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NHS Continuing Healthcare

 

NHS Continuing Healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals, aged 18 years and over outside of hospital who have been deemed to have a “Primary Health Need” and have on-going complex, intense or unpredictable healthcare needs. NHS Continuing Healthcare can be provided by the NHS in a residential home, nursing home or at the patient’s own home.

Eligibility for NHS Continuing Healthcare is not dependent on any particular disease, diagnosis or medical condition. Eligibility is assessed through a process as defined in the Department of Health and Social Care National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

This video put together by NHS England provides a useful guide to the Continuing Healthcare process.

  • Where is NHS Continuing Healthcare provided?

    Where is NHS Continuing Healthcare provided?

    NHS Continuing Healthcare can be provided by the NHS in any setting, including a nursing home, residential home or in your own home.  Those in receipt of NHS Continuing Healthcare continue to be entitled to access  the full range of NHS health services. This means, for example, GP, Hospital and Community Nursing Services.

    NHS Continuing Healthcare is non-means tested and therefore a patient will not be charged a contribution to their care.

  • Consent for NHS CHC applications

    Consent for NHS CHC applications

    Before any NHS Continuing Healthcare assessment can take place, the referring professional must discuss the process with you and a CHC Consent Form must also be completed.

    This is really important as it ensures that the individual and/or their family fully understands and agrees to the CHC process as well as agreeing to the sharing of personal information with relevant health and social care professionals as required.

    Click here for the CHC consent form

     

  • How is CHC assessed in Herefordshire and Worcestershire?

    How is CHC assessed in Herefordshire and Worcestershire?

    In order 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

    In order for the NHS Continuing Healthcare process to begin you, or your chosen representative will need to provide written consent , both for the process to take place, and for the sharing of data with the relevant health and social care professionals.

    Although the usual NHS Continuing Healthcare assessment would involve a face-to-face Multi-Disciplinary Team meeting, due to COVID-19 some of these meetings are being completed virtually in order to reduce the risk of spreading the virus.

    Stage 1: NHS Continuing Healthcare Checklist Screening Tool

    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 Checklist which can be found here: https://www.continuing-healthcare.co.uk/files/NHS_continuing_healthcare_checklist_-_October_2018_revised.pdf

    They may also speak to your family or others who support you to build up a picture of your needs.(this will be based upon you ability to consent to this) This checklist is sent to us, the NHS Continuing Healthcare team at Herefordshire and Worcestershire CCG. You should also receive a copy of the Checklist tool.

    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.

    Stage 2: The Multi-Disciplinary Team Meeting

    A ‘multi-disciplinary team’ (MDT) means a team drawn from a number of professional ‘disciplines’ such as doctors, nurses, therapists and social workers.

    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, CHC staff from Herefordshire and Worcestershire CCG will make sure that you, your chosen representative, as appropriate, and whoever cares for you are invited to be involved. If you need an advocate to support you through the assessment process, The CCG can help arrange this for you.

    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. 
    https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool

  • What is a Decision Support Tool ?

    What is a Decision Support Tool ?

    The decision support tool allows the multi-disciplinary team to gather a full picture of your health and care needs by looking at 12 different areas:

    1. Breathing
    2. Nutrition
    3. Continence
    4. Skin
    5. Mobility
    6. Communication
    7. Psychological and Emotional Needs
    8. Cognition
    9. Behaviour
    10. Drug Therapies and Medication: Symptom Control
    11. Altered States of Consciousness
    12. Other significant care needs to be taken in consideration

    These care needs are then considered against the NHS Continuing Healthcare 4 key indicators to assess whether the individual has a Primary Health Need and should therefore be recommended eligible for NHS Continuing Healthcare.

  • What is a Primary Health Need?

    What is a Primary Health Need?

    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. 

    A ‘primary health need’ is a concept, rather than a legally set definition. It was introduced by the Secretary of State for Health, to assist in identifying whether a person’s primary need is for healthcare (therefore being the duty of the NHS to provide under the 2006 Act) rather than for social care (under the Care Act 2014).

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

    Nature, Complexity, Intensity and Unpredictability are also known as the NHS Continuing Healthcare 4 key indicators.

     

    What are the 4 Key Indicators of a Primary Health Need?

    Nature: this describes your needs and the type of needs e.g physical, psychological, etc. Nature also describes the effects of your needs on you and the type of help you may require to help manage and meet your needs.

    Intensity: this considers the extent and severity of your needs and the type and level of support you need to meet them, which includes the need for ongoing or continuous care.

