Continuing Healthcare (CHC)
NHS Continuing Healthcare (CHC) is a care package for people aged over 18 that is 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.
If a health care or social care worker thinks you might be in need of an NHS CHC package, they will do a Checklist to see if you meet the criteria for a full CHC assessment. A Checklist is a screening tool, it is used to help practitioners identify people who may need a full assessment of eligibility for NHS CHC. The Checklist does not indicate whether you are eligible for NHS CHC, only whether you require a full assessment of eligibility. it is important to be aware that the majority of people who “screen in” (have a positive Checklist) are found not to be eligible once the full assessment has been done. Completion of the Checklist will be done at a suitable time and place – it wouldn’t be appropriate to do this, for example, if you were in hospital.
If the Checklist shows you aren’t eligible for a full CHC assessment 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.
If the Checklist shows you are eligible for a full assessment, a CHC co-ordinator will arrange a meeting with you, your representative(s) and a multi-disciplinary team (MDT) of health and social care professionals who are involved in your care. After the meeting, which usually takes about two hours, the MDT will make a recommendation to the ICB. 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.
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.
If you are unhappy with the ICB decision
If you are unhappy with either the process or a decision made regarding eligibility for NHS continuing healthcare, you can request a review of the decision by contacting the ICB. For further information regarding the review of an eligibility decision, please click on the link for the Local Resolution Procedure. For any further information please contact the team at firstname.lastname@example.org.
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 if you are not eligible for social care support you might have 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 ICB to support your health and social care needs.
All CHC funding for care in your own home is now funded in the form of a PHB. It can be provided in three different ways, for more information please visit the Personal Health Budget web page…
More information on PHBs
Information for providers
Rates for care providers (at home or care home) are determined by either AQP contract agreements or individual package agreements. Nottingham and Nottinghamshire ICB rates are automatically uplifted at the beginning of each financial year for AQP providers. Individually negotiated prices are not routinely uplifted in the same way. The ICB will consider uplift requests within the national planning guidance each year between 1 April and 30 June. Uplift requests should be sent to email@example.com by the 30 June. Uplift requests received after this date will not be considered.