NHS Continuing Healthcare (CHC), NHS-funded Nursing Care (FNC) and Personal Health Budgets (PHB)
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care October 2018 (Revised) sets out the key principles and processes, the framework documents can be viewed https://www.england.nhs.uk/healthcare/.
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS for those people found to be eligible (over 18 years of age). If your overall assessment of care needs shows that you have a ‘primary health need’, you are likely to be eligible for NHS Continuing Healthcare. Once eligible for NHS Continuing Healthcare, your care will be funded by the NHS, this is however, subject to regular reviews, and, should your care needs change, the funding arrangements are also likely to change and you may have to pay for your care.
Eligibility for NHS Continuing Healthcare does not depend on:
Please note that if you have a disability or if you have been diagnosed with a long-term illness or condition, this does not necessarily mean that you will be eligible for NHS Continuing Healthcare funding.
Applying for Continuing Healthcare (CHC) Funding
First, it is usual to have what is referred to as a ‘checklist’ completed by either a health or social care worker. This will see whether a person could be eligible for a Continuing Healthcare assessment which is referred to as a DST (Decision Support Tool). If the Checklist does not ‘screen in’ for an assessment (DST), the checklist can be repeated if the person’s health changes. (Even if the person does not ‘screen in’ for CHC, the checklist should be sent to the local CHC team to record that this has taken place.)
When considering if someone is likely to meet CHC eligibility, they should only be assessed when it is the right time and place for them. It is not usually appropriate to assess someone’s longer term needs when they are in hospital or during a period of acute illness. The CHC checklist threshold has intentionally been set low to ensure all people who might be CHC eligible have the opportunity to be assessed for CHC funding.
The health or social care worker should consider if they think the person has a ‘primary health need’ before completing a CHC checklist. If the health or social care worker does not think the person is likely to be eligible for CHC funding, they should discuss with the person/representatives the reasons for their decision and make sure this is written onto the person’s records.
For those people who ‘screen in’ for a full CHC assessment (DST), a CHC co-ordinator will arrange for a multi-disciplinary team (MDT) meeting. This meeting will include the person and their representative. This meeting will usually take approximately 2 hours and includes the relevant professionals (including social care) who support the person.
Following the completion of the DST, the MDT will make a recommendation to the Clinical Commissioning Group (CCG, which is responsible for CHC-funded care) on whether they think (recommend) the person is CHC-eligible or not. Only in exceptional circumstances, and for clear reasons, should the MDT’s recommendation not be followed.
The CCG can request further evidence if they are not able to verify the recommendation, from the documentation and evidence submitted.
There are several recommendations that can be made, depending on the results of the DST:
Note the NHS-funded Nursing Care and joint funded packages with Social Care may include a means-tested element. If a person is eligible for NHS CHC funding, the cost of the health and social care will be met by the CCG, there may be extra charges by the care home for ‘lifestyle choices’ which are outside health and social care costs.
NHS-funded Nursing Care (FNC)
The NHS is responsible for care that must be provided by a registered nurse. People who have been assessed by a multi-disciplinary team (MDT) as not being eligible for NHS CHC funding but are receiving their care from a care home with nursing may be entitled to a contribution towards their assessed registered nursing input. This is known as NHS-funded Nursing Care (FNC).
Before a decision on NHS FNC is made, a decision on whether the person is eligible for CHC funding must be made first. If a person is not eligible for NHS CHC funding but is entitled to NHS FNC, the Funded Nursing Care contribution will be made directly to the care home by the CCG responsible. The Department of Health and Social Care decides each year on the rate of the contribution. The remainder of the cost of a person’s care is paid through the local authority (Social Care, and is subject to means testing or the person might fund the care themselves
Please click on the link below to see a short film which explains CHC further: https://www.youtube.com/watch?v=DdTqGTPSRb8
A Personal Health Budget (PHB) is an agreed amount of money to support someone’s health and social care needs which has been planned and agreed by the person (or their representative) and the CCG.
People eligible for CHC funding are entitled to receive this funding in the form of a Personal Health Budget (PHB). From 1 April 2019, all CHC domiciliary (care in your own home) packages will be in the form of a PHB.
A PHB can be provided in three different ways or using a combination of these ways:
What if the individual/representative does not agree with the decision? (Complaint/Appeal)
If the checklist indicated that the person did not ‘screen in’ and at that stage they did not proceed to a full assessment, the person or their representative can request the CHC Department to reconsider with evidence of why they disagree. If the CCG agrees that the checklist was correct and does not ‘screen in’ and does not proceed to a full assessment the person or their representative is entitled to make a formal complaint to the CCG.
If the decision was made as a result of the full assessment, the person or representative can contact the CHC Department (address below) to lodge an appeal against the decision within 6 months of the decision. The details of how to lodge the appeal will be sent along with any letter confirming that the individual is not considered to be CHC eligible.
These organisations can provide independent support with the CHC process:
Healthwatch Bedford Borough: www.healthwatchbedfordborough.co.uk
Healthwatch Central Bedfordshire: www.healthwatch-centralbedfordshire.org.uk
Bedfordshire, Luton and Milton (BLMK) CCGs are committed to work within the NHS CHC Framework. The CCGs will continue to work closely together to quality monitor local processes and assessments and delivery of quality commissioned care.
Personal Health Budgets
Bedfordshire Clinical Commissioning Group
Continuing Healthcare Department