NHS Continuing Healthcare (CHC)

The first step is to have a screening tool completed with a health or social care professional (a checklist). Health and social care staff use the checklist to help judge whether a full assessment for NHS Continuing Healthcare should happen. 

The second step is a full assessment of eligibility. This involves a multi-disciplinary team applying the ‘Decision Support Tool’. The tool will be completed by health and social care professionals. This looks at twelve different types of need, for example, mobility, nutrition, and behaviour. The tool helps decide on the nature, complexity, intensity and unpredictability of your needs known as a ‘primary health need’. 

This is likely to be a complex medical condition that requires substantial ongoing healthcare. Eligibility is not dependent on a particular diagnosis or disease, or determined by the location of where your care is provided. If your assessment does not identify a primary health need, you will not be eligible for NHS continuing healthcare. 

We follow national guidance and criteria in assessing your care needs and eligibility. You will be fully informed and involved throughout this process. If you wish, you can ask a member of your family, a friend, a carer or perhaps another representative, to support you during this assessment process. We encourage you to do this.

In some cases, an urgent decision is needed, for example those who are terminally ill, and this can be assessed via use of the fast Track Tool to provide timely NHS continuing healthcare for those rapidly deteriorating and entering a terminal phase.

Your health needs are assessed by looking at all of your care needs and relating them to four indicators:

•    Nature – the type of condition or treatment required.
•    Complexity – symptoms that interact; therefore difficult to manage or control.
•    Intensity – one or more health needs, so severe they require regular intervention.
•    Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to the person or others. 

If you are eligible, NHS Cambridgeshire & Peterborough will be responsible for identifying and funding a package of care that has been discussed and agreed with you and your family or representative. Funding is subject to regular review and if your healthcare needs change, the funding arrangements may also change. As this is a health funded service it is not dependent on savings or income.

Fast Track Pathway funding may be required if an appropriate clinician (a registered nursing or registered medical practitioner) considers a person is eligible for the immediate provision of NHS Continuing Healthcare because they have:

• A rapidly deteriorating condition and
• The condition may be entering a terminal phase.

NHS Continuing Healthcare means a package of on-going care in your own home or care home that is dependent on your assessed needs and arranged and funded by the NHS.

Referral Process:

With your consent, an appropriate clinician will complete the Fast Track Pathway Tool to establish your eligibility for the immediate provision of NHS Continuing Healthcare.    A member of your healthcare team should explain to you why a referral is being made and ask you about your care preferences i.e. a nursing home setting or care at home.

As part of this process, a clinical assessment will be completed alongside the Fast Track Pathway Tool which will be sent to NHS Cambridgeshire and Peterborough Integrated Care Board  to enable them to arrange a package of care for you as urgently as possible, should you meet the eligibility criteria.

• Not all care homes or care agencies within Cambridgeshire and Peterborough are approved providers.
• The Integrated Care Board will commission care in your preferred setting where this is possible.
• All care homes and care agencies commissioned by the Integrated Care Board are registered with the Care Quality Commission (CQC).
• The Integrated Care Board will endeavour to have care provision in place within 48 hours, where this is reasonably practicable.    Should this not be achieved, you will be kept informed throughout the process.
• Correspondence from the Integrated Care Board will be sent to you or your representative to confirm Fast Track funding is in place.

Will you have to pay for your care?

No - The NHS care package provided should meet your health and associated social care needs as identified in the Fast Track Pathway Tool and clinical assessment.

Please be aware that any benefits you currently received may be affected once you are in receipt of NHS Continuing Healthcare. It is advisable that you discuss this with the Department for Work and Pensions who will be able to provide further information. The helpline telephone number is 0800 731 0469 or further information can be found via the Department for Work and Pensions website.  

Fast Track funding is not awarded indefinitely and is subject to review:

The Complex Cases Team will complete an initial review to ensure your care arrangements are effectively meeting your care needs. 

Your care arrangements may need to be amended to take account of any changes in your health needs.  There may be some instances where it is appropriate to reassess your eligibility for Fast Track funding.  For example, the decision may have been made when you were acutely unwell, and your condition may have since stabilised.  Your entitlement and level of funding will rely on the outcome of the reviews and therefore is subject to change.

If you no longer fulfil the criteria for Fast Track funding and still require an on-going package of care, you may be liable to pay for part or all your care.   Your Local Authority will be able to advise further on this.

