The process surrounding CHC funding is set out in The National framework for NHS continuing healthcare assessments and NHS-funded nursing care by the Department of Health and Social Care.
Stage 1 - Continuing healthcare checklist
A CHC checklist is the first stage in determining whether an individual is entitled to free care.
An assessment for continuing healthcare funding should not be undertaken whilst a patient is in an acute hospital setting. The assessment should take place once the patient has been discharged to a nursing home or into health and social care. If the patient is already in a nursing home or remains in their own home, then the responsibility for conducting an assessment lies with the Integrated Care Board (ICB).
A nurse assessor or social worker will consider the individual’s needs across a range of 12 domains, or areas of need and score them on the basis of A (high moderate), B (moderate) or C (low/none).
If an individual is scored as having two or more A scorings, 5 or more B scorings or 1 A and 4 B scorings, then they proceed to stage 2 and a full assessment.
A PDF of an example checklist is available here.
Stage 2 - Decision support tool
If the CHC checklist is positive, a multi-disciplinary team (referred to as a MDT) will carry out a full assessment using the Decision Support Tool (DST).
The multi-disciplinary team is made up of clinicians, often a social worker, social healthcare professional, a GP and a nurse assessor.
The MDT will assess the individual against 12 care domains and score on a scale from no needs, to priority needs.
The MDT will review the individual’s needs in relation to four characteristics; nature, intensity, complexity and unpredictability. This will help the team decide whether you have a primary health need and are eligible for continuing healthcare funding.
An example decision support tool document is available here.
Stage 3 - Outcome
The multi-disciplinary team will recommend to the ICB whether the individual is eligible for CHC or not. There are two outcomes:
- If an individual is eligible, the NHS becomes responsible for planning, sourcing and funding the package of support based on the care needs identified.
- If the individual is found to be not eligible for CHC, you can ask the ICB to review its decision through an appeal.
Timeframes
The NHS Continuing Healthcare assessment process is expected to be completed within 28 days from the date of referral.
If the process takes longer than this, and the individual is found eligible for CHC funding, the NHS should be responsible for covering any care fees incurred due to the delay.
Fast track assessment
If an individual is approaching the end of their life, then a fast-track Continuing Healthcare funding assessment may be appropriate. This enables the individual to receive prompt NHS funding to meet the cost of their care at the end of life stage.
The NHS CHC fast track pathway is for individuals with rapidly deteriorating conditions who may be entering a terminal phase of their life. A GP can complete the fast track pathway tool.
It should be noted that strict time limits that base eligibility will be specified, however expected length of life remaining should not be imposed.
Appeals
If you do not agree with the decision reached by the MDT panel, then the decision can be appealed. This has to be backed by evidence, to demonstrate that the decision reached was flawed.
We can assist in the appeals process. With our expert knowledge and experience of this complex area, we can advise on whether you have a basis for an appeal by reviewing the evidence and assisting you with the full appeals process. We have a strong success rate of securing funding after attending the panel hearings and advocating for our clients.
How Compass CHC can help
Having an expert on your side matters. We have over 10 years experience helping individuals and families navigate the continuing healthcare process. We help ensure the correct scorings are awarded that accurately reflect the health needs of the individual. We will work tirelessly to secure the best outcome for you, in the swiftest timeframe, and for a fixed cost.
We specialise in securing funding from day one. Don’t wait until a negative decision has been made and it is then necessary to appeal the outcome, this can take many months and all the while the individual will have to pay the cost of their care.
Unsure if you or a loved one qualifies?
If you think you or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
Submit an enquiry to get started.
