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.
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.
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.
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: NHS continuing healthcare checklist - GOV.UK (www.gov.uk)
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 ICB. 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 ICB 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 ICB 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://
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:
- 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 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.
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.
The multi-disciplinary team will put forward their recommendation with regards to eligibility for NHS Continuing Healthcare to Herefordshire and Worcestershire ICB.
A registered professional within the ICB 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.
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 ICB has a Continuing Healthcare Commissioning Policy including information regarding patient choice and resource allocation.
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.
NHS CHC Appeals: Local Resolution
The local resolution process applies when an individual or their representative (who holds the appropriate legal authority) wishes to challenge the outcome following the CHC full consideration assessment as outlined in the National Framework for Continuing Healthcare and NHS-funded Nursing Care (revised 2022).
In the first instance, individuals or their representative should speak directly to the ICB Lead Assessor and/or MDT members who completed the DST, for clarity of a DST outcome.
If the individual or their representative remain unhappy, following the above, contact should be made with the CHC Appeals Team, the email and postal information of which, is documented on the CHC eligibility decision letter sent to them.
Requests for an appeal should be made to:
Continuing Healthcare – Appeals Team
Herefordshire and Worcestershire ICB
Kirkham House
John Comyn Drive
WR3 7GD
Tel: 0330 053 4356 Option 1 then 3
Appeals Dept: hwicb.
SPA: hwicb.
You can appeal against a decision you do not agree with for the following reasons:
- You disagree with the outcome of the Decision Support Tool (DST)
- The process used was not in line with the National Framework
- The assessment did not consider the right evidence.
You must inform the ICB of your request to appeal within 6 months of the date on the letter telling you the outcome of your assessment. Once you have made a request for an appeal, you will receive contact from the team and will be sent documents for completion (including consent and questionnaire).
The appellant should also indicate in writing, the reason(s) they believe that eligibility for full NHS CHC funding is met. A Notification of Appeal/Comments Form will be sent for completion.
The ICB has the right to prioritise appeals for individuals with and without capacity, who are currently in receipt of a care package.
If, after decisions have been made and explained, you are still unsatisfied then we do have a complaints procedure. You can find out more information about it on this page: Stakeholder and Public Liaison and Information Team :: Herefordshire and Worcestershire Integrated Care System (icb.nhs.uk)