What does the re-assessment involve?

If it is appropriate to reassess your eligibility for NHS Continuing Healthcare, a member of the Complex Cases Team will be in touch with you to arrange the assessment.  This is known as the Decision Support Tool meeting.  This usually occurs in the place where your care is being provided and will involve yourself and your family if you choose for them to be involved.  Staff members from the care provider will also be involved, along with other healthcare professionals involved in your care where appropriate.  

Can I opt out of the Fast Track process?

Yes - The Fast Track pathway is designed to offer an immediate provision of care.  If you prefer to keep your current care arrangements in place, i.e. family supporting, then you may opt out of the process.  However, if circumstances change, a new Fast Track referral may be submitted at any time.

If you do not qualify for NHS Continuing Healthcare and are resident in a care home with nursing, you may be eligible for NHS-funded Nursing Care (FNC).  This type of funding is available for individuals who have registered nursing needs and are receiving their care in a care home with nursing.  Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for NHS-funded Nursing Care.

If you are eligible for NHS-funded Nursing Care, it will be paid directly to the care home for care provided, supervised, or planned by, registered nurses that are employed by the care home.   If you are self-funding your placement at the nursing home, these funds should be reflected in your care home fees.

Please talk to the manager of the home to discuss how NHS-funded Nursing Care affects your fees.  If your placement is funded by Social Services, the NHS-funded Nursing Care payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

If NHS continuing healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive 'mixed' packages of care, where some services come from the NHS and some from social services. Where local social services provide your care, they will usually do a financial assessment to decide whether the person should make any financial contribution.

If you feel you may be eligible for either NHS continuing healthcare or NHS funded nursing care and you are registered with a GP within the NHS Cambridgeshire & Peterborough area then please speak to your social worker, GP or other health or social care professional and request completion of an NHS Continuing Healthcare Checklist. 

You can also contact the Complex Cases Team on 0330 057 1022
 
Email us: cpicb.complexcases-chc@nhs.net 

Cambridgeshire Local Authority: 0345 045 5202 or email careinfo@cambridgeshire.gov.uk

Peterborough Local Authority: 01733 747474 (option 5) 

A Personal Health budget is an amount of money that can be spent on meeting someone’s long-term health and wellbeing needs if they have been found eligible for NHS Continuing Healthcare.  Clients will be able to receive their personal health budget payments direct, to enable them to make their own arrangements to purchase the services they need.  Alternatively, they could have their budget managed by another organisation such as a charity or the NHS will commission the service direct if they prefer.

The allocation of this budget is agreed between the individual and the Personal Health Budget Team, based upon a detailed care and support plan which identifies both healthcare and wellbeing outcomes.

We believe everything we do should focus on people’s individual health and wellbeing needs. That’s why wherever possible, we are trying to personalise the things we do.

Many people have said that by using a personal health budget, they have more flexibility, choice and control over how money gets spent on their care and support and makes them feel more involved and more positive. A personal health budget enables you to work with a healthcare professional to prioritise the care needs that are important to you and create a care plan that reflects your own personal health and social goals.

If you are registered to a GP within the NHS Cambridgeshire & and Peterborough area, are eligible for NHS Continuing Healthcare and are receiving your care at home, you can ask for a Personal Health Budget.

Your Continuing Healthcare Nurse is responsible for making sure the help and support you are receiving is meeting your needs.  As your needs change, so might your Personal Health Budget, to make sure it is giving you the most appropriate support.  Eligibility for NHS Continuing Healthcare funding is also reviewed regularly.

In order to ensure that your care support plan provides you with increased flexibility and choice, is safe, and that public funds will be spent appropriately, all care support plans will be regularly reviewed by the Personal Health Budget Team.  It is important that the use of personal health budgets is fair and equitable to all. 

If you want to know more or you have any questions about personal health budgets, you can call and speak to a member of the Personal Health Budget Team on 0330 057 1022.

Some children and young people up to age 18 may have very complex health needs. These may be the result of:

•  congenital conditions
•  disability
•  long term or life limiting conditions
•  serious illness or injury

How to make a referral:

A referral can be made by any professional working with the child or young person, who feels there is an identified health need that cannot be met by existing universal or specialist services alone. 

You can contact the Children’s Continuing Care Team by calling them 0330 057 1022 or by email: cpicb.childrenscontinuingcare@nhs.net to request the referral form.

