Understanding Continuing Healthcare Assessments
NHS Continuing Healthcare (CHC) provides 100% NHS funding for care if an individual has a 'primary health need'. This guide explains the CHC assessment process, from initial screening to multi-disciplinary team assessments and decision-making. It offers practical advice for families preparing for assessments and outlines the appeal process if eligibility is denied.
Important
Understanding NHS Continuing Healthcare (CHC) Assessments: A Comprehensive Guide for Families
Navigating the complexities of care funding can be a daunting experience for families, especially when a loved one requires significant ongoing support due to a complex medical condition. NHS Continuing Healthcare (CHC) is a package of care funded solely by the NHS for individuals who have a primary health need. Understanding what CHC is, who is eligible, and how the assessment process works is crucial for families seeking appropriate care and financial support.
This guide aims to demystify the CHC assessment process, offering practical, actionable advice and signposting to essential resources. We understand that this can be an emotionally challenging time, and our goal is to provide clarity and support as you advocate for your loved one's care.
What is NHS Continuing Healthcare (CHC)?
NHS Continuing Healthcare (CHC) is a package of care arranged and funded by the NHS for individuals aged 18 or over who have a primary health need arising from a complex medical condition. This care can be provided in various settings, including a person's own home, a care home with nursing, or a hospice. Crucially, if you are eligible for CHC, the NHS will cover 100% of the cost of your care, including accommodation costs if the care is provided in a residential setting.
It's important to understand that CHC is not means-tested, meaning your income or savings will not be considered when determining eligibility. The decision is based purely on your assessed health needs.
Key Characteristics of CHC:
- NHS-funded: 100% of care costs are covered by the NHS.
- Not means-tested: Financial situation is irrelevant to eligibility.
- Primary health need: Eligibility is based on the nature, intensity, complexity, and unpredictability of health needs.
- Flexible settings: Care can be provided at home or in a care home with nursing.
- Regularly reviewed: Eligibility is reviewed periodically to ensure the care package remains appropriate.
Who is Eligible for CHC? The 'Primary Health Need' Criterion
Eligibility for CHC is determined by whether an individual has a 'primary health need'. This is a complex concept, and it's not simply about having a diagnosis or requiring nursing care. Instead, it's about the overall nature, intensity, complexity, and unpredictability of an individual's care needs.
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care outlines the criteria and process for assessment. This framework is used by NHS Integrated Care Boards (ICBs) across England to make consistent decisions. The key areas considered are:
- Nature: The quality and type of needs, considering the particular health condition and the support required.
- Intensity: The amount, severity, and quantity of care needed, including the duration of care interactions.
- Complexity: How difficult it is to manage the needs, often involving multiple conditions or specialist interventions.
- Unpredictability: The degree to which needs fluctuate, creating a risk to the individual's health if not promptly addressed.
The CHC Assessment Process: Step-by-Step
The CHC assessment process can be lengthy and involves several stages. Understanding each step can help families prepare and participate effectively.
Step 1: Initial Checklist Assessment
The first step is typically a 'Checklist' assessment. This is a screening tool used to identify whether an individual is likely to have needs that warrant a full CHC assessment. It can be completed by a healthcare professional (e.g., a nurse, doctor, or social worker) in any setting, such as a hospital, care home, or your own home.
- Purpose: To quickly screen out individuals who clearly do not have a primary health need.
- Outcome: If the Checklist indicates a 'positive' outcome, it means there's a possibility of eligibility, and a full assessment is recommended. A 'negative' outcome means no further assessment is immediately required, though you can appeal this decision.
Step 2: Comprehensive Assessment – The Multi-Disciplinary Team (MDT)
If the Checklist is positive, or if there's an urgent need for care (e.g., a rapidly deteriorating condition), a full CHC assessment will be arranged. This is carried out by a Multi-Disciplinary Team (MDT).
- Who is in the MDT? The team will typically include at least two professionals from different disciplines who are familiar with the individual's health and social care needs (e.g., a nurse, social worker, doctor, therapist).
- What happens? The MDT will gather detailed information about all aspects of the individual's care needs across 12 'domains' of care (e.g., breathing, nutrition, continence, skin integrity, mobility, communication, behaviour, cognition, medication, psychological and emotional needs, therapy and rehabilitation, and other significant needs). They will review medical records, care plans, and may observe the individual.
- Your Role: You, as the family, are crucial to this stage. You should be invited to contribute to the assessment, provide your perspective, and highlight aspects of care that might not be immediately obvious from records. This is your opportunity to paint a full picture of your loved one's daily challenges and the support they require.
Step 3: Decision Making – The Decision Support Tool (DST)
The information gathered by the MDT is used to complete a 'Decision Support Tool' (DST). The DST is a comprehensive document that summarises the individual's needs across the 12 care domains, assigning a level of need (e.g., 'no need', 'low', 'moderate', 'high', 'severe', 'priority') to each domain.
- Recommendation: The MDT uses the completed DST to make a recommendation to the Integrated Care Board (ICB) about whether the individual has a 'primary health need' for CHC funding.
