Continuing Healthcare (CHC)
What is NHS Continuing Healthcare?
NHS Wakefield Clinical Commissioning Group (CCG) acknowledges its responsibility to clearly identify our statutory powers and duties in relation to the commissioning of NHS Continuing Healthcare (CHC) for patients, and demonstrate adherence with these responsibilities.
“Continuing healthcare” means care provided over an extended period of time, to a person aged 18 or over, to meet physical or mental health needs that have arisen as a result of disability, accident or illness.
NHS CHC is the name given to a package of care which is arranged and funded solely by the NHS as part of the duty to provide healthcare services currently under section 3(1)(e) of the National Health Service Act 2006. It applies where the individual is assessed as having a primary health need. Some people have continuing healthcare arranged for them in a nursing home. Other people have care in their own home or elsewhere in the community.
Anyone deemed eligible for CHC is also eligible to access regular NHS services, such as care from their GP or local hospital. The NHS would not fund regular NHS services in a package of continuing healthcare because they are already available, unless there were exceptional circumstances.
Funded nursing care is the name given to a weekly payment made by the NHS in specific circumstances. The payments can only be made to a care home with nursing, to pay for care from a registered nurse. The weekly payment is set by the Government.
Revised national framework
The National Framework for NHS Continuing Healthcare and NHS Funded-Nursing Care has recently been revised. For the updated framework and associated tools (for example the NHS Continuing Healthcare Checklist or Decision Support Tool) please visit the Department of Health and Social Care website.
Please read thePublic Guidance: NHS Continuing Healthcare and NHS-funded Nursing Care for more information.
Primary health need
To be eligible for CHC the individual must be assessed as having a ‘primary health need’. The eligibility criteria used to determine a ‘primary health need’ considers the nature, complexity, intensity and unpredictability of the care needs. However, complex, social care needs only will not amount to a primary healthcare need.
Case law has confirmed that it is unlikely that an individual will have a primary health need unless their needs predominantly require the provision of services which can properly be described as “healthcare services” as opposed to social services.
The emphasis is “need” rather than “condition” focused. It does not necessarily follow that the mere presence of a healthcare need means that the individual is entitled to CHC. The healthcare need must be a primary need balanced against the need for social care.
How does the assessment process start?
The first step in deciding whether a person is eligible for CHC is the completion of a Checklist. A Checklist can be completed by a nurse, therapist or social worker. Occasionally, a Checklist might be completed by another member of staff from the NHS or the Local Authority, such as a GP or Care Manager. The Checklist is used to screen people and decide whether a full assessment for CHC should take place.
If you believe that you or someone you know may be eligible for CHC, you should ask their GP or a nurse or social worker who knows them and also whether they will complete a Checklist for them.
A Checklist should not be completed without the person's consent. NHS Wakefield CCG has set out guidance for professionals to ensure that they ask the person whether they agree to being assessed. Anyone who is being assessed is also asked to agree to their personal information being shared, so that care can be arranged for them, if necessary.
What happens once a Checklist is completed?
When the Checklist has been completed, it is sent to the CHC Team at NHS Wakefield CCG, where it is reviewed.
The CCG will decide whether the person should be assessed for eligibility for CHC based on the Checklist and any supporting information that is available. A Checklist must be completed before an assessment for continuing healthcare begins, unless the person is already eligible for CHC or is being referred for CHC via the Fast Track.
Use of the Decision Support Tool (DST)
The decision making process to be followed is set out in the Directions (which it is a legal requirement to follow); however the Framework and DST provide additional guidance. The CHC Team will arrange for an assessment by a multi-disciplinary team, and the DST will be completed and used to inform the decision about whether the individual has a primary healthcare need.
Where possible the individual and/or their representative should be present when the DST is completed. Where there is a disagreement about which score to recommend, the higher should be recommended and the disagreement should be noted on the DST.
The DST states that there should be a clear recommendation for eligibility for CHC where:
- A level of priority need is shown (where this applies), or
- The need in two or more care domains is assessed to be severe
- The DST states that there can bean indication of eligibility for CHC where:
- One domain is recorded as severe with needs in a number of other domains, or
- There are a number of domains with high or moderate needs
It is important to bear in mind that although the DST supports the process of determining eligibility, it cannot directly determine eligibility and the exercise of professional judgment is necessary in all cases.
Packages of care
There is a large amount of discretion in terms of how CHC services can lawfully be provided. Difficult judgments have to be made as to how a limited budget can be best allocated to the maximum advantage of the greatest number of people.
It is perfectly legal to take resources based rationing decisions as to what services can be offered to an individual. There is no legal requirement that every healthcare or social need of an individual must be fulfilled.
Is Continuing Healthcare provided for life?
Everyone who is eligible for continuing healthcare or funded nursing care should have regular reviews of their care. The clinical team work with the person and others involved in their care, to ensure they receive the right amount of care.
The team also regularly check that the person remains eligible for NHS support with their care. This includes people assessed on the Fast Track. These checks usually take place at least every year and the first review is usually arranged within the first three months of care being provided by the NHS.
Is there a quicker assessment for people close to the end of life?
Some people who are close to the end of their lives may be referred for CHC on the ‘Fast Track'. This is a streamlined process for people whose health is rapidly deteriorating and need end of life care. Eligibility for CHC on the fast track can only be approved by an ‘Appropriate Clinician.'
The Department of Health has produced a tool to assess people on the Fast Track. This tool contains guidance notes, which includes the definition of an ‘Appropriate Clinician.' It also sets out the criterion that must be met to qualify for CHC on the Fast Track. The CCG reviews Fast Track assessments within the same working day of receiving them, with the aim of arranging urgent packages of care quickly.
Where a Fast Track referral is made on a Friday, the clinician should send the referral to the CHC Team at the CCG by 12 noon where possible, to allow time for a response. The CCG also checks that Fast Track assessments have been completed properly, and provides feedback to the ‘Appropriate Clinician' on the assessment.
As mentioned above, the CCG will write to the patient, or someone appointed on their behalf, to tell them the outcome. Where a patient is eligible for CHC on the Fast Track, the letter will confirm details of the care that will be arranged for them.