What is NHS Continuing Healthcare?

Ever wondered if there’s help available for long-term health needs in England? Well, NHS Continuing Healthcare (NHS CHC) might be the answer you’re looking for. So, what is NHS continuing healthcare?

Here’s the brief: NHS Continuing Healthcare is a package of care funded by the National Health Service (NHS) for people with complex and ongoing health needs, providing support at home, in a care home, or elsewhere.

It’s for those whose healthcare needs are significant and require more intense care beyond what social services can provide.

Let’s get into the topic further.

What is NHS Continuing Healthcare?

Imagine a care package that covers everything – medical care, support with daily tasks, and even care home stays if needed. That’s NHS CHC! It’s there for people whose health needs are so intense and ongoing that the NHS takes full responsibility for their care.

So, NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over, organised and paid for by the NHS. To get this funding, people need to be evaluated by integrated commissioning boards (ICBs) using a specific process to decide if they have a “primary health need.”

This process is outlined in the National Framework, which the Department of Health and Social Care published. It’s supported by regulations from the NHS Commissioning Board and Clinical Commissioning Groups, as amended in 2012.

Who Qualifies for NHS Continuing Healthcare?

Qualifying for NHS CHC involves a thorough assessment process. The key criteria include:

Age Criteria

NHS Continuing Healthcare is mainly for adults aged 18 and above. But, if kids or teenagers have needs from disability, accident, or illness that regular or special services can’t fully handle, they might get a special “continuing care package.”

Complexity of Healthcare Needs

Individuals must have significant and ongoing healthcare needs. This could include intensive nursing care, therapy, or specialised support due to complex medical conditions.

Assessment Process

A team of healthcare pros from various fields decides eligibility for NHS CHC. They assess:

• The amount of help needed.
• The complexity and intensity of the needs.
• The unpredictability of the needs and the health risks if proper care isn’t given.

Needs-Based Eligibility

Eligibility depends on the assessed care needs, not on a specific diagnosis. So, people with various health conditions might qualify if their needs fit the criteria. The assessment considers both physical and mental health needs. Conditions such as dementia, neurological disorders, or severe disabilities may qualify.

Involvement in Assessment

People should be actively involved in the assessment process, and their views and needs should be considered. Consulting with carers and family members is important, too.

Timely Decision-Making

A decision on whether someone is eligible for a full assessment of NHS Continuing Healthcare should usually be made within 28 days of the initial assessment or request.

Referral to Local Council

If someone isn’t eligible for NHS Continuing Healthcare, they might be referred to their local council to see if they qualify for other support.

Partial Support

Even if someone isn’t eligible for full NHS Continuing Healthcare, they might still get partial support. This could be a “joint package” of care, where the NHS helps with some of the needed support.

What is the NHS Continuing Healthcare Checklist?

Here’s a sample CHC checklist for NHS:

Breathing: Check if the person needs help breathing, like using oxygen or a ventilator.
[✓] Needs help with breathing.

Nutrition (Food and Drink): See if the person can eat and drink on their own or if they need help or special nutrition.
[✓] Needs help with feeding.

Continence: Find out if the person can control their bladder and bowels or if they need help or special care.
[✓] Needs special continence care.

Skin (Including Wounds and Ulcers): Look at the person’s skin to see if they have any wounds or ulcers needing special care.
[✓] Has wounds needing special care.

Mobility: Check if the person can move around on their own or if they need help or special equipment.
[✓] Needs help with mobility.

Communication: See if the person can talk effectively or if they need help, like speech therapy or special aids.
[✓] Needs speech therapy.

Psychological and Emotional Needs: Check the person’s feelings and emotional well-being to see if they need counselling or therapy.
[✓] Needs counselling for emotional support.

Cognition (Understanding): Look at the person’s memory and understanding to see if they need help.
[✓] Has trouble understanding and needs support.

Behaviour: Check if the person shows challenging behaviours or needs help managing them.
[✓] Needs help managing behaviour.

Drug Therapies and Medicine: Look at the person’s medications to see if they need complex management or monitoring.
[✓] Needs complex medication management.

Altered States of Consciousness: See if the person sometimes becomes unconscious or confused and needs special care.
[✓] Experiences changes in consciousness.

Other Significant Care Needs: Consider any other important care needs not covered before.
[✓] Needs help with wound care.

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Requirements

Each need is rated as “priority”, “severe”, “high”, “moderate”, “low”, or “no needs”.

To qualify for NHS Continuing Healthcare, you typically need at least 1 ‘priority need’ or ‘severe need’ in at least 2 areas. You might also qualify if you have severe needs in 1 area along with other needs or if you have several high or moderate needs based on their nature, intensity, complexity, or unpredictability.

Overall, the assessment considers all your needs and how they interact with each other. It also looks at evidence from risk assessments.

Your opinions and those of your caregivers are taken into account during the assessment. You should receive a copy of the decision documents along with clear reasons for the decision.

You can get a blank copy of the NHS Continuing Healthcare decision support tool from the GOV.UK website.

Fast-track assessment for NHS Continuing