- ICB Decision: The ICB then reviews the DST and the MDT's recommendation to make the final decision on eligibility. This decision should be communicated to you in writing, along with clear reasons.
Step 4: Care Planning and Review
If your loved one is found eligible for CHC, a care package will be commissioned and funded by the NHS. This will involve developing a personalised care plan that meets their assessed needs. The care package will be regularly reviewed to ensure it remains appropriate as needs may change over time.
Preparing for the Assessment: Practical Tips for Families
Being prepared can significantly improve your experience and the outcome of the CHC assessment process. Here are some actionable steps you can take:
- Keep a comprehensive diary: Document your loved one's daily care needs, including the time spent on various tasks, any challenging behaviours, and how their needs fluctuate. Note down any incidents, falls, or significant health events.
- Gather all relevant documents: This includes medical records, care plans, hospital discharge summaries, GP notes, and any assessments from therapists (e.g., physiotherapists, occupational therapists).
- Understand the 12 domains: Familiarise yourself with the 12 domains of need used in the DST. Think about how your loved one's needs manifest in each area.
- Prepare a written statement: Write down your perspective on your loved one's needs, highlighting the complexity, intensity, and unpredictability of their care requirements. Share specific examples.
- Attend all meetings: Ensure you are present at the Checklist assessment and the MDT assessment. Your input is vital.
- Bring an advocate: Consider bringing a trusted family member, friend, or a professional advocate to support you during meetings and help you take notes.
- Ask questions: Don't hesitate to ask for clarification on any aspect of the process or the terminology used.
- Request copies: Always ask for copies of the Checklist, the DST, and the final eligibility decision letter.
What if Eligibility is Denied? The Appeal Process
If your loved one is found not eligible for CHC, you have the right to appeal the decision. The appeal process involves several stages:
- Local Resolution: Initially, you should appeal to the Integrated Care Board (ICB) that made the decision. They will review the case internally.
- Independent Review: If you are still unsatisfied after local resolution, you can request an independent review by NHS England. This involves a separate panel reviewing all the evidence and making a recommendation to NHS England.
- Parliamentary and Health Service Ombudsman (PHSO): As a final step, if you remain unhappy after the independent review, you can complain to the PHSO, who investigates complaints about the NHS in England.
It's highly recommended to seek advice from a specialist CHC advocacy service or a legal professional experienced in CHC appeals if you decide to appeal. They can help you understand the grounds for appeal and prepare your case effectively.
Retrospective Claims: Looking Back at Unfunded Care
In some cases, individuals may have paid for their own care (or had it funded by social services) when they should have been eligible for CHC. It is possible to make a retrospective claim to reclaim these costs.
- Time Limits: There are deadlines for retrospective claims, so it's important to act quickly if you believe this applies to your loved one's situation. Currently, there is no national deadline, but local ICBs may have their own policies.
- Evidence: You will need to provide evidence that your loved one's primary health needs during the period in question met the CHC eligibility criteria.
- Complexity: Retrospective claims can be very complex and often require significant documentation and expert advice.
Need Further Assistance and Information?
Frequently Asked Questions
What is the difference between NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care (FNC)?
NHS Continuing Healthcare (CHC) is a full package of care funded by the NHS for individuals with a 'primary health need', covering all care costs, including accommodation if in a care home. NHS-funded Nursing Care (FNC) is a flat-rate contribution paid by the NHS directly to a care home with nursing to cover the cost of care provided by a registered nurse, for individuals who don't qualify for full CHC.
How long does the CHC assessment process usually take?
The CHC assessment process can vary significantly in length. The initial Checklist assessment should be completed promptly. The full MDT assessment and decision-making process can take several weeks or even months, depending on the complexity of the case and the local Integrated Care Board's (ICB) workload. There are national timescales that ICBs are expected to adhere to, but delays can occur.
Can I request a CHC assessment for my loved one?
Yes, absolutely. You can request a Checklist assessment from any healthcare professional involved in your loved one's care, such as their GP, hospital discharge team, social worker, or care home manager. You do not need to wait for one to be offered.
What if my loved one's condition deteriorates rapidly during the assessment process?
If your loved one's condition is rapidly deteriorating, or they have a life-limiting condition that is entering its final stages, they may be eligible for a 'Fast Track' pathway to CHC. This is a much quicker assessment process designed to ensure urgent care needs are met. You should highlight any rapid deterioration to the healthcare professionals involved immediately.
Does being eligible for CHC mean I will automatically get a certain type of care or care home?
If eligible for CHC, the NHS will fund a care package that meets your loved one's assessed needs. While you should be involved in the care planning process and have your preferences considered, the NHS will commission a package that is deemed appropriate and cost-effective. This could be care at home or a place in a care home with nursing, depending on the assessed needs and availability.
Need More Help?
Support Organisations
- Age UK:0800 678 1602
- Carers UK:0808 808 7777
- Alzheimer's Society:0333 150 3456
- Parkinson's UK:0808 800 0303