Some people with long-term complex health needs qualify for care and support funded solely by the NHS. This is known as NHS Continuing Healthcare (CHC).
NHS Continuing Healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
This process is set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised July 2022).
If you are a healthcare professional in Sussex, take a look at the information regarding Continuing Healthcare for patients registered with a GP in Sussex.
Am I eligible for NHS Continuing Healthcare?
NHS Continuing Healthcare is for adults. Children and Young People may receive a continuing care package. For more information, please visit our Children and Young People’s Continuing Care.
To be eligible for NHS Continuing Healthcare, you must be assessed by a team of healthcare professionals called a multidisciplinary team (MDT). 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. NHS Continuing Healthcare is subject to regular review and if your needs change then your eligibility for NHS Continuing Healthcare may change.
Before a Checklist referral is completed the process should be discussed with you and you will be asked for your consent.
Depending on the outcome of the screening Checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS Continuing Healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.
Being referred for a full assessment doesn’t necessarily mean you’ll be eligible for NHS Continuing Healthcare. The purpose of the screening Checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
The professional(s) completing the Checklist should record in writing the reasons for their decision, and sign and date it. A copy of the completed Checklist is available to you at your request.
It is possible for the relevant health professionals to determine that a screening checklist would not be appropriate at any given time. This could be a professional decision based on the health and care information available or if your needs have not changed from a previous NHS Continuing Healthcare assessment.
Blank copy of the NHS Continuing Healthcare Checklist
A decision about eligibility for a full assessment for NHS Continuing Healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
If you aren’t eligible for NHS Continuing Healthcare, you can be referred to your local authority who can discuss with you whether you may be eligible for support from them.
If you are not eligible for NHS Continuing Healthcare, but you are assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you may be eligible for NHS-funded Nursing Care (FNC).
This means that the NHS will pay a contribution towards the cost of your registered nursing care which is paid directly to the nursing home (please check payment arrangements with your nursing home). NHS FNC is available irrespective of who is funding the rest of the nursing home fees.
If following screening for NHS Continuing Healthcare, using a checklist, you disagree with a decision not to proceed to full assessment of eligibility for NHS CHC, you can ask the AACC Team to reconsider the decision. We refer to this as a checklist challenge.
Your request is logged, and both the checklist and any supporting information is reviewed to ensure the correct decision has been made. This process is completed as soon as possible and usually within three months.
A final decision letter is sent on completion of the process and if applicable provides details of the ICB complaints process if you wish to request further consideration.
NHS Continuing Healthcare Fast Track process
If your health is rapidly deteriorating and you may be entering a terminal phase, you should be considered for the NHS Continuing Healthcare Fast Track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
Blank copy of the NHS Continuing Healthcare Fast Track Tool
If you are a healthcare professional and wish to submit a referral, please use our referral portal.
Assessments for Continuing Healthcare
You should be fully involved in the assessment process and kept informed and have your views about your needs and support considered. Carers and family members should also be consulted where appropriate.
Full assessments for NHS Continuing Healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of two professionals from different healthcare professions. The MDT should usually include professionals already involved in your care.
The NHS Continuing Healthcare assessment will be arranged by the All-Age Continuing Care (AACC) team and will include you and / or your representative.
The team’s assessment will consider your needs under the following headings (or domains):
- breathing
- nutrition (food and drink)
- continence
- skin (including wounds and ulcers)
- mobility
- communication
- psychological and emotional needs
- cognition (understanding)
- behaviour
- drug therapies and medication
- altered states of consciousness
- other significant care needs
The levels of need considered in these domains range between priority, severe, high, moderate, low or no needs.
In all cases, the overall need, and interactions between needs, will be considered, together with evidence from risk assessments, in deciding whether NHS Continuing Healthcare should be provided.
The assessment should consider your views and the views of any carers you have. A copy of the decision documents are available on request, which include clear reasons for the decision.
Blank copy of the NHS Continuing Healthcare Decision Support Tool (DST)
Applying for funding once eligible
If you’re eligible for NHS Continuing Healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable, including support in your own home and the option of a Personal Health Budget (PHB). For more information, please visit our PHB page.
If it’s agreed that a care home is the best option for you, there could be more than one local care home that’s suitable to meet your needs.
All organisations will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options. Please see the NHS Continuing Healthcare Choice and Equity policy.
If you’re eligible for NHS Continuing Healthcare, your needs and support package will normally be reviewed within three months and thereafter at least annually.
This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS Continuing Healthcare.
Appeals - requesting a Continuing Healthcare Local Resolution
If you disagree with the eligibility decision made by the AACC Team (after a full assessment of eligibility including the completion of the Decision Support Tool – DST), or if you have concerns about the procedure followed by the AACC Team to reach its eligibility decision, you can ask the AACC Team to reconsider your case through its Local Resolution process.
