Continuing Healthcare



What is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is provided to people who have been deemed to have a high level of nursing care needs.

How do I qualify?

To determine whether a patient is eligible for Continuing Healthcare funding the local Continuing Healthcare Team will need to carry out a comprehensive assessment to assess the level of health need.  This will involve collecting information from healthcare professionals, and the Local Authority as well as any other representatives involved in the patient’s care.  The assessor will take into consideration all aspects of the patient’s health and wellbeing, including physical, mental and psychological needs.

How long will it take?

First a Screening Checklist will be carried out to see whether a patient may be eligible for the funding.If this Checklist is positive a more detailed assessment will then take place.

What is a Decision Support Tool (DST)?

A Decision Support Tool is the name of the official toolkit that is used by the healthcare professionals to review the patient’s healthcare needs.There are twelve specific care domains (including areas such as continence, behaviour and nutrition) that are considered in every assessment, and this is used to decide whether the patient is eligible for Continuing Healthcare.We will discuss the content of this toolkit with you in great detail throughout the conduct of this case.

What if there is a delay?

Unfortunately there is currently a substantial backlog and the local CHC Team are months behind.Despite repeated attempts to ensure assessments are carried out within the recommended 28 days, this is not happening.However if the patient is deemed eligible (even if it takes many months to conclude) the funding will be back dated from the 29th day.The date the funding will go back to is 29 days from the date on which the local CHC Team were notified of the potential claim.

Will I be able to attend the Assessment?

The patient’s relatives are invited to attend throughout the process.Often, if the patient is in a Care Home, the Manager will complete the first part of the process by submitting a Checklist.You should ask for a copy of this Checklist.There are then two further processes and on each occasion it is important that the family attend.If you are instructing Moore & Tibbits to represent you we will also attend on that day.

What happens if the CHC Team request further information? Will this delay the process?

On some occasions, when the first assessment is carried out (known as a Trigger Assessment) it may come to light that further information is required, for example if the patient is being reviewed by a CPN (Community Psychiatric Nurse) or has regular appointments with a Consultant the CHC Team may ask for a report from them.It is important that reports are obtained as this gives an accurate and up to date position as to the current level of needs.Any request for reports should be disclosed and copies sent to you.

What happens if the patient is eligible for Continuing Healthcare Funding?

If funding is awarded the local Primary Care Trust (PCT) will pay for the whole package of care that the patient requires.You should not be expected to pay any contribution.The patient will continue to receive their state pension, however if they would have been entitled to Attendance Allowance the DWP (Department for Works and Pensions) about the continuing healthcare payments as the allowance will then cease once the funding is paid.

Will the current care arrangements continue?

The local CHC Team work to take patient’s preferences into account when organising care packages.However, the CHC Team do work within a framework of preferred care providers across Coventry and Warwickshire that provide a good quality of care for a reasonable cost, and in some circumstances they may suggest that a person should be moved.Furthermore, if during the assessment it becomes apparent that the existing care provider is not managing to meet the patient’s needs, again it is possible that the patient could be moved.

Is Continuing Healthcare Funding permanent?

No.Funding is reviewed on a regular basis.It is recommended that the first review takes place three months after the first award, and thereafter on an annual basis.Due to the existing backlog those reviews are not currently taking place as regularly as they should do.However, it is important that you note that the CHC is not guaranteed for life, and if there is an improvement or changes in the patient’s condition it is likely a reassessment will be instigated.

If the patient lives at home and currently receives Direct Payments, and/or payment from the Independent Living Fund (ILF) will this be affected?

Yes.The national framework which provides the guidance for CHC Funding currently indicates that the PCT is not able to make Direct Payments for any patient’s care and cannot enter into a joint package of care for patients to retain their Independent Living Funding.

Should you require any further detailed guidance regarding the funding please do let us know.  There are various websites available that give additional information, in particular Age UK and The Department of Health.  We are happy to provide you with further information in relation to this.

Will I be awarded CHC Funding as a result of my diagnosis?

No.It is a common misconception that people believe once they have been diagnosed with illnesses such as Cancer, Parkinson’s or Advanced Dementia that funding will be automatically provided – this is not the case.The patient will need to demonstrate that they have a very high level of health need, and this is the primary reason as to why care is being provided.The patient’s actual diagnosis will not ensure automatic qualification.Please find attached our Guide to the recent practices of the local CHC Team when they carry out their assessments.

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