Continuing healthcare: NHS Gloucestershire CCG (2023)

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Continuing Healthcare (CHC) is care provided and funded exclusively by the NHS to adults aged 18 or over with complex health needs.

Your eligibility for NHS CHC is based on proving 'primary care need'. “Essential health need” does not refer to why you need care or support, nor is it based on your condition and diagnosis; this applies to all your actual daily care needs.

Basic health needs should be assessed by considering all care needs and comparing them to four main characteristics:

• Nature– type of condition or required treatment (quality and quantity)
• Complexity– symptoms that are interconnected and therefore difficult to manage and control
• Intensity– one or more health needs serious enough to require regular intervention
• unpredictable– unexpected changes in your condition that are difficult to deal with and that pose a risk to you or others.

NHS Continuing Care can be provided in a variety of settings outside of hospital, such as your own home or nursing home.

NHS Continuing Healthcare is regularly assessed and if your needs change, your entitlement to NHS Continuing Healthcare may change.

How is the assessment made?

The evaluation process consists of two phases.

1. NHS Monitoring Checklist

For most people there isinitial assessment listwhich is used to decide whether a full HCC evaluation is needed. Before the checklist can be completed, the process will need to be discussed with you and your consent may be sought. The checklist can be completed by an NHS social or health professional, usually including you or, if you wish, your family, carers or representative.

Depending on the outcome of the checklist, you will either be informed that you do not meet the full NHS assessment criteria for continuing healthcare and are therefore ineligible, or you will be referred to a CCG for a full eligibility assessment.

2. NHS Continuing Health Assessment completed

As part of the subsequent NHS eligibility review, your needs will be considered by a multidisciplinary team (MDT). An MDT team is made up of 2 or more professionals and usually includes health and social care professionals who are aware of your health and social care needs and, if possible, have recently been involved in your assessment, treatment or care.

The assessment will, with your consent, take into account the input of different professionals involved in your care, such as your GP, to create an overview of your needs.

The MDT will then use the information from your assessment to complete the Decision Support Tool (DST).

The aim of the DST is to help the MDT assess the nature, complexity, intensity and unpredictability of your needs - and so recommend whether you have an 'essential health need'

You should be fully involved in the assessment process and be informed, and include your views on your needs and support.

The MDT will then make a recommendation to the CCG about whether you have essential health needs, which will determine whether you are eligible for NHS follow-up care. The GCC will normally accept this recommendation, except in exceptional circumstances and clearly stated reasons for its decision.

A decision on eligibility for NHS Continuing Care should normally be made within 28 days of receiving an initial assessment or receiving a request for a full assessment from the CCG. Although in some situations it may take more than 28 days to make a decision.

The CCG will notify you in writing, together with a copy of the ISD, as soon as possible, giving you a clear reason for its decision about your eligibility. It will also explain your right to request a review of the decision.

review of the decision

After a full assessment, you have the right to ask for a review of the decision that you are not eligible for continued NHS care. This must be done within six months of the date of the decision letter stating how to request a reconsideration of the decision.

accelerated financing

If your condition is rapidly deteriorating and you may be entering the terminal stage, you should consider fast track funding from NHS CHC to ensure you get the right package of care and support as soon as possible. In the case of an expedited route, there is no need to complete a checklist or decision support tool. Instead, the appropriate doctor will complete the examination.quick tracking toolto determine whether you are eligible for continuing NHS healthcare.

This doctor will send the completed Fast Track tool directly to your CCG, who must arrange a package of care for you, usually within 48 hours of receiving the completed Fast Track tool.

Care planning and support

If you are eligible for NHS Continuing Care, the next step is to arrange a package of care and support that meets your assessed needs.

Depending on your situation, different options may be suitable, including home support and a Personal Health Budget (PHB) option.

If a nursing home is determined to be the best option for you, there may be more than one suitable nursing home.

All organizations will work with you and take your views into account when agreeing your care and support package and where it will be delivered. However, they may also consider other factors such as the cost and value for money of different options.

personal health budgets

From April 2014, anyone who is eligible for CHC and wants to receive care outside a nursing home will be able to receive the money they need to meet their health needs in the form of a Personal Health Care Budget in the form of Direct Assistance. payment. This gives people more choice about how, when and by whom they will be cared for and supported.

Ongoing reviews of NHS healthcare

If you are eligible for NHS Continuing Care, your needs and support package will normally be reviewed within 3 months and at least annually thereafter. This assessment will consider whether your current package of care and support meets the assessed needs. If your needs have changed, the review will also consider whether you are still eligible for NHS Continuing Care.

Funded care

If you are not entitled to NHS Continuing Care but have been assessed as needing care in a nursing home (in other words, a registered nursing home), you may qualify for NHS Funded Nursing (FNC).

This means that the NHS will cover part of the cost of your registered care, which is paid directly to the care home. NHS-funded care is available regardless of who pays the rest of your care home fees.

After a full assessment, you have the right to appeal a decision that you are not fit to continue with NHS healthcare. More information on local resolutions is available.

If you think you or a loved one may be eligible for NHS funding for long-term care, talk to your social worker, GP or other health or social care professional. You can also contact the Continuing Care team.

Get in touch with the team

Aftercare
The Sanger House
5220 Kuria Hrabri
Delta road
Gloucester Business Park
Brockwortha
Gloucester
GL3 4FE

Telephone:0300 421 0302
E-mail: Tim GLCCG.CHC-SPA@nhs.net

Working hours: from 9:00 a.m. to 5:00 p.m., from Monday to Friday.

Alternatively, you can talk to your GP, social worker or health worker.

Further reading

• NHS Continuing Care na NHS.uk
• National framework for CHC and FNC
• What is NHS Continuous Health Care (easy to read)
• Evaluation of the checklist
• Decision support tool
• quick tracking tool

This public information film is a guide for individuals and their families to NHS monitoring and what to expect during the assessment process.