Continuing Healthcare (CHC)
NHS Continuing Healthcare (CHC) is a care package for people aged over 18 that’s funded entirely by the NHS. To qualify for CHC, you’ll need to be assessed to see if you have a ‘primary health need’ that requires healthcare, rather than social care.
If you’re eligible for CHC, the NHS will pay for your care. This will be reviewed regularly, especially if your care needs change, so there’s a possibility you might have to pay for your care in the future.
To be eligible for CHC, you don’t need to have a disability, specific health condition or illness, and it doesn’t depend on where the care will be provided.
Applying for CHC funding
There are a few steps in the process, which we’ve laid out for you below.
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Initial assessment
When you apply for CHC funding, a health or social care worker will assess your needs to see if they think you’re likely to be eligible. If they think you aren’t eligible, they’ll discuss their reasons with you (or your representatives) and this discussion will be kept on your records.
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Checklist
If the health or social care worker thinks you are eligible, they’ll conduct an assessment using a ‘checklist’. This will be done at a suitable time and place – it wouldn’t be appropriate to do this, for example, if you were in hospital or during an acute illness.
If the checklist shows you aren’t eligible for CHC funding at that point, it will be held on record so we know it’s been completed. If your health changes at any time, the checklist can be repeated.
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Full assessment
If the checklist shows you are eligible, a CHC co-ordinator will arrange a meeting with you, your representative(s) and a multi-disciplinary team (MDT) of health professionals who are involved in your care. After the meeting, which usually takes about two hours, the MDT will make a recommendation to us. The MDT can recommend:
- fully funded CHC, in your home or in a nursing or residential home;
- NHS funded nursing care in a nursing home;
- a joint funded package of care, with social care, in your home or in another location; or
- that you are not eligible for funding.
Some of these options may include means testing, or extra charges by a care home for ‘lifestyle choices’ that are outside normal health and social care costs.
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CCG decision
Only in exceptional circumstances, and for clear reasons, will the MDT’s recommendation not be followed. However, we can ask for more evidence if we’re not able to verify the recommendation.
Can I appeal if the checklist or full assessment finds I’m not eligible?
You or your representative can ask us to reconsider the decision if the checklist indicates you aren’t eligible and you aren’t put forward for a full assessment. If we agree the checklist is correct, you’re entitled to make a Formal Complaint.
If, following a full assessment, we write to confirm you aren’t eligible for CHC funding, the letter we send you will include details on how you can lodge an appeal with us, which you can do within six months of the decision being made.
Nursing care funding
If the MDT recommends that care is provided by a registered nurse in a nursing or care home, you might be entitled to a contribution towards assisted nursing. This funding is known as NHS Funded Nursing Care.
Before a decision on nursing care funding is made, you’ll need to be assessed in the same way as we’ve explained in the ‘applying for CHC funding’ section above. If you aren’t eligible for CHC funding but are entitled to nursing care funding, we’ll make the contribution directly to the nursing or care home.
The rest of the cost will be paid through the local authority, or you might choose to fund your care yourself.
Personal health budgets
A personal health budget (PHB) is an amount of money planned and agreed between you (or your representative) and the CCGs to support your health and social care needs.
All CHC funding for care in your own home is now paid in the form of a PHB. It can be provided in three different ways, or in a combination of any of the three.
- A notional budget held by the CCGs and used to buy services on your behalf
- A budget managed on your behalf by an independent third party
- A direct payment to you so you or your representative can buy services directly
There are five key requirements for a PHB.
- You must know how much money you have for your health and care support
- You are able to choose the health and wellbeing outcomes you want to achieve in agreement with a healthcare professional
- You are able to create your own care plan, with support if you wish
- You are able to choose how your budget or direct payment is held and managed
- You are able to spend the money in ways and at times that make sense to you, as agreed in your plan
