The process of applying for NHS Continuing Healthcare (NHS CHC) can be confusing, so to help we’ve outlined the steps of the process below.
NHS Continuing Healthcare funding is a package of care provided to meet the personal care costs for an individual, regardless of their setting, be it in a nursing home, residential home or living at home. It should be noted that NHS Continuing Healthcare is not means tested.
The process for applying for NHS Continuing Healthcare funding will largely depend upon the location in which the individual requiring the assessment is living. This can often be in the hospital awaiting discharge, living at home with full-time care, or in a nursing or residential home. We shall address each aspect in turn below:
Where the patient is still in hospital
Section 2 (2) of the Community Care (delayed discharges etc.) Act 2003 states that when a patient is in a hospital setting, the hospital is responsible for ensuring all reasonable steps are taken for a full assessment for NHS Continuing Healthcare funding to be carried out prior to discharge, where it is the case that it appears the patient has a need for such care. Unfortunately, in our experience, this often doesn’t occur. Assumptions may be made that where a patient has been in a nursing home, suffers an episode that requires hospital admission, and is then due to be discharged back to the nursing home the assessment for Continuing Healthcare is not required.
This is obviously incorrect, it may have been the case that the patient did not require or meet the criteria for NHS Continuing Healthcare funding prior to their hospital admission. But their health needs have now increased and their care needs are now a primary health need at the point of discharge. This would then make them eligible for NHS continuing healthcare funding. We would, therefore, suggest that the family involved in the discharge of the patient from hospital take steps to inform the discharge team that an assessment for Continuing Healthcare funding has taken place, or shall take place, prior to discharge from the hospital.
When residing in a nursing home
In order to be classified as a nursing home, the home must be registered and will be required to have registered nursing staff and social care professionals who are employed by the home. It is often the case that when an individual is living in a nursing home, possibly long term, that the local ICB (Integrated Care Board) will request that the initial checklist assessment for Continuing Healthcare funding is completed by the registered nurse employed by the home. Please be aware, however, this is not always the case and many ICB’s employ Nurse Assessors specifically for the task of undertaking assessments of patients for continuing healthcare funding.
As a first point of contact we would always suggest that individuals approach their ICB directly, whatever the setting of the patient. The National Framework for Continuing Healthcare Funding makes it clear that the responsibility for coordinating and arranging the assessment for Continuing Healthcare Funding falls to the responsible commissioner and local authority, namely the ICB in which the patient resides.
When residing in a residential home
As above, the first port of call should be to contact their local ICB directly. Residential homes are less likely to employ registered nurses and therefore unlikely to have a qualified nurse available to undertake the CHC checklist assessment. If the patient has a social worker involved in their care planning and package of care, then this would be a secondary point of contact that you could request to undertake a checklist assessment for continuing healthcare funding. If the patient is under the treatment plan of the local District Nursing team then they would be able to undertake a Continuing Healthcare funding checklist assessment to be used as an initial screening tool. Finally, an individual’s General Practitioner may be willing to complete an assessment of the initial phases of Continuing Healthcare funding.
When the patient lives at home
The assessment process would be similar to the case if the patient was in a residential home. It is unlikely that they will have full-time nursing care and support from a Registered General Nurse and therefore such an individual would not be available to complete the initial screening assessment.
We would advise as before and, in all health and social care instances, that patients initially contact their local ICB and request an assessment. However, if this is unsuccessful then the options would be to contact the individual’s General Practitioner, and/or Social Worker or a member of the District Nursing team if they are being treated or involved with any of the above.
The assessment process itself
The first step for anyone to be considered for eligibility for NHS Continuing Healthcare funding is assessment via a Continuing Healthcare funding checklist assessment. This is intended as a screening tool with a low bar of eligibility to satisfy. The full process to determine entitlement to Continuing Healthcare funding is a two-stage assessment process.
Only if an individual passes a checklist assessment will they be referred for a full multi-disciplinary assessment undertaken on a Decision Support Tool (DST) document. This is the second stage of the assessment process.
In order to pass a checklist, an individual must have either two or more A’s, 1 A and 4 B’s, or 5 B’s within the 11 areas of consideration. In addition, an individual who has an A in the domain of Behaviour, Breathing or Altered States of Consciousness will automatically require a full assessment for Continuing Healthcare Funding, irrespective of what the other scores within the checklist assessment are. For example, an individual could have 1 A for Behaviour and score C in all other areas, and they will still require a full Decision Support Tool assessment undertaken by a multi-disciplinary team.
The scoring process can be complicated, if you have any questions about entitlement to Continuing Healthcare funding, the assessment process, or would like independent advice on your funding options, get in touch for a free, no obligation and confidential discussion.
Author: Tim Davies LLB
