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Everything you Need to Know about NHS CHC Funding 

Everything you Need to Know about NHS CHC Funding 

07 December 2020

Did you know that people with long-term complex care needs may be eligible to receive funding from the NHS that would cover all of their care costs? The NHS also offer some people the option of having their care organised for them, and they may pay for home adaptations too.  

In this article, we will explain what NHS Continuing Healthcare funding is, who is eligible for this money and how to get CHC funding. We are also going to talk about what a CHC funding checklist consists of and how continuing healthcare assessments work. 

 

What is NHS Continuing Healthcare? 

In England, NHS Continuing Healthcare is a care package that is fully organised and funded by the NHS to support an adult’s long-term complex health needs. This could be due to a disability, illness or accident. CHC funding pays for the care a person over the age of 18 receives outside of hospital, in the form of at-home care or care in a residential home.  

 

Who can get CHC funding? 

To be eligible for NHS Continuing Healthcare funding someone needs to have a ‘primary health need’. This means that someone's care is mainly needed to support their health or prevent their health from getting worse (as opposed to social or personal care needs).  

An adult’s eligibility and health needs are open to the interpretation of a professionally trained and experienced assessment team. A person’s diagnosis is not the factor that qualifies someone for NHS CHC funding, therefore it is not possible to know if someone will be able to get funding without an assessment. The needs of an individual can change, therefore a person’s eligibility for CHC funding can also change.  

The financial situation of a person will not be included in an NHS CHC assessment as Continuing Healthcare is not means tested (it is not based on how much money a person has, or how much care a person can afford). The NHS have a duty to cover the care costs of a person’s long-term complex health needs.  

Can someone with dementia get CHC funding? 

As mentioned above, the criteria for receiving CHC funding is not based on what condition a person has. Therefore, some people with Dementia may be eligible for NHS Continuing Healthcare, but others may not be eligible. This is because CHC assessments and results are based on a person’s health needs (not their personal care or social needs).  

 

How to get CHC funding 

If you think yourself, a friend, or a loved one is eligible for NHS Continuing Healthcare ask a GP, social worker or healthcare professional for a Checklist assessment. It is also possible to contact your Clinical Commissioning Group’s continuing healthcare department directly to ask for an assessment. 

Sometimes, an assessment will be organised for you if you have been in hospital after an accident, fall or stroke, and you may need long-term care. An assessment should be set up for someone whose health deteriorates and needs care, but this does not always happen, so it is important to check if you are eligible for CHC funding.  

If you are unsure about whether you are eligible for CHC funding, you should still ask for an assessment to find out.  

 

All about the assessments for NHS CHC funding: 

The assessment period for Continuing Healthcare funding can be confusing and difficult for some people. If you need support or advice visit the Beacon website or call their helpline – 0345 548 0300.  

How many CHC funding assessments are there? 

There are two assessments for Continuing Healthcare funding. A CHC funding checklist assessment and a full CHC funding assessment. The checklist assessment decides whether someone needs a full assessment, and the full assessment decides whether someone is eligible for NHS CHC funding.  

Who carries out the Continuing Healthcare assessments? 

A nurse, doctor or social worker can carry out a CHC funding checklist assessment. They must get your consent before doing this (unless under the Mental Capacity Act a person lacks the mental capacity to consent). 

Clinical commissioning groups (CCGs) carry out both CHC funding checklist assessments and full assessments. CCGs are NHS organisations that arrange local healthcare services. 

A multidisciplinary team (MDT) carry out a full CHC funding assessment. This team is made up of 2 healthcare professionals with different healthcare jobs. An MDT usually has representatives from health and social care who already help the candidate with their care. You will be told who the people are that are going to carry out the assessment.  

 

What does the CHC funding checklist assessment involve? 

The NHS Continuing Healthcare checklist is the first assessment carried out to decide if someone may be eligible for CHC funding. During an assessment a team will consider: 

·     The help a person needs 

·     The complexity of a person’s needs  

·     The intensity of a person’s needs 

·     The unpredictability of a person’s needs 

·     The possible risks if someone does not receive care 

The team carrying out the CHC checklist assessment will write down why they think some is or is not eligible for funding, and you will be given a copy of this written assessment. 

 

What is involved in a CHC funding full assessment? 

The multidisciplinary team that carries out a person’s full assessment for NHS CHC funding will consider a person’s needs. These needs will be grouped under the following titles: 

·     Respiratory needs (breathing) 

·     Nutritional needs (eating and drinking) 

·     Bathroom needs (continence) 

·     Skin-related needs (e.g., ulcers or wounds) 

·     Mobility needs (movement) 

·     Communication needs (speaking and listening) 

·     Psychological and emotional needs  

·     Understanding 

·     Behavioural needs  

·     Medication and treatments 

·     Consciousness (and difficulties with consciousness) 

·     Other important care needs 

These titles and needs make up a Decision Support Tool. A DST is used by the team assessing an individual’s needs. In the assessment a person’s needs will be assessed as ‘priority’, ‘severe’, ‘high’, ‘moderate’, ‘low’, or ‘no needs’. If someone has at least one priority need or two severe needs they will probably be eligible for NHS Continuing Healthcare funding. If someone has one severe need and other high or moderate needs, they may also be eligible for NHS CHC funding. The unpredictability, intensity and severity of needs are also taken into account. 

A candidate’s views will be considered, and the views of their carers. The team will give you a copy of the written assessment with their reasons why you are or are not eligible for CHC funding.  

 

How long does it take to find out if you are eligible for NHS Continuing Healthcare funding? 

Someone should know the results of a CHC funding assessment 28 days after their assessment was requested or their first assessment took place. This is the case unless someone’s care package is fast-tracked. 

If the results take longer than 28 days (and the reason for this is unjustifiable), you are entitled to a refund for any care costs from the 29th day onwards.  

Can a CHC assessment be fast-tracked? 

If someone urgently needs care their assessment may be fast-tracked. This could be the case if someone has a terminal illness or is nearing the end of life. Fast-track service usually takes around 48 hours.   

When is CHC eligibility reviewed?  

A person’s care and health needs can change, therefore their eligibility for NHS Continuing Healthcare can change. Therefore, a person's needs and care package are reviewed after the first 3 months of receiving it, and then every year after that.  

Sara
Author Sara