Continuing Healthcare (CHC), also known as NHS Continuing Healthcare, is a package of care arranged and funded solely by the National Health Service (NHS) in England. It is for adults (aged 18 and over) with significant ongoing healthcare needs. This support can be provided in various settings, including at home, in a care home, or in other accommodation.
Continuing Healthcare is designed for individuals with complex medical needs. These needs typically involve chronic illnesses, disabilities, or an end-of-life condition. The NHS funds these packages when the primary need is healthcare rather than social care.
Healthcare vs Social Care
To understand CHC, we need to differentiate between healthcare and social care:
- Healthcare involves diagnosing and treating health conditions. Services are usually provided by doctors, nurses, and other medical professionals. The NHS typically funds it.
- Social Care refers to personal and practical support to help an individual live independently. It includes assistance with daily activities such as washing, dressing, or cooking. Local authorities may provide funding, often subject to means-testing.
In CHC, the primary focus is on healthcare needs. If a person’s primary needs are for healthcare, they could be eligible for CHC.
Eligibility for CHC
Who is it for?
CHC caters to individuals with complex, severe, or unpredictable healthcare needs. These may include:
- People with disabilities or serious medical conditions.
- Individuals requiring extensive or skilled nursing care.
- Patients nearing the end of life.
The Eligibility Criteria
Eligibility for CHC is not about a specific diagnosis or condition. Instead, it focuses on the nature, intensity, complexity, and unpredictability of an individual’s healthcare needs.
- Nature – This refers to the individual’s needs and the overall effect on their health and well-being. Consideration is given to the types of interventions and the skills required by those delivering the care or treatment.
- Intensity – This involves the quantity, severity, and continuity of needs. How much and how often care is needed are crucial factors.
- Complexity – This looks at how the needs present and interact with each other. It addresses the challenges in managing the individual’s care related to the environment and the skill required to monitor the symptoms.
- Unpredictability – This assesses how changeable the individual’s condition is and the level of risk involved. It also considers how difficult it is to manage a rapidly fluctuating condition and the level of monitoring required to ensure stability.
The Assessment Process
Initial Checklist Assessment
The first step in the CHC assessment process is the Checklist Tool. Healthcare or social care professionals usually complete it, such as a nurse, doctor, social worker, or therapist.
- The checklist decides if a person requires a full assessment.
- It is a broad screening tool, not definitive, but identifies individuals who may need more detailed assessments.
Full Assessment
If the checklist indicates potential eligibility, a full assessment follows. This comprehensive process involves a multidisciplinary team (MDT) of health and social care professionals.
- The MDT uses the Decision Support Tool (DST), which assesses needs across 12 domains (e.g. behaviour, cognition, breathing, nutrition).
- Each domain is scored on a range from “no needs” to “severe” or “priority needs.”
Decision Making
Once the full assessment is complete, the MDT makes a recommendation to the Clinical Commissioning Group (CCG), responsible for funding and organising care.
- If eligible, the NHS arranges and funds the care package.
- If deemed ineligible, the individual or their family can ask for a review or appeal.
Annual Reviews
NHS CHC eligibility is not permanent. Annual reviews ensure the care package remains appropriate and adjust to any changes in health needs.
Care Settings
CHC packages can be delivered in various settings, depending on individual needs and circumstances.
Care at Home
For many, receiving care in the comfort of their home is preferable. The NHS funds carers to provide support with:
- Personal care such as washing and dressing.
- Medical treatments, like administering medications.
- Therapeutic activities to maintain health and well-being.
Care Homes
Others may require settings with constant supervision and support, like a care home.
- It includes room and board, along with nursing care.
- In some cases, the NHS may provide additional funding for tailored needs within a care home environment.
Other Settings
There may be occasions where different settings such as supported living arrangements become necessary, depending on complex or specific healthcare needs.
Funding and Costs
In CHC, funding comes entirely from the NHS. This financial support covers comprehensive care needs.
Cost Implications
CHC is not means-tested. Unlike social care, where the local authority considers the individual’s financial circumstances, CHC focuses solely on healthcare needs, not financial status.
Supplements and Additional Costs
Occasionally, situations arise where special supplements fund extra care costs not covered by standard CHC packages. Individuals or their families won’t typically need to contribute financially unless they choose enhanced services beyond NHS care’s scope.
Transitioning to CHC
Transitioning to CHC involves:
- A smooth handover from existing care arrangements, ensuring no gap in support.
- Coordination across different healthcare and social care platforms to maintain consistent, quality care.
Importance of a Smooth Transition
A smooth transition reduces anxiety and ensures continuity of care, allowing individuals to receive the support needed without interruption.
Rights and Advocacy
Understanding and accessing CHC can be challenging. It’s vital for individuals and their families to know their rights during the process.
Advocacy Services
Several organisations offer advocacy services, helping people understand their care needs and navigate CHC assessments and appeals.
- Age UK and Citizens Advice provide guidance and support.
- Independent advocates can also help represent the interests of individuals through the eligibility and appeal process.
Complaints and Appeals
If you disagree with a decision on CHC:
- Request a review within 6 months of the decision.
- You may escalate concerns to the Parliamentary and Health Service Ombudsman if dissatisfied with the review outcome.
Appeals can involve intricate processes, and having professional support or advocacy can be invaluable.
Conclusion
Continuing Healthcare (CHC) is a crucial NHS provision for individuals with significant, ongoing healthcare needs. It ensures that people with the most complex health requirements receive the appropriate level of care, fully funded by the NHS.
Whether at home or in a care home, CHC aims to deliver tailored support for the most vulnerable in society. Even though the process involves detailed assessments and criteria, understanding CHC can empower individuals and families to navigate the healthcare journey effectively.
Ensuring eligibility, managing assessments and reviews, and acknowledging the rights of patients and their families are all integral to the CHC experience. With proper information, advocacy, and support, individuals can make informed decisions about their healthcare needs.
