What is CHC Funding?
There is a great deal of confusion and controversy surrounding Continued Healthcare funding also known as CHC funding. Some of this confusion we will try and clear up here; but first of all we will explain specifically CHC funding actually is.
NHS Continued Health Care is a means by which the NHS provides a care package that funds the full cost of a person’s assessed health and social care needs. If they are living in a residential or nursing home it will also cover the cost of the associated accommodation. However, if they are living at home it will not cover accommodation costs.
Recipients are people that have successfully been assessed as having a primary health need. Additionally, this need must be assessed as complex, substantial and ongoing. This wording ‘primary health need’ is very important because if your primary need is social care with some additional health needs you would not qualify. However, if your primary need is assessed as health with additional social care needs you will qualify. For the absence of confusion I will reiterate the point if you are assessed as qualifying for CHC support it will cover all of your needs including Health and Social needs.
Put simply, an individual has a primary health need if, having taken into account all their health and social care needs, it can be said that the main aspects or majority of the care they require is focused on addressing or preventing health needs (National framework for NHS continuing healthcare and NHS funded nursing).
Where can I receive CHC funding?
The location of the care that is delivered is not a factor in assessing needs, which means funding is not restricted to a particular setting. It can therefore be received in a nursing home, a residential care home, a hospice or even in your own home. The assessed health need is the key factor not the location.
Even though location is not an important element of CHC funding, you should bear in mind that in most cases in order to demonstrate a primary health need the type of care an individual will need may not be deliverable outside of a registered nursing home. It is not that the NHS is refusing to pay the cost of a residential care home, it is just a fact that in many cases they do not have staff qualified to deliver the required care and support of an individual that qualifies.
Having said that, there are many examples of residential care homes receiving CHC funding for residents and providing exemplary care to the individual that fully meets their needs. However, this is probably the exception rather than the rule. In all cases the Home Manager of any home will be able to fully explain whether they can support you or your loved one.
How much is CHC funding?
Unlike many examples of Social Care Funding, the NHS does not maintain a one size fits all policy for setting CHC funding rates. Once a decision has been made that an individual qualifies for it, a further assessment is made to identify specifically what care is needed. They will endeavour to find the most cost effective means of delivering that care, but, they will ensure that all the various elements are identified, commissioned and delivered.
Each qualifying individual gets a personalised and individual care package which may include, if appropriate, basic nursing care such as wound care, administration of medication, management of Peg Feed* (see PEG definition at the bottom of this Blog) and/or a range of other support. It also includes basic social care needs such as washing, dressing or support with eating and in some cases it will include specialist therapies such as speech and language therapy and physiotherapy.
The funding criteria depends on the individual and what their care needs are deemed to be at the time of assessment, or indeed what they are anticipated to be in the near future.
Do I have too much money to qualify?
The NHS Continuing Healthcare Funding is non-means tested, this means that nobody looks into your financial situation prior to a decision on whether to award or not. It does not matter how much or how little money you have as this does not form part of the decision process.
You can own your own home, have a thriving highly profitable business or you could be retired living only on a state pension and it would have no bearing. The Assessor would base their decision solely on the criteria as to whether you have a primary health need.
Will I qualify for CHC funding?
There are numerous articles, blogs and news stories that talk about post code lotteries and inconsistencies in the assessment process and this article is not going to add to those. What it will do is provide an overall explanation into process is and what to expect. Further articles specifically deal with the individual elements of the CHC assessment process.
The NHS states the following on their website:
To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:
- What help you need
- How complex your needs are
- How intense your needs can be
- How unpredictable they are, including any risks to your health if the right care isn’t provided at the right time
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
This is very top level and I will explain in a bit more detail the steps they will go through.
Initial Assessment for Continuing Healthcare
The initial checklist assessment is either completed in hospital as your discharge date approaches or once you return home or to a care home. The NHS advice to professionals is that they should try and wait until the patient is in their permanent setting so that the assessment team can see exactly what they need to adapt to life outside of a hospital. This is so that they know what the on-going needs are likely to be. There would be no point assessing you the day you are admitted to hospital because things will change and you will probably improve during your stay.
The assessment is either completed at your request, that of a loved one or will be recommended by one of the healthcare professionals looking after you. It is a standard form that should be filled in with your full consent and participation by a nurse, doctor, social worker or other healthcare professional. See a copy of the initial assessment form, which is also called NHS Continuing Healthcare Checklist.
The purpose of this initial checklist is to screen out those people that definitely won’t qualify for CHC funding so that the CCG specialist teams do not waste time and money completing unnecessary and pointless assessments. The NHS do not like to describe and assessment as a pass or fail; although many individuals and families will see it this way. Officially there are two outcomes:
- You don’t meet the criteria for a full assessment of NHS continuing healthcare
- You do meet the criteria for a full assessment of NHS continuing healthcare
Therefore, if you “pass” this part of the process it does not mean you are eligible for CHC funding it just means you will be referred for a full assessment of eligibility. This has to be completed within 28 days, although on many occasions due to the well-known pressures on the NHS this target is not always achieved.
The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.
Read a separate article that explains this process in much more detail and helps prepare you for this process.
Full Assessment for Continuing Healthcare
The full NHS continuing healthcare assessments are completed by at least two professionals from different healthcare disciplines (for example you may get a nurse and a social worker). This is known as a multidisciplinary team (MDT). The MDT will normally include both health and social care professionals that will not all be directly involved in your care.
They will complete another checklist which has a different format and is much more detailed than the initial assessment. Read a copy of the assessment form, also called NHS Continuing Healthcare Decision Support Tool.
This is the final stage of the assessment if you qualify following this assessment your care will be arranged and paid for by the NHS.
Our next blog on the CHC Funding will explain this process in much more detail and help prepare you for this process.
Once I qualify, is funding guaranteed for life?
The short answer to that question is no.
The NHS reserves the right to re-assess qualifying people at regular intervals to ensure they still qualify for the funding. Normally this is done three months after initially qualifying and annually thereafter, but this is only a guideline. If they become aware of any significant changes outside of these timescales they may do a re-assessment sooner. Similarly, if they are understaffed or are experiencing very high workloads they may take longer to re-assess.
It states clearly on the NHS website:
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
Put simply even if your condition continues if its impact on you and your required care needs changes so too may your eligibility for CHC funding.
Read our blog on the Continuing Healthcare (CHC) Funding process
*Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient’s stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation).
**This author of this article is Geraint Williams, he is one of the Directors of Greensleeves Care and a highly experienced healthcare professional. He has worked across a range of different healthcare companies that includes charities and commercial companies and he has filled a number of different roles including Registered Manager of several Residential and Nursing Homes. Geraint has supported a number of different people though the CHC assessment process but he also helped his own family achieve CHC funding so he is well versed in its complexities and challenges.