    Complexity: this describes how your needs may interact or affect each other, which may make them difficult to manage or control. It also looks at the level of skill required to monitor your symptoms, treat your condition and/or manage your care.

    Unpredictability: this looks at how your needs may vary and fluctuate and how a difficulty in predicting changes in your needs might create challenges in being able to manage or meet them. This includes the risks to your health if adequate and timely care is not provided.

  • How is the final Eligibility Decision made?

    How is the final Eligibility Decision made?

    The multi-disciplinary team will put forward their recommendation with regards to eligibility for NHS Continuing Healthcare to Herefordshire and Worcestershire  CCG.

    A registered professional within the CCG will review the recommendation made by the multi-disciplinary team, alongside the supportive evidence collected, and finalise or “verify” 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. If you are found to be not eligible for NHS Continuing Healthcare you have the right to appeal the decision.

  • What happens if I am assessed and deemed eligible for NHS Continuing Healthcare?

    What happens if I am assessed and deemed eligible for NHS Continuing Healthcare?

    If you are eligible for Continuing Healthcare a CHC Nurse will be in contact with you to discuss next steps including a decision regarding a Personal Health Budget.  The CCG has a Continuing Healthcare Commissioning Policy including information regarding patient choice and resource allocation. 

  • What if my care needs change?

    What if my care needs change?

    If you are deemed eligible for NHS Continuing Healthcare, this is subject to review initially after three months and then at least annually there after.  The main purpose of the review is to ensure the care package remains appropriate, this is completed by a CHC Nurse and a review document is completed, patient and/or their representative are included and the outcome of the review will be sent in writing.  If during the review your needs have changed it may be appropriate for the CHC Nurse to arrange an MDT and complete a new Decision Support Tool (DST), this will be confirmed in writing to you or your representative including details of the MDT meeting to attend.   Should needs change and it is deemed that you are no longer  eligible for NHS Continuing Healthcare funding, a referral to the Local Authority will be made to determine the funding stream to meet your on-going care needs where appropriate. 

 

What happens if I am assessed and deemed not eligible for NHS Continuing Healthcare?

  • What is the NHS Continuing Health Care Appeals Process?

    What is the NHS Continuing Health Care Appeals Process?

    If you have requested an appeal within 3 months of receipt of a CHC assessment outcome letter, the CHC team will confirm receipt of your letter within 10 days.  The appeal process has three stages.

    Stage 1

    An informal meeting will be arranged with you or your representative and a CHC Senior Manager. This meeting is to attempt to resolve any concerns initially through an informal two-way meaningful discussion.  There will be a written summary of this meeting.  Where resolution has not been reached the appeal will move to stage 2.  We aim to complete this process within 28 days.

    Stage 2

    A formal meeting known as a Local Resolution Panel (LRP). In order to facilitate this, the CCG may require additional information, including records and reports for the three-month period prior to the DST being appealed.  Once all the information has been gathered by the Appeal team the meeting will be arranged.  You will be invited to put forward the reasons why they remain dissatisfied with CCG’s decision  The Panel will usually include a Chair, CHC Manager and Local Authority representative.

    Stage 3

    In the event you remain dissatisfied following the outcome of stage 2 Local Resolution Process, you are entitled to submit a request to NHS England for an independent review of your case . If you would like to refer your case to an Independent Review Panel (IRP), you will need to write directly to the NHS Commissioning Board in the Midlands Region.  A request for Independent Review Panel (IRP) should be submitted in writing within 6 months of the outcome of the Local Resolution Panel outcome letter (stage two), details of how to progress to stage 3 will be included in this letter.

    More information on IRPs can be found in this NHS England leaflet: https://www.england.nhs.uk/publication/nhs-continuing-healthcare-independent-review-process-public-information-guide/
    You can contact the loval IRP via email:This email address is being protected from spambots. You need JavaScript enabled to view it. or phone: 0113 8253232

     

    Finally if following the three stage appeal process you remain  unhappy with the outcome of the independent review, they can complain to the Parliamentary and Health Service Ombudsman. Further advice specific to CHC can be found on the Ombudsman website: www.ombudsman.org.uk

    It is important to note that during the appeal process the original CHC eligibility funding decision made by the CCG remains effective.

    If the original decision is overturned either through the Local Resolution Process or the NHS England Independent Review Process and you are found eligible the CCG will seek to provide reimbursement of any appropriate Care Costs incurred during the period under consideration.

  • What is an Integrated Package of Care?

    What is an Integrated Package of Care?

    If you are not eligible for NHS Continuing Healthcare, the NHS may still have a responsibility to contribute to your health needs – either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned by the CCG or funded by both a local authority and a CCG, this is known as an integrated package of care. 

