacity Advocate will have to be appointed if an individual lacks capacity, has no friends/family who can be consulted, and is facing decisions about serious medical treatment, a hospital stay of more than 28 days or a long-term change of accommodation.

• Eligibility for NHS Continuing Healthcare is based on an assessment of the individual's day-to-day care needs and whether these constitute a 'primary health need'.

• Eligibility is not based on the diagnosis, setting of care, the qualifications of the staff needed to deliver care or on any other input-based as opposed to needs-based criteria.

The NHS Continuing Healthcare Delivery Model can be accessed online https://nhschc.co.uk/