Continuing Healthcare

What is Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a fully funded package of care for some people over the age of 18 who have a primary health care need, related to a disability, accident or illness. The term ‘primary healthcare need’ helps determine which services are appropriate for the NHS to provide, and which services the local authority will need to provide via social care.

To determine if you have a primary healthcare need, you will need to consider:

Nature: This outlines your needs and the effects these have on you. This also includes any interventions you may need to manage your conditions.
Intensity: This includes the severity of your needs and the support that is needed for your condition(s) to be controlled.
Complexity: Relates to how your needs present and the level of skill required to monitor symptoms, treat conditions or manage your care.
Unpredictability: Relates to how much your conditions fluctuate and the challenges that this creates.

The CHC team sits within the Integrated Care Board (ICB) for your local area. The ICB is the body responsible for making commissioning decisions about NHS services in your area.

If you live in…	Your ICB is…	The CHC details
Runnymede, Spelthorne, Elmbridge, Woking, Guildford, Waverly, Mole Valley, Epsom and Ewell, Reigate and Banstead or Tandridge	Surrey Heartlands: NHS Surrey Heartlands Integrated Care Board – ICS	Continuing Healthcare – ICS
Surrey Heath	Frimley ICB: NHS Frimley – Home	NHS Frimley – Continuing Healthcare

There are 2 different referral pathways to access CHC funding; Fast track CHC and CHC. There are some key differences between the 2 pathways, which include who can refer you for CHC and the assessment process.

Fast Track CHC

What is Fast Track Continuing Healthcare?

The Fast Track CHC referral pathway is for individuals who have been assessed as being in a terminal phase of their illness and who are experiencing a rapid decline in their health.

Who can Refer for Fast Track Continuing Healthcare?

A clinician must refer an individual for Fast Track CHC. A clinician could be a GP, hospital consultant, district nurse or a hospice nurse.

What is the Assessment process for Fast Track CHC?

As the health of the individual who is being referred for Fast Track CHC is rapidly declining, a decision needs to be made about their eligibility for funding quickly, in order that a care package can be arranged as soon as possible.

The referring clinician will send information on the reasons for a Fast Track CHC referral, supported by any relevant documentation and prognosis, if possible, to the ICB. If the ICB determine that the Fast Track CHC referral pathway it is the correct one, the multi-disciplinary team will work to put a care package in place for that individual.

If you would like more information about the Fast Track Pathway, please click this link: Fast-track pathway tool for NHS continuing healthcare guidance – GOV.UK

What if my friend or relative is in care home but needs to receive end of life care. Will they be moved?

This depends on the care home they live in, and if it can provide the level of care required to meet their needs. The CHC team would discuss this with the care home directly.

My friend or relative lives in Surrey, but we live elsewhere in the UK. Would we be able to move them closer to us if they receive Fast Track CHC?

If your friend or relative is currently a Surrey resident and are at the time of their Fast Track CHC referral, their relevant ICB will fund their care. However, it is possible that an alternative care provider in the UK could provide their care, so they are closer to family and friends as they reach the end of their life.

You would need to discuss it with the relevant CHC team who completed the assessment.

If you or friend or relative have a primary healthcare need but are not considered to be at the end of life, you can still apply for continuing healthcare, through the standard referral pathway.

The 12 Care Categories:

Throughout the CHC assessment process your care needs will be assessed against 12 care categories. These categories are:

Breathing
Nutrition
Continence
Skin
Mobility
Communication
Psychological and Emotional Needs
Cognition
Behaviour
Drug Therapies and Medication: Symptom control
Altered States of Consciousness
Other significant care needs

If you would like more information about the 12 Care Categories, please click this link: Beacon CHC | What is the Continuing Healthcare Full Assessment? – Beacon CHC

Initial checklist

The first stage of applying for CHC involves completing an initial checklist. This checklist can be completed by yourself, a social worker, nurse, consultant, GP or care home staff.

The initial checklist asks you to assess your care needs, within the 12 care categories mentioned above. These needs will then be marked as High, Medium or Low.

To qualify for a full assessment (the next stage of the process), you would need to be assessed to have:

2 or more categories rated as a high
5 or more categories rated as moderate, or 1 rated high and 4 rated moderate
1 high rating in the following categories: Behaviour, Breathing, Drug therapies and Medication, and Altered states of Consciousness.

Once completed, the initial checklist needs to be to sent to the ICB , along with any supporting documentation such as care plans or risk assessments. The CHC team will then review the initial checklist and any supporting documentation and decide if you qualify for a full assessment.

You will receive a decision letter within 28 days giving you the outcome of your screening checklist and outlining your rights to appeal that decision.

There are only 2 potential outcomes from an initial checklist; you are eligible for a full assessment, or you are not.

If you have not received a decision letter within 28 days of completing the initial checklist, the health and social care professional who completed the assessment will need to contact the ICB on your behalf and chase a response.

Full Assessment

If you are eligible for a full assessment the ICB will appoint a coordinating assessor, who will work with a multidisciplinary team of health and social care professionals to assess your needs. Your coordinating assessor will also contact you, or the person you care for, to invite you / them to the multidisciplinary meeting. You can also request for a family member or someone who carers for yourself or your family member or relative to attend to provide support.

During the multidisciplinary meeting your coordinating assessor will use the CHC decision support tool to organise the evidence highlighting your care needs into the 12 care categories.

For more information about the assessment criteria for each category, please look at the NHS website : NHS continuing healthcare decision support tool guidance – GOV.UK

The evidence that is used to complete the decision support tool is taken from your social, medical and care records. This can include care plans, hospital records, social care records, GP records, daily care records or any assessment documents, and can include written or verbal information about your care.