    If an MDT identify an un-met health need this is documented in the Decision Support Tool (DST) and considered by a joint Health and Social Care Quality Assurance Panel. If agreed the integrated package will be confirmed to you in writing. 

 

What is Fast Track NHS Continuing Healthcare? 

Fast Track refers to the need for care to be available quickly, with recognition that there may not be sufficient time to complete a Full NHS Continuing Healthcare (CHC) assessment. The Fast Track process is set out in the National Framework for NHS Continuing Healthcare. The Fast Track pathway tool can be accessed here: https://www.gov.uk/government/publications/nhs-continuing-healthcare-fast-track-pathway-tool 

  • How is it different to a full NHS Continuing Healthcare assessment?

    How is it different to a full NHS Continuing Healthcare assessment?

    The Fast Track Pathway should be applied when an individual has been identified as having a ‘primary health need’, which is also rapidly deteriorating.

    Fast Track funding is usually for a period of up to three months. Towards the end of this period a review and a full NHS CHC assessment will then be arranged. This could lead to a decision that you or your family member no longer has a primary health need and funding for CHC may end.

  • What can I expect during a Fast Track assessment?

    What can I expect during a Fast Track assessment?

    1. The professional responsible for care identifies there is a rapid deterioration in condition which may be entering a terminal phase. They will discuss the application process with you and complete a CHC consent form, Care Requirement Form and the Fast Track Tool
    2. The professional will then send the application directly to the CHC team at the CCG
    3. The CHC team will check that the application is fully completed and that it meets the criteria for the Fast Track Pathway (e.g there is evidence to support rapid deterioration)
    4. The CCG will then approve and commission appropriate care to meet the care needs with the aim for care to be in place within 48 hours.
    5. After 6 weeks a review will be completed to assess whether there has been any change in need and to ensure that the care is meeting your needs.

    In Worcestershire Fast Tracks are administered by the CHC Fast track Nurse however the referrer (Community Nurse, Hospital, Hospice, Nursing Home Registered Nurse etc) will complete a referral and liaise with the CHC Fast track team to ensure your assessed care needs are met.   In Herefordshire Fast Tracks are administered by St Michael’s Hospice who will liaise with patients and/or their representatives directly, in liaison with the CHC team.  

  • How will my care needs be reviewed?

    How will my care needs be reviewed?

    Within 3 months our NHS Continuing Healthcare (CHC) team will complete a review, often by phone to the care provider. If you, or your relative’s, condition remains rapidly deteriorating the CHC team will defer the review for a few weeks, with care continuing to be provided throughout this time.

    After the review of care needs, if appropriate, due to a stabilised condition, The CHC team will arrange a Multi disciplinary Team Meeting (MDT) to begin the process of assessing whether you or your family member remains eligible for CHC.


What is Funded Nursing Care?

If you are not eligible for NHS Continuing Healthcare, but are in a nursing home (a care home that is registered to provide nursing care), you may be eligible for NHS Funded Nursing Care.

The Funded Nursing Care contribution is paid directly to the care home by the NHS. If you pay your own care fees, this amount should be deducted from your bill. If you are funded by the local authority, this amount will be deducted from the fees paid to the care home.

Your nursing home will receive £183.92 per week, which is the figure set by the Department of Health for 2020/21 and it is reviewed each year.

Funded Nursing Care is reviewed at 3 months then annually thereafter by a CHC Nurse, you or your representative and your care provider will be involved in the review and the outcome will be confirmed in writing.

If you do not agree with the outcome of your CHC checklist or Funded Nursing Care Determination , then you can identify your reasons to the CCG through the NHS Complaints procedure by writing to:

By Post:

The Complaints Team
NHS Herefordshire and Worcestershire CCG
The Coach House
John Comyn Drive
Perdiswell
Worcester WR3 7NS

By Email:  This email address is being protected from spambots. You need JavaScript enabled to view it.

 

If you would like more information

If you would like further information on NHS Continuing Healthcare or Funded Nursing Care you can contact the Continuing Healthcare team either by telephone, email or in writing to:

Main CHC telephone: 01905 681975
Main CHC email address: This email address is being protected from spambots. You need JavaScript enabled to view it.
CHC Appeal email address: This email address is being protected from spambots. You need JavaScript enabled to view it.

Herefordshire and Worcestershire CCG Continuing Healthcare Department
Rear Ground Floor
Acton House
Perdiswell Park
John Comyn Drive
Worcester        
WR3 7GD

Please note, drop in appointments are not available at this address. Please telephone the main CHC number to book an appointment if you need to meet with a member of the team.