Luton Clinical Commissioning Group

NHS Luton Clinical Commissioning Group

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Continuing Healthcare

NHS Continuing Healthcare (CHC), NHS-funded Nursing Care (FNC) and Personal Health Budgets (PHB)

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care October 2018 (Revised) sets out the key principles and processes, the framework documents can be viewed here.
 
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS for those people found to be eligible (over 18 years of age). If your overall assessment of care needs shows that you have a ‘primary health need’, you are likely to be eligible for NHS Continuing Healthcare. Once eligible for NHS Continuing Healthcare, your care will be funded by the NHS, this is however, subject to regular reviews, and, should your care needs change, the funding arrangements are also likely to change and you may have to pay for your care.

Eligibility for NHS Continuing Healthcare does not depend on:
 
  • A specific health condition, illness or diagnosis
  • Who provides the care, or
  • Where the care is provided.
Please note that if you have a disability or if you have been diagnosed with a long-term illness or condition, this does not necessarily mean that you will be eligible for NHS Continuing Healthcare funding.
 
Applying for Continuing Healthcare (CHC) Funding

First, it is usual to have what is referred to as a ‘checklist’ completed by either a health or social care worker. This will see whether a person could be eligible for a Continuing Healthcare assessment which is referred to as a DST (Decision Support Tool). If the Checklist does not ‘screen in’ for an assessment (DST), the checklist can be repeated if the person’s health changes. (Even if the person does not ‘screen in’ for CHC, the checklist should be sent to the local CHC team to record that this has taken place.)

When considering if someone is likely to meet CHC eligibility, they should only be assessed when it is the right time and place for them. It is not usually appropriate to assess someone’s longer term needs when they are in hospital or during a period of acute illness. The CHC checklist threshold has intentionally been set low to ensure all people who might be CHC eligible have the opportunity to be assessed for CHC funding.

The health or social care worker should consider if they think the person has a ‘primary health need’ before completing a CHC checklist. If the health or social care worker does not think the person is likely to be eligible for CHC funding, they should discuss with the person/representatives the reasons for their decision and make sure this is written onto the person’s records.

For those people who ‘screen in’ for a full CHC assessment (DST), a CHC co-ordinator will arrange for a multi-disciplinary team (MDT) meeting. This meeting will include the person and their representative. This meeting will usually take approximately 2 hours and includes the relevant professionals (including social care) who support the person.

Following the completion of the DST, the MDT will make a recommendation to the Clinical Commissioning Group (CCG, which is responsible for CHC-funded care) on whether they think (recommend) the person is CHC-eligible or not. Only in exceptional circumstances, and for clear reasons, should the MDT’s recommendation not be followed.
The CCG can request further evidence if they are not able to verify the recommendation, from the documentation and evidence submitted.

There are several recommendations that can be made, depending on the results of the DST:
 
  • Fully funded Continuing Healthcare, at the person’s home or in a nursing/residential home setting
  • NHS-funded Nursing Care in a nursing home setting
  • Joint funded package of care, with Social Care, at the person’s home or other setting
  • Not eligible for funding
Note the NHS-funded Nursing Care and joint funded packages with Social Care may include a means-tested element. If a person is eligible for NHS CHC funding, the cost of the health and social care will be met by the CCG, there may be extra charges by the care home for ‘lifestyle choices’ which are outside health and social care costs.
 
NHS-funded Nursing Care (FNC)
 
The NHS is responsible for care that must be provided by a registered nurse. People who have been assessed by a multi-disciplinary team (MDT) as not being eligible for NHS CHC funding but are receiving their care from a care home with nursing may be entitled to a contribution towards their assessed registered nursing input. This is known as NHS-funded Nursing Care (FNC).
 
Before a decision on NHS FNC is made, a decision on whether the person is eligible for CHC funding must be made first. If a person is not eligible for NHS CHC funding but is entitled to NHS FNC, the Funded Nursing Care contribution will be made directly to the care home by the CCG responsible. The Department of Health and Social Care decides each year on the rate of the contribution. The remainder of the cost of a person’s care is paid through the local authority (Social Care), and is subject to means testing or the person might fund the care themselves.
 
Information about continuing healthcare funding can be found in the NHS Continuing Healthcare and NHS funded Nursing Care Public Information Leaflet and in the easy read book ‘What is NHS Continuing Healthcare‘.
 
Please click on the link below to see a short videos which explains CHC further:
Watch some videos which explain the Continuing Healthcare process.

Personal Health Budgets (PHB)
 
A Personal Health Budget (PHB) is an agreed amount of money to support someone’s health and social care needs which has been planned and agreed by the person (or their representative) and the CCG.

People eligible for CHC funding are entitled to receive this funding in the form of a Personal Health Budget (PHB). From 1 April 2019, all CHC domiciliary (care in your own home) packages will be in the form of a PHB.

A PHB can be provided in three different ways or using a combination of these ways:
 
  1. A notional budget held by the commissioner (CCG)
  2. A budget managed on the person’s behalf by a third party
  3. A payment to the person (direct payment)
What if the individual/representative does not agree with the decision? (Complaint/Appeal)

If the checklist indicated that the person did not ‘screen in’ and at that stage they did not proceed to a full assessment, the person or their representative can request the CHC Department to reconsider with evidence of why they disagree. If the CCG agrees that the checklist was correct and does not ‘screen in’ and does not proceed to a full assessment the person or their representative is entitled to make a formal complaint to the CCG.

If the decision was made as a result of the full assessment, the person or representative can contact the CHC Department to lodge an appeal against the decision within 6 months of the decision. The details of how to lodge the appeal will be sent along with any letter confirming that the individual is not considered to be CHC eligible.

How service user or their representatives can apply for consideration for NHS Continuing Healthcare funding.

If you would like to apply for continuing healthcare funding or have an enquiry, you can either contact the continuing healthcare team or download and complete the application form and return the form either by email / post (lccg.continuinghealthcare@nhs.net). Alternatively you can contact the team at the addresses or phone numbers listed below.

Alternatively you can download and complete the application form and return the completed form either by email or post to the continuing healthcare team

Please be advised emails sent enclosing personal or sensitive information from email addresses that are not secure are sent at your own risk. Emails can be sent encrypted with the exception of NHS.net emails, which are only secure if sent to another NHS.net account.
 
Download the CHC Funding Application here. 

These organisations can provide independent support with the CHC process:

Beacon: http://www.beaconchc.co.uk/ 

Further Information about Continuing Healthcare

Here you can find some links to other websites or documents which you may find useful:
 
Bedfordshire, Luton and Milton (BLMK) CCGs are committed to work within the NHS CHC Framework. The CCGs will continue to work closely together to quality monitor local processes and assessments and delivery of quality commissioned care.

At each assessment stage you will be requested to complete a Survey on the service you receive. This can be completed on paper or over the telephone. Alternatively, you may complete the survey online using the link below:
 
https://nhs.quiqcare.com/survey/548fd9ff1fd4ad77fd679663a20571cf


Getting in touch

You can contact the Continuing Healthcare team at:

Luton Continuing Healthcare Team
NHS Luton Clinical Commissioning Group
Arndale House, 3rd Floor,
37 The Mall, Luton,
LU1 2LJ.

Phone number: 01582 532208.
Email address: (lccg.continuinghealthcare@nhs.net) 
 

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