Eligibility and Reviews:

The Integrated Care Board follows national guidance issued by the Department of Health (now the Department of Health and Social Care) in 2016.

Some children or young people up to their 18th birthday may have very complex health needs that require a package of continuing care. 

The child or young persons continuing care needs will be reviewed three months after the package of care has commenced and then annually thereafter, or when a child or young person’s health or function is known to have significantly changed.

The families of a child or young person eligible for continuing care have a ‘right to have’ a personal health budget, covering the part of their care package which would be provided by the NHS.  This will be discussed further at the assessment meeting.

Transition:

Where a child or young person is eligible for continuing care, a NHS Continuing Healthcare checklist will be submitted by the Children’s Continuing Care Team to the Adult Continuing Healthcare Team for verification when the child is aged 16-17.  This will be held by the Complex Cases Team until the child reaches 17 years of age, when an adult NHS Continuing Healthcare assessment will be undertaken to establish eligibility post 18.

The Complex Cases Team will help and guide you through our established appeals process.  It is not necessary to engage legal counsel to pursue an appeal.
If you would like to make an appeal, or speak to someone about an ongoing appeal please contact:
Complex Cases Team
NHS Cambridgeshire and Peterborough Integrated Care Board
Gemini House
Cambridgeshire Business Park
Angel Drove
Ely
Cambridgeshire
CB7 4EA

Tel: 0330 057 1022
Email: cpicb.complexcases-chc@nhs.net

If for any reason you are dissatisfied the assessment process and wish to raise a complaint about how this was undertaken, please contact:
The Patient Experience Team
NHS Cambridgeshire and Peterborough Integrated Care Board
Gemini House
Cambridgeshire Business Park
Angel Drove
Ely
Cambridgeshire
CB7 4EA

Tel: 0330 057 1025
Email: cpicb.PET@nhs.net

Guidance setting out the principles and processes for addressing NHS Continuing Healthcare previously unassessed period of care can be found here: https://www.gov.uk/government/publications/continuing-healthcare-previously-unassessed-periods-of-care

Section 117 of the Mental Health Act 1983 outlines the legal duty to provide “after-care” for individuals who have been detained in hospital under certain sections of the Mental Health Act.   This after-care, often referred to as “Section 117 after-care” is provided by the NHS and social services once these individuals are discharged from hospital.

The NHS Section 117 Team can be contacted on 0330 057 1022 or by email: cpicb.complexcases-chc@nhs.net 

Contact us

Call us: 0330 057 1022 
Email us: capccg.complexcases-chc@nhs.net 
Write to us: Complex Cases Team, 
Gemini House, 
Cambridgeshire Business Park, 
Angel Drove, 
Ely CB7 4EA 

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care – July 2022 (Revised) – visit GOV.UK (www.gov.uk) 

National Framework for Children and Young People’s Continuing Care – 2016 - visit GOV.UK (www.gov.uk) 

Public information leaflets -NHS Continuing Healthcare and NHS-funded Nursing Care – visit - GOV.UK ( www.gov.uk) 

National Guidance on Personal Health Budgets – visit GOV.UK (www.gov.uk) 

The following trusted organisations also provide a wealth of useful information on NHS Continuing Healthcare:

Beacon: 
If you require free information and advice on NHS Continuing Healthcare, you can contact Beacon on 0345 548 0300, or via their website – www.beaconcchc.co.uk which has free resources and information.  Beacon will provide 90 minutes of free impartial advice.

Healthwatch Cambridgeshire and Healthwatch Peterborough:
Are the independent champions for people who use health and social care services in the Cambridgeshire and Peterborough area.  Their role is to ensure that those who run local health and care services understand and act on what really matters to people.  Healthwatch listen to what people like about services and what could be improved.  They share what people tell them with those with the power to make change happen.  Healthwatch encourage services to involve people in decisions that affect them.  They also help people find the information they need about services in their area.  For more information visit www.healthwatchcambridgeshire.co.uk

Age UK: 
Provides support, advice and hope for older people.
For more information visit www.ageuk.org.uk or call 0800 678 1602
Age UK Cambridgeshire & Peterborough – Tel: 0300 666 9860

Alzheimer’s Society:
Is a leading dementia charity in the UK, providing help, support and hope for people affected by dementia.  For more information visit www.alzheimers.org.uk or call 0333 150 3456.