What to expect at a 3-Month or annual CHC review

What is the purpose of a CHC review?

A review should consider: 

• whether the existing package is meeting your relative’s assessed needs;  

• if those needs have changed since CHC was awarded; 

• are the current care plans accurate; and 

• do the funding arrangements remain appropriate? 

The review should not focus on whether CHC should continue. If your relative’s needs have increased, the review may identify that additional support, equipment, supervision or clinical input is required. 

The reviewer should consider the reality of your relative’s needs over time, rather than relying on how they appear during a short meeting. This is particularly important where needs fluctuate or serious incidents occur intermittently. 

Is a review the same as a reassessment?

No. A review looks at whether your relative’s needs and care arrangements have changed. 

A full CHC assessment is a fresh assessment of eligibility. It should involve a multidisciplinary team and a new Decision Support Tool, or DST. 

A full reassessment should only occur where there is clear evidence of a change in needs that may affect eligibility. An ICB should not use a routine review as a shortcut to remove funding. 

Equally, the fact that a different reviewer describes a need differently does not necessarily establish that the need itself has changed. 

What should happen before the review?

You should be given a reasonable opportunity to prepare and participate. 

Before the meeting, ask the ICB to confirm: 

• whether it is a routine review or a reassessment; 

• who will attend; 

• which records will be considered; and 

• what tool or document will be used. 

You should also request a copy of the previous DST, current care plans and whatever tool/document the reviewer will be completing. 

The reviewer should compare your relative’s current needs with those identified in the original DST so this document should be central to the discussion. Make sure you look at it carefully in advance. 

What should you prepare?

You do not need to produce every care record available. Focus on evidence that shows: 

• significant changes since the previous assessment; 

• the frequency and severity of important needs; 

• the care required to manage risks; 

• recent incidents or deterioration; and 

• any gap between the care plan and what is actually being provided. 

Relevant evidence may include recent care notes, risk assessments, incident records and reports from clinicians or the care provider. 

The key question is not simply whether your relative appears stable or their needs are being “managed”. It is what care, monitoring and intervention are required to keep them stable. 

Managed needs remain needs

A need should not be treated as having disappeared simply because it is being managed successfully. 

For example, challenging behaviour may occur less frequently because staff are able to recognise triggers and intervene early to prevent escalation. The frequency of falls may have reduced because dedicated 1:1 care is in place. Choking episodes may not have happened because care staff are following skilled instructions.  

The review should identify the underlying need and the measures required to manage it. 

Only where a need has been permanently reduced or eliminated should this have a bearing on CHC eligibility.  

What should happen during the meeting?

The reviewer should compare your relative’s current needs with those recorded in the previous DST.  

In each care domain, you should have an opportunity to: 

• explain any changes; 

• correct inaccurate statements; 

• identify important missing evidence; 

• describe fluctuating or less frequent needs; and 

• explain what would happen without the current care arrangements. 

Do not allow the discussion to be based solely on how your relative presents during the meeting. A short period of apparent stability may not reflect the level of care required throughout the day and night. 

If you disagree with the reviewer’s account, ask for your comments to be recorded. 

REMEMBER: The review must make comparison with the original DST to determine if things have changed. If this doesn’t happen, the review does not comply with national guidance. 

What are the possible outcomes?

CHC continues without significant change 

Where the care package remains appropriate and there is no evidence of a material change in need, CHC should continue. 

CHC continues, but the care package changes 

The review may identify that the package needs to increase or be delivered differently. 

A proposed reduction should be supported by evidence that the relevant need or required intervention has genuinely reduced. It should not be based simply on cost or on the fact that the care provider is currently managing. 

A full reassessment is arranged 

Where there is clear evidence of a significant change, the ICB may arrange a full reassessment. 

This should involve a multidisciplinary team meeting and a new DST. It does not automatically mean that CHC will be withdrawn. 

The assessment should identify what has materially changed since the previous eligibility decision. 

CHC is withdrawn following reassessment 

A routine review should not itself remove CHC funding. 

If a later reassessment results in withdrawal, the ICB should provide a written decision explaining its reasons, when funding will end and how the decision may be challenged. 

You should then examine whether the alleged reduction in need is supported by the records. A lower score or different wording does not, by itself, prove that needs have materially changed. 

For detailed guidance, read our separate article on what to do when CHC funding is withdrawn. 

What happens at an FNC review? 

NHS-funded Nursing Care, or FNC, should also normally be reviewed within three months and then annually. 

The review should consider whether registered nursing care remains appropriate and whether the person’s needs have increased to the point that full CHC should be considered. 

An FNC review should not be treated as a simple administrative exercise. 

When might the review process need to be challenged?

You should look more closely at the process where: 

• the previous DST is ignored or not included at all; 

• the reviewer relies on a brief snapshot; 

• clinical evidence is not considered or is inaccurate; 

• managed needs are treated as needs that no longer exist; 

• important incidents are omitted; 

• the review is used as if it were a full reassessment; or 

• a proposed reassessment is not linked to a clear change in need. 

Not every disagreement means that the review is wrong. The strength of any challenge will depend on the records, the accuracy of the review and whether the National Framework has been applied properly. 

What should you do after the review?

Ask for a copy of the completed review document and written confirmation of the outcome. 

Check that it accurately records: 

• the needs discussed; 

• any changes since the previous assessment; 

• the care required to manage risks; 

• your comments; and 

• the next steps. 

Where the document is inaccurate, respond in writing promptly. An incorrect review record may later be relied upon during a reassessment. 

How Farley Dwek can assist with a CHC review

A review can have significant consequences if needs are understated or the existing package is treated as evidence that those needs have reduced. 

Farley Dwek’s specialist CHC Nurse Assessors can review the previous DST and current care evidence, identify areas of concern and represent your relative at the review. 

Our advice may be particularly valuable where: 

• the ICB suggests that needs have reduced; 

• the records do not reflect the care being provided; 

• the current package is inadequate; 

• a full reassessment has been proposed; or 

• existing funding may be at risk. 

The detailed clinical analysis of the records, the comparison with the previous DST and the arguments that should be raised will depend on the individual evidence. These are matters our team can address through the CHC Review Advocacy Service.