What is NHS Continuing Healthcare Funding - in a nutshell?

In a nutshell, NHS Continuing Healthcare (CHC) is a package of care commissioned by the NHS to meet the long-term care requirements of individuals living in the community, whose primary need is for healthcare. The NHS must meet the full cost of care, including accommodation, regardless of the individual’s financial means.

Eligibility is assessed by reference to a document called the National Framework. Published by the Department of Health in 2012, the National Framework was designed to standardise the process and criteria for determining eligibility. It is a lengthy but well-constructed document and is used throughout England. While the guidance in the National Framework is not statuatory, it is expected that practitioners will adhere to its provisions.

The Assessment Process

The assessment process is two-fold: an initial screening Checklist, followed by a full assessment by a multidisciplinary team (MDT) which completes the Decision Support Tool.

The family should be fully informed of and involved in all aspects of the assessment.

The screening Checklist filters out those who clearly do not meet the criteria for CHC funding. Only those who score sufficiently highly on the Checklist will be referred for a full assessment.

The full assessment – also referred to as “the MDT” or “DST” – is carried out by a multi-disciplinary team of health and social care professionals, using a Decision Support Tool (DST).

Both the Checklist and DST are divided into twelve “domains of care” – Breathing, Nutrition, Continence, Skin, Mobility, Communication, Psychological & Emotional Needs, Cognition, Behaviour, Drug Therapies & Medications, Altered States of Consciousness. Each domain is assigned a level of need, ranging from “no needs” to “priority” (although not every domain carries a severe or priority weighting); the levels of need help quantify the quantity and quality of care.

The Decision Support Tool assists the MDT in assessing whether the individual’s primary need is for social care or for healthcare.

Eligibility for CHC Funding is determined by the application of the “Primary Health Need Test”, also called the “Four Key Characteristics”. The Key Characteristics describe:

• The nature of the care needs
• The intensity of the care needs
• The complexity of the care needs
• The unpredictability of the care needs

Once the Decision Support Tool is complete, the MDT makes a recommendation to the Integrated Care Board (ICB) – the local arm of the NHS – which then ratifies the decision.

Eligibility For CHC Funding

Eligibility for CHC is needs-based and is not means-tested. Healthcare is free at the point of need, regardless of the patient’s ability to pay.

If you are found eligible for CHC funding, the NHS will take over the full cost of your care, including accommodation. It is unlawful to be asked to pay any additional costs. The decision will be reviewed after three months and then annually thereafter. Funding status can only be reassessed if there is a significant change in need.

If you are found not eligible for CHC funding, this does not necessarily mean that you do not meet the criteria! Many decisions are overturned on appeal.

We can assist with the determination of eligibility, either before the assessment or after a decision of ineligibility.

We have combined clinical and legal expertise to guide, support and advise you through the assessment and appeal process.