The multidisciplinary team will use this information to assign a level of need, which ranges from ‘No Needs’ to ‘Severe’. However, in the categories of Breathing, Behaviour, Drug Therapies and Altered States of consciousness, you or the person you care for may be assessed as having a ‘priority need’.

Once all 12 categories have been assessed by the multidisciplinary team, they will make a recommendation to the ICB. This will be based on whether they believe you or the person you care for has sufficiently intense, complex or unpredictable needs which deems you or them eligible for CHC.

Once a decision has been made by the ICB you will receive a letter explaining the outcome of your assessment and how they have arrived at that outcome. You should receive this letter 28 days after your assessment.

How do I appeal a decision?

If you are unhappy with the outcome of your assessment you can submit an appeal. You need to submit an appeal within 6 months of receiving the outcome of your assessment. You will need to request an appeal in writing and outline why you wish to appeal the decision.

There are 3 stages to the appeal process:

Stage 1: Includes an internal review of your original assessment, with the original evidence, but with different staff. If you are unhappy with the result of the review you can move on to stage 2.

Stage 2 : Involves the ICB arranging a Local Resolution Meeting with the person needing the care and the multidisciplinary team. In preparation for this meeting more evidence will be collected, including evidence from the NHS, Social Care and family members. This will give you an opportunity to raise any concerns and discuss them with the CHC team. If you are still unhappy with the outcome of the local resolution meeting, you can move on to Stage 3.

Stage 3: Involves sending your case to NHS England for review by an independent panel. The Pannel will then make a recommendation to the ICB.

If your care needs change during the appeals process, a reassessment will take place. However, the appeal will still go through so any funding can be appropriately backdated.

Can I make a formal complaint about the Continuing Healthcare team?

Yes, you can make a complaint about CHC by following the NHS complaints procedure. However, submitting a formal complaint will not change the outcome of your assessment. If you want the ICB to reconsider their decision about your funding you will need to follow the appeals process.

To submit a formal complaint you will need to write to the ICB outlining why you want to submit a complaint. This must be done within 12 months of an incident taking place, or you being made aware of a problem.

For more information about submitting a formal complaint or to seek support in submitting one, please contact your local Independent Health Complaints Advocacy Service: Support to make a complaint about an NHS service (Advocacy) – Healthwatch Surrey.

I have been awarded CHC, when does my funding start?

If you have been awarded CHC following a full assessment, the ICB is required to backdate your funding to the date they received the referral for a full assessment. They are also required to refund the full costs of care from day 29 of them receiving a completed screening check list.

Who arranges my care?

If you or the person you care for have been awarded CHC funding the care will be arranged for you by the CHC team. This includes care agencies to provide care at home or arranging care in a nursing home.

You will be offered 3 options to choose from by the CHC team. You do have a right to refuse the options they have offered.

You may also be offered a Personal Health Budget. This gives you or an appointed representative more control over how your care needs are met. If you want more information about Personal Health Budgets, or support in managing a Personal Health Budget, please contact Surrey Independent Living Charity: Surrey Independent Living Charity (SILC).

I, or the person I care for, has been awarded CHC, but has had a change in their needs, will they need to be reassessed?

If you, or the person you care for, have had a change in care needs, then this may need a reassessment. A second screening checklist will be completed and your original checklist and the new check list will be compared.

If there has been one major change in one of the 12 categories, or multiple small changes across different categories, a new full assessment will take place.

Is my CHC funding for life?

If you have been awarded CHC your eligibility and funding status will be reviewed after 3 months. This is to ensure that all your needs are being met and that you are still eligible for care. Once this 3 month review has been completed you will have your eligibility and funding reviewed annually (every year).

Can I “top up” my care?

If you are awarded CHC you are unable to self-fund for part of your care. As CHC is provided by the NHS it takes an “all or nothing” approach to paying for care. Through the CHC assessment process your care needs should have been assessed and the funding awarded should be enough to fully cover your care needs.

If you feel that the funding awarded does not cover the cost of your care, you will need to follow the appeals process.

I/the person I care for is already in a care home; will they have to be moved?

If you or the person you care for are currently living in a care home the CHC team will talk to the care home manager to determine if they have the resources and facilities to deliver the care needed in the home.

I or the person I care for was discharged from hospital to a care home with CHC funding. When will this be reviewed and how much notice will I get if it is being reduced or stopped?

If you or the person you care for has been awarded CHC funding this will be reviewed after 3 months and then annually. If during a review it is assessed that a reduction of funding is required or that funding is no longer eligible, then written notice will be provided. If funding is being removed, 28-days’ notice will be provided. During this 28-day notice period social services will take over and carry out a care assessment and financial assessment.

I would like advice on my personal CHC process, where can I go for information, advice and support?

Beacon CHC offers a range of support, including advisors who can answer general questions, free 90-minute meetings to get specific guidance from a trained advisor and a range of free resources and guides on CHC.

There is also the option to access advocacy through Beacon CHC, however this does come at a cost.

For more information about Beacon CHC, please visit their website: Beacon CHC | Free advice & expert representation – Beacon CHC

The CHC application process: things to consider

Health or social care professional support – consider asking a health or social care professional if they would be willing to attend the assessment or to help prepare you for it; someone who knows about your specific condition / needs if possible.
Letters of support – consider obtaining letters from healthcare professionals involved in your care, supporting your needs
Care diary – consider preparing a care diary looking at your ‘worst day’.
Consult the DST – consider looking at the 12 domains of the “Decision Support Tool” (DST) in advance, to see how your needs fit in to them.
Process diary – consider keeping a diary of the process, from checklist to possible appeal.