To request Local Resolution please write to the All-Age Continuing Care Team and send to
Email:
sxicb.aacc-appealsandirp@nhs.net
Post:
NHS Sussex All-Age Continuing Care
Sackville House
Brooks Close
Lewes
East Sussex
BN7 2FZ
Please ensure you log an appeal within six months of the date of the outcome of the DST decision.
On receipt of your request the appeal will be logged and a CHC Clinical Lead will be allocated to reconsider your case. You will receive an acknowledgement letter and may be asked to provide further information. We aim to review all requests within three months of receipt, but in some cases it may take longer.
Appeal stages
There are two stages of a CHC appeal:
- Stage 1 – informal resolution (telephone call)
- Stage 2 – formal resolution (Local Resolution Meeting)
Stage 1 – informal resolution
One of the AACC Clinical Team Leaders will call you to discuss your concerns and ensure they understand how you would like them to focus their review. This call is also an opportunity for you to ask questions and learn more about the process and timeframes.
The case (including all assessment documents and evidence) is reviewed by the Clinical Team Leader and further actions could be identified, or the case resolved at this stage.
Stage 2 – formal resolution
If a satisfactory solution cannot be found through informal resolution, then a Local Resolution Meeting (LRM) will be offered to provide all parties with the opportunity to work together in reaching a consensus.
It is NHS England’s expectation that all Local Resolution processes are completed and a Local Resolution Meeting (LRM) with appellants’ full participation takes place before a request for an Independent Review (IR) by NHS England can be considered. To avoid a deferral of your Appeal back to NHS Sussex AACC for completion of the LRM, we would recommend that you attend this meeting.
You will have an opportunity to supply any evidence or information in advance of an LRM and finally a decision would be communicated in writing.
It is important the LRM is used as a forum where all parties can respectfully engage in discussions with the assessment and outcome.
We aim to complete the Local Resolution process within three months of receiving your completed appeals comments form.
Independent review
Where it has not been possible to resolve the matter through the Local Resolution process, you can apply to NHSE for an Independent Review of the decision.
Contact details for NHSE are provided at completion of your Local Resolution within the final AACC Team decision letter.
Please be aware NHSE can ask the ICB to attempt further Local Resolution prior to the Independent Review.
For further information on Appeals, please contact the AACC Team at sxicb.aacc-appealsandirp@nhs.net or call on 0300 140 0069. This service is available Monday to Friday 0900-1700.
Deprivation of Liberty (DoL)
Your liberty can only be taken away from you in very specific situations. The Mental Capacity Act calls this a Deprivation of Liberty (DoL).
Being deprived of liberty means that you’re not free to go anywhere without permission or close supervision. It also means that you’re continuously supervised. This is against the law unless it’s done under the rules of the Mental Capacity Act.
A Deprivation of Liberty should only be used if it’s the least restrictive way of keeping you safe. Or making sure that you have the right medical treatment.
The Mental Capacity Act
The Mental Capacity Act and Human Rights Act tells us that no one over the age of 16 can be deprived of their liberty, except in certain situations and only when very specific procedures are in place (DoL authorisation).
This is to protect people who do not have the ability (mental capacity) to make decisions regarding their care, treatment, or residence; preventing them from being deprived of their liberty, without appropriate review and approval of actions leading to a deprivation.
Deprivation of Liberty and Continuing Healthcare
Changes in the law over the past few years have meant that NHS Surrey and Sussex is required to explore and seek DoL authorisations from the Court of Protection, for any individual who is funded by the AACC team, i.e. anyone whom the AACC team is aware of living in their own home or supported living and who may have a care in place that the ICB is involved with commissioning.
The Court needs to approve the care and declare it to be in an individual’s best interests.
This means that an individual who may not have mental capacity to decide on their care, treatment, and place of residence and who is funded by AACC, will be referred for a DoL authorisation via an application to the Court of Protection, to be completed by a nurse assessor from AACC’s DoL team.
During this process their care and support plan will be looked at to explore any Deprivations of Liberty that might be occurring.
Key rights for an individual with a DoL order
- The arrangements are in the individual’s best interests.
- The individual is entitled to express their views and feelings in relation to the proposed arrangement and to have someone appointed to support and represent them.
- The individual is given a legal right of appeal over the arrangements. The arrangements are reviewed and continue for no longer than necessary.
Please contact the AACC DoLS Team if you have any questions or would like any additional information.
- Email: sxicb.dols@nhs.net
- Telephone: 0300 140 0069
- The Team are available Monday – Friday from 0900 – 1700