Hello. My name is Trish O’Gorman, and I’m
the Head of NHS Continuing Healthcare at NHS England. As some of you may know, how NHS Continuing
Healthcare works is described in a National Framework for NHS Continuing Healthcare. This
National Framework is written and published by the Department of Health and Social Care.
It is very detailed and it is quite long and there is a lot of information to understand. Clinical Commissioning Groups have the legal
responsibility to assess for NHS Continuing Healthcare and, if eligible, fund packages
of care. We wanted to do something that would help to make NHS Continuing Healthcare easier to understand for people and their families, so we’ve
made this film. The film is made using pictures, text and
sound; however, if you would like to have a copy of the script for this film it can
be found on our NHS England Website, I hope you find this film helpful and that
it helps you to understand more about the assessment process for NHS Continuing Healthcare. Thank you. Introduction
This film is a guide for people who may need ongoing care and support because of complicated,
intense or unpredictable healthcare needs from a disability, accident or illness. It
will explain how the NHS decides if someone’s care should be paid for entirely by the NHS.
Care that is paid for entirely by the NHS is called NHS Continuing Healthcare. How NHS
Continuing Healthcare works is described in the National Framework for NHS Continuing
Healthcare, which is written by the Department of Health and Social Care .
Because NHS Continuing Healthcare is such a long name, we will call it CHC.
This film is divided into sections. These are: Introduction
Some important facts about CHC Before the process starts…
Step 1 – The Screening Step 2 – The Full Assessment
Planning your support Reviews, and
NHS Continuing Healthcare Fast-Track Pathway Some important facts about CHC
CHC is available only for people who: are 18 or older, live somewhere like a care
home or their own home, but not in a hospital setting, and who have been assessed as having
a ‘primary health need’. The primary health need must be agreed from
a health assessment. It’s difficult to explain in a simple way what we mean by a ‘primary
health need’, as it’s very complicated, with lots of different parts. One part is
about your main need for care. Your main need for care should be because you have complicated,
intense or unpredictable health needs from a disability, accident or illness. So if you
have difficulty with things like breathing, eating and drinking, taking medicines, moving
about, memory and thinking, or other difficulties, you may be eligible for CHC.
To find out if you are eligible for CHC, you need to go through a process with two different
stages. Stage 1 – the screening, will be used to decide if you need to move on to Stage
2. Some people will not move on to Stage 2. Stage 2 is a full assessment, which should
not take longer than 28 days, but sometimes there may be delays. Before the process starts…
To start with, the person – or you – needs to give informed consent for the CHC process
to happen, and for information about you to be shared between the health and social care
workers involved. Informed consent means agreeing to something when you have full understanding
of what could happen, and know all the possible risks and benefits. Your consent may be checked
again, or you may be asked for your consent again, later in the CHC process.
It’s important that you understand as much as you can about CHC before deciding if you
want to consent. For example, you need to know that if you are eligible for CHC, the
NHS will become responsible for and will pay for all your care and support, but you might
lose some welfare benefits. If there are worries that you can’t give
informed consent for any reasons, the Mental Capacity Act has to be used to prove you are
not able to give consent. If you can consent, then you decide whether
you want the CHC process to happen. If you can’t consent, a health or social
care worker will normally be the decision-maker. The decision-maker should talk with all the
people who have real interest in you, like family, friends and care staff. The decision-maker
listens to everyone and then decides if asking for CHC funding is the best thing for you.
This is called a ‘best interests’ decision. Asking for CHC funding is usually the best
thing to do, as if you are eligible, you do not pay anything towards the costs of your
care. The ‘best interests’ decision must be
written down. The CHC process can only begin if the ‘best interests’ decision is that
the process should start. Step 1 – the screening.
Step 1 in the CHC process is the screening. This part is short. It is done by completing
a simple form called a Checklist. The Checklist is completed by a social care
worker or a health worker, like a nurse. They will meet with you to discuss your needs.
You can have an advocate with you, and friends or family, whoever is important.
The Checklist should normally happen when you are in a community setting, like your
home or a care home. The worker will ask about your health and
the help you need. If you have a person-centred plan or another
plan, you can use this to help explain your needs.
The worker will need to consider information about your care needs from other people, like
your family or others who support you, and other health or social care workers who work
with you. The worker will use all the information to
complete the checklist. You should get a copy of this.
The results will show if you can go on to the next stage or not.
The checklist should be sent to the Clinical Commissioning Group (or CCG), even if you
are not eligible to go on to the next stage. If the checklist results show you are not
eligible to move on to the full assessment and you have a good reason to think this is
wrong, you can ask the CCG to think again about their decision. Step 2 – the full assessment.
