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Continuing Healthcare

NHS Continuing Healthcare

In Cheshire and Wirral the NHS Continuing Healthcare Service is hosted by NHS South Cheshire Clinical Commissioning Group (CCG) on behalf of:

  • NHS Eastern Cheshire CCG
  • NHS Vale Royal CCG
  • NHS West Cheshire CCG
  • NHS Wirral CCG

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is the name given to a package of care that is arranged and funded by the NHS for people outside of hospital who have ongoing healthcare needs. NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or a care home.

Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness and who has been found to have a ‘primary healthcare need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (October 2018 revised).

The service will accept referrals for individuals who have a learning disability and/or a mental health diagnosis when a NHS Continuing Healthcare Checklist tool has been applied and the individual has positively screened in for full assessment as per the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (revised 2018).  

In addition referrals will be accepted for individuals under Section 117 of the Mental Health Act (1983) where it is required that the CCG and the local authority, in cooperation with voluntary agencies, provide or arrange for the provision of aftercare to patients detained in hospital for treatment under section 3, 37, 45A, 47 or 48 of the Act who then cease to be detained. This includes patients granted leave of absence under Section 17 and patients going on community treatment orders. 

Individuals will have substantial health needs which are permanent and are associated with multiple and poorly-controlled health conditions and co-morbidities. Individuals are high risk, high demand service users who will require ongoing complex care case management.

This short film published by NHS England gives an introduction to NHS Continuing Healthcare.

Who is eligible for NHS Continuing Healthcare?

 

Anyone over the age of 18 who has a complex medical condition and substantial and ongoing care needs may be eligible for NHS Continuing Healthcare.

 

Eligibility for NHS Continuing Healthcare does not depend on:

  • a specific health condition, illness or diagnosis
  • who provides the care, or
  • where the care is provided

 

Not everyone with a disability or long-term condition will be eligible.

Assessment and Decision

 

The assessment process for NHS Continuing Healthcare is person-centred; this means putting you, your views about your needs and the care and support you require at the centre of the process.

 

For most individuals there is an initial Checklist assessment. This is the screening tool used by health and social care staff to identify those people who may be eligible to undertake a full assessment for NHS Continuing Healthcare. The Checklist does not indicate whether the individual is eligible for NHS Continuing Healthcare, only whether they require full assessment of eligibility for NHS Continuing Healthcare.

 

If the Checklist has been completed and indicates that there is a need to carry out a full assessment of eligibility for NHS Continuing Healthcare the Clinical Commissioning Group will arrange for a multidisciplinary team to carry out an assessment of your needs. 

 

A multidisciplinary team is made up of two or more health or social care professionals who may already be involved in your care.

 

The multidisciplinary team will share the information they hold about you or your relative's care needs and jointly complete a Decision Support Tool. 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. 

 

The multidisciplinary team will also take into account your views and together with all of this information a recommendation is then put forward to your local Clinical Commissioning Group who ultimately decides whether or not you or your relative is eligible for funding.

 

If your needs change then your eligibility for NHS Continuing Healthcare may also change. 

 

Fast Track Tool

 

There are times when a person is in need of an urgent package of care due to a rapidly deteriorating condition which may be entering a terminal phase; in these situations an appropriate clinician will complete the Fast Track Tool. Your local NHS Continuing Healthcare Team will then process this and arrange for a package of care as quickly as possible.

Reviews

A review of your care needs will be undertaken at regular intervals.

If following any review it is decided that you no longer meet the eligibility criteria for NHS Continuing Healthcare, social services may carry out an assessment to determine if you are eligible for support from them.

 

What if I am not eligible for NHS Continuing Healthcare?

 

If you are not eligible for NHS Continuing Healthcare, the local authority will discuss with you whether you may be eligible for support from them. 

 

If you are not eligible for NHS Continuing Healthcare but are assessed as having healthcare or nursing needs, you still may receive some care from the NHS.

 

If you live in your own home, this could be provided as part of a joint package of care, where some services come from the NHS and some from social services.

 

If you live in a care home with nursing you may be eligible for NHS Funded Nursing Care (FNC).This type of funding is available for people that 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 FNC.

 

How can I apply for NHS Continuing Healthcare?

 

If you think this affects you or someone you care for and you are already receiving care services from health or social care e.g. GP, Community Nurse or Social Worker you may wish to discuss this with them in the first instance.  

 

If you are in hospital and have been assessed as requiring care on discharge then the hospital discharge team will discuss this with you.

 

Continuing Care for Children and Young People

 

Some children and young people may have very complex health needs requiring additional health support that is not routinely available. This additional health support is called continuing care. The Clinical Commissioning Group is responsible for assessing children and young people to see if they are eligible for continuing care.

 

A continuing care package of support may be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone (GP practices, hospitals or in the community). The Cheshire and Wirral children’s complex care service is guided by the National Framework for Children and Young People’s Continuing Care (Department of Health 2016) and will work alongside social care and education to provide the most appropriate support at home, in school and in the community.

 

Who is Eligible?

 

Any child or young person up to their 18th birthday who has a complex health need or disability may be eligible.

 

When a child reaches 18, adult NHS Continuing Healthcare arrangements may apply however there are significant differences between Children and Young People’s Continuing Care and NHS Continuing Healthcare for adults. Although a child or young person may be in receipt of Children’s Continuing Care they may not be eligible for NHS Continuing Healthcare as an adult.

 

All children and young people in receipt of children’s continuing care will be assessed aged 17 to see if they are likely to be eligible for NHS Continuing Healthcare.

 

How can you access Continuing Care for Children and Young People?

 

A referral can be made by any healthcare, social care professional or carer who feels a continuing care package may be required. A referral form should be submitted to complexcare.admin@nhs.net along with signed consent from the child, young person or person with parental responsibility.

 

Further Information

 

Personal Health Budgets

As of April 2014 the Government confirmed that adults who are eligible for NHS Continuing Healthcare and children and young people eligible for Continuing Care have the right to request a Personal Health Budget.

A Personal Health Budget can be used to meet your health needs including

  • Agency care staff
  • Respite care
  • Equipment 

A Personal Health Budget cannot be used for:

  • Emergency care, or for care that is normally provided from a GP
  • Gambling
  • Debt repayment
  • Alcohol
  • Tobacco
  • Anything unlawful

NHS England has produced a short film describing Personal Health Budgets and how these can be provided as part of NHS Continuing Healthcare.

 

 

 

 

 

For more information:

Read our leaflet An introduction to Personal Health Budgets, Support Services and Personalised Care Planning or visit www.nhs.uk  

NHS Guidance on Continuing Healthcare Redress

NHS England has published guidance on issues CCGs should consider when determining claims from individuals for retrospective funding of Continuing Healthcare needs. For more information on this please visit https://www.england.nhs.uk/wp-content/uploads/2015/04/nhs-cont-hlthcr-rdress-guid-fin.pdf 

 

Local Policies relating to NHS Continuing Healthcare:

 

  • Continuing Healthcare Commissioning Policy
  • Personal Health Budget Policy

 

Useful Links

 

The following links provide further information on NHS Continuing Healthcare:

 

 

For further information on how to notify us of a request for assessment of eligibility, please contact the NHS Funded and Continuing Healthcare Team, telephone 01625 663 808, e-mail ecccg.chc@nhs.net or write to:

Administration, NHS Funded and Continuing Healthcare Team

1st Floor, West Wing
New Alderley House
Victoria Road
Macclesfield
Cheshire
SK10 3BL

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