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Continuing Healthcare & Funded Nursing Care

The Continuing Healthcare team is responsible for:

  • The implementation of the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care process for eligibility and appeals;
  • The assessment of individuals in nursing placement who may meet eligibility criteria for NHS Continuing Healthcare and NHS Funded Nursing Care and ongoing reviews;
  • Reviewing eligibility for NHS Continuing Healthcare for retrospective cases;
  • Care management of CHC cases within nursing homes including safeguarding.

 

Background

NHS Continuing Healthcare (CHC) was established in 1995. In 2001, NHS Funded Nursing Care (FNC) was also introduced for people paying their own fees. In 2003 NHS FNC extended to Social Services funded clients.

In October 2007 the Government introduced a National Framework to ensure consistency of approach taken by local NHS bodies by providing a common framework for determining eligibility for NHS Continuing Healthcare and NHS Funded Nursing Care as well as setting out a standard process for assessment of eligibility.

The National Framework was reviewed and revised in July 2009 and implemented in October 2009. It has been revised again to reflect changes within the NHS from April 2013 and re-published in November 2012.

 

NHS Continuing Care (CHC)

NHS Continuing Healthcare is a term used to describe a primary health need. This is where the primary need for care must relate to a person's health. Eligibility for NHS Continuing Healthcare is not dependent on diagnosis or setting of care.

NHS Continuing Healthcare is the name given to a care package that is arranged and funded solely by the NHS for individuals who have ongoing healthcare needs. NHS Continuing Healthcare can be provided in a wide range of settings outside of hospital including a care home and in a person's own home.

 

NHS Funded Nursing Care (FNC)

NHS funded nursing care is care provided by a registered nurse, for people who live in a registered nursing home, paid for by the NHS, through a single payment direct to the care home.

 

Process for assessing NHS Continuing Healthcare and Funded Nursing Care


NHS Checklist

The first step is to have an assessment with a health or social care professional using a screening tool called the Checklist Tool. The Checklist Tool is used to decide whether you should be referred for a full assessment. Individuals should have a NHS Continuing Healthcare Checklist applied on discharge from services, at review or other trigger.

If the checklist indicates full referral for NHS Continuing Healthcare is necessary a full up-to-date assessment of the person's needs will be arranged.

If the checklist indicates full referral for NHS Continuing Healthcare is NOT necessary then the Local Authority will be responsible for arranging a community care assessment. 
 

Fast Track Assessment

Some people who need an urgent decision, such as those who are terminally ill, should be fast-tracked to receive NHS continuing healthcare immediately.
 

Full Assessment

If the Checklist Tool indicates eligibility for NHS Continuing Healthcare, a full assessment will be carried out by a multi-disciplinary team (MDT). This is a team of people who have different roles related to the individuals care. An MDT can consist of a minimum of two professionals with different roles, this may most appropriately be Health and Social Care Professionals. Consent of the patient is obtained and if unable to give consent, then a best interest decision will be undertaken to determine the appropriate person to give consent. The multi-disciplinary team gathers information from the individuals, their family, care providers and other professionals as necessary, completes the assessment of need and the Decision Support Tool and agrees a recommendation. This tool is used in association with an assessment to decide whether an individual's main or primary care needs relate to health by looking at what help is needed in relation to several types of care needs e.g. mobility, skin, behaviour and how complex, intense and unpredictable these needs are and to identify risks is care was not provided. A decision is then made about the level of need. The overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, to decide whether NHS Continuing Healthcare should be provided.

An individual will be assessed for NHS Continuing Healthcare in the first instance before a decision is made about whether they are eligible for NHS Funded Nursing Care. The Individual/Representative should be fully involved in the assessment and decision-making process.
 

Decision Making

NHS Northern, Eastern and Western Devon CCG have the legal and commissioning responsibility for NHS Continuing Healthcare, and Plymouth Community Healthcare will be undertaking these processes on behalf of the CCG.

Information regarding the Clinical Commissioning Group is available on the following website: www.newdevonccg.nhs.uk/

The multi-disciplinary team recommendation is submitted for ratification at the Plymouth Continuing Care Panel.

The completed Decision Support Tool will result in one of the following outcomes:

a) A 'primary health need' is established and the recommendation is for NHS Continuing Healthcare to commission the care costs.

b) A 'primary health need' is not established and the MDT recommendation supports this decision and then the Local Authority will be responsible for arranging an assessment to determine any contribution to ongoing care costs.
 

Appeals

The Department of Health guidance is that individuals, their families or representatives have 6 months to appeal a decision of ineligibility if they are able to demonstrate their concern is related to the:

  • procedure followed by Plymouth Community Healthcare in making the decision; or
  • the application of the criterion in relation to such a decision

 

Deadline for assessment of eligibility for NHS Continuing Healthcare funding for cases during the period 1 April 2004 to 31 March 2012

On 15 March 2012, the Department of Health announced the introduction of deadlines for individuals to request an assessment of eligibility for NHS Continuing Healthcare (NHS CHC) funding, for previously un-assessed cases during the period 1 April 2004 - 31 March 2012.

The deadline for the time period from 1 April 2004 - 31 March 2011 was 30 September 2012, and for 1 April 2011 - 31 March 2012 was 31 March 2013 and therefore is now closed.

Some cases may be accepted after the date outlined above if there are exceptional circumstances for doing so.

The deadline does not apply to people who wish to request a current assessment for NHS Continuing Healthcare.

Cut-off dates - Frequently Asked Questions

 

Reviews

Eligibility for NHS Continuing Healthcare will be reviewed after 3 months following initial decision and annually thereafter, unless needs change and more regular reviews are required.

If the individual needs change, the package of care may need to be altered or the responsibility for funding the care may change. Neither the NHS nor the local authority should withdraw from an existing care or funding arrangement without a joint reassessment of that person's needs, and without first consulting with one another and with the person or their representative about any proposed changes and ensuring that alternative funding or services are in place.

 

Referrals

The Continuing Healthcare Team and Locality Teams within Plymouth Community Healthcare undertake the Continuing Healthcare process on behalf of NHS Northern, Eastern & Western Devon Clinical Commissioning Group.

Any Health or Social Care professional, individual, family member or carer can request an assessment via the GP Surgery, Community Nurse or by contacting the Continuing Care Team (details at the top of this page).

 

Contact

Service Lead: Phil Clowes

Continuing Healthcare Team
Ground Floor
Beauchamp Centre
Mount Gould Hospital
Plymouth

Tel: 01752 434231
Fax: 01752 315307

Email: PCHCIC.CHCFNCPlymouth@nhs.net

Opening hours: 8:30 am - 4:30 pm
Monday to Friday (excluding Bank Holidays)