The CCG will choose someone to co-ordinate the full assessment, so that you have a named
person to check things with. The full assessment has two parts – an Assessment
of Needs, and the Decision Support Tool. The Assessment of needs must give accurate
and up-to-date information about your health and social care needs. This information should
come from you and your family, and a multi-disciplinary team involved in your care. (A multi-disciplinary
team is a group of 2 or more professionals, who are different types of health and social
care workers, like psychiatrists, nurses, social workers, care managers, occupational
therapists, and so on, who work together.) The multi-disciplinary team uses all of the
information from your assessment of needs to complete the Decision Support Tool.
The finished Decision Support Tool helps the CCG decide if you should get CHC or not.
The Decision Support Tool has 12 sections, called Domains. Each domain helps you think
about a different care need, and consider the sort of support and how much support is
needed to manage it. The domains are: 1. Breathing – This is about your needs
with any breathing difficulties you may have, like breathlessness, asthma, or Chronic Obstructive
Pulmonary Disease. 2. Nutrition – This is about whether you
can eat and drink, and if you need help with this, like feeding by PEG, or if you have
problems swallowing, like dysphagia. 3. Continence – This is about your needs
with using the loo, like whether you can control this, or if you need help with things like
managing constipation, catheters, urinary tract infections, and so on. 4. Skin Integrity– This is about looking
after your skin. Some people are more at risk because they have a skin condition, which
can break their skin down, or they may have pressure damage or wounds that take a long
time to heal. 5. Mobility – This is to do with how well
you can move and control your body, and if you can stand or walk. It’s important to
think about your safety, and if you are at risk of falling and need support.
6. Communication – This is about whether you can express your needs and understand
others, in ways like talking or signing, use of pictures or Braille, hearing aids or other
communication technology. 7. Psychological and emotional needs – This
is about your mental and emotional health, including things like mood disturbances, hallucinations,
or anxiety. It’s also about the effects of these, like when people have depression
they may get very withdrawn and refuse to accept help from others, which makes it harder
for them to get better. 8. Cognition – This is to do with brain
skills, like memory, understanding risks, decision-making, understanding where you are,
and road safety. This affects the type of support you need to manage your day-to-day
life and stay safe from harm. 9. Behaviour – This is about the way you
behave, like being aggressive or noisy, or being frustrated because you have difficulty
communicating with others. Some behaviour is difficult for others to cope with, which
is called ‘challenging’ behaviour, or some behaviours could be a risk to you, or
other people, or things, and will need special support and care.
10. Drug therapies and medication – This is about your experience of your symptoms
and the medication you need. This could mean things like coping with pain, insulin injections,
any side effects, or if you need prompting and supervision with medication.
11. Altered states of consciousness – This is about the conditions that affect consciousness,
like having epilepsy or Transient Ischaemic Attacks (TIAs) which are like mini strokes. Section 12 is for ‘other significant care
needs’ that are not described in the other domains, if the care needs are really important
for you. The order in which you think about the domains
doesn’t matter, as long as you think about ‘other significant care needs’ last.
Workers from the multi-disciplinary team write about your care needs for each domain. They
also measure your needs with these weightings: ‘No needs’, ‘Low’, ‘Moderate’,
‘High’ and – for some domains – ‘Severe’, or ‘Priority’.
The domains and weightings are shown in a chart, called the Assessment of needs table.
This can give a good picture of all your needs together.
If all your care needs are measured as ‘No need’ or ‘Low need’, this shows that
you are not eligible for CHC. However, if your care needs include one ‘Priority’,
or two or more ‘Severe’ weightings, then you are very likely to be eligible for CHC. If your care needs show a mix of different
weightings, you may still be eligible for CHC because we also consider the Nature, Intensity,
Complexity and Unpredictability of your needs. Nature: This describes what your needs are
like, and the effect they have on you, including the type of support or treatment that works
best to manage those needs. Intensity: This describes how much (like how
often) and how severe your needs are. It also describes the support needed to help you,
including the need for ongoing care. Complexity: This is about how your needs affect
each other, like if one of your needs makes another need change or get worse, and become
difficult to manage. It also describes the level of skill needed to check your symptoms,
treat the condition and/or manage your care. Unpredictability: This is about how much and
how often your needs can change, and what the challenges are for the people who give
you care and support. It should also explain the risk to your health if the right care
is not given at the right time. Someone with an unpredictable healthcare need is likely
to have a changeable and unstable condition. The Decision Support Tool helps health and
social care workers identify and describe your needs. With this knowledge and their
skills and professional judgement, they work out if they think you have a primary health
need, and should therefore be eligible for CHC. This is called their recommendation. When the Assessment of your needs and Decision
Support Tool are complete, you need to check if you agree with what has been written about
you. The multi-disciplinary team can give you a
copy of all the forms and documents that have been written.
The documents and the recommendation are also shared with the CCG, and the CCG decides if
they agree with the recommendation. The CCG usually agree with the recommendation from
the multi-disciplinary team, unless there are very strong reasons why they can’t. You
will then get a letter from the CCG saying whether you are eligible for CHC. If you
are not eligible, the CCG should explain why. If the CCG decides you should not have CHC
but you have good reason to think this is wrong, you can ask them to think again about
their decision. The CCG will listen to you to understand why you disagree with the decision.
They will check the multi-disciplinary team looked at all the important information to
make the correct recommendation. This is called ‘local resolution’ and normally sorts
out any disagreements. If you’re still unhappy with the CCG decision, you can then ask for
an independent review from NHS England. If you aren’t eligible for CHC, the NHS
may still have a responsibility to provide you with care and support to help you manage
your health needs, like by commissioning services, or paying for some of your help and support.
Care that is commissioned or paid for by a local authority and a CCG is called ‘joint-funding’
or a ‘joint package’. If your care is paid for by the CCG and the
local authority together, you may have to pay a contribution (or part of the cost) for
your social care. The CCG will not charge you for the NHS care you need.
If you’re not eligible for joint funding, you may be eligible for support from your
local authority. Planning your support
If you are eligible for CHC, the next step is to agree on your health and wellbeing goals,
and the care you will get. This is called ‘planning your support’. A CHC nurse will
work with you to make your Support Plan. They will talk with you about:
the health and wellbeing goals you want to achieve
the care and support you need in your day-to-day life
how your needs and care will be managed where your care will be given, like, in your
own home or in a care home, and which organisation/s will be responsible for
meeting your needs Your wishes should be an important part of
the decisions that you both make together. It is possible to use CHC funding to continue
with any care or support you were already getting. You would only do this if the care
you had was good quality, and met your needs. It’s also important that any support or
care is what you would choose for yourself, as long as it is safe, affordable and meets
your needs. For this reason, anyone eligible for CHC has the right to have their CHC funding
as a personal health budget. Personal health budgets give people real choice
and control over how to meet their health and care needs.
Personal health budgets work in a similar way to personal budgets from social care services.
They work in 3 ways (or a mix of these), which are:
1. The money can be held by the NHS 2. The money can be held by an organisation
that you choose or agree to 3. The money can be held by you as a Direct
Payment for healthcare, so you buy and manage your own care.
A personal health budget is not new money. It just allows you to use NHS funding to plan
your care in different ways, ways that work better for you. Reviews
If you are eligible for CHC and your care package is started, the CCG will check things
with you after 3 months. They will check to see if the care you get is meeting your needs
and goals, and if CHC is still needed. This is called a review.
After that, the CCG will meet with you every year for a review. Each review will check
to see: if your needs and goals are being met
if your care package still fits your needs, and
if you are still eligible for CHC. NHS Continuing Healthcare Fast-Track Pathway
If you have a health condition that is getting much worse quickly, and you are near the end
of your life, you may be eligible for the CHC fast-track pathway. This is when things
are done very quickly, so you can get treatment and support as urgently as possible.
To get your care fast-tracked, a doctor or a nurse has to complete one referral form
called the Fast-Track Pathway Tool. This form is used to explain that you have a quickly
deteriorating health condition, and that you may be near the end of your life. This form
goes to the CCG. Fast-track referrals from health professionals
are usually accepted straightaway, but the CCG may need to check some information, if
they have any questions. The screening and Decision Support Tool are
not used if you need fast-track care but your care will be reviewed when needed. If your
health improves or stabilises while you’re on the fast-track pathway, a full CHC assessment
will be completed. This helps the CCG check if you still need CHC.
The CCG will check things with you after 3 months. They will check to see if the care
you get is meeting your needs and goals, and if CHC is still needed. This is called a review. After that, the CCG will meet with you every
year for a review. Each review will check to see:
if your needs and goals are being met if your care package still fits your needs,
and if you are still eligible for CHC. Well, I hope you have found this film helpful
and it has broadened your understanding of NHS Continuing Healthcare and the assessment
process. If you would like more information about NHS
Continuing Healthcare you can contact your local Clinical Commissioning Group’s NHS
Continuing Healthcare team. Your health or social care professional should be able to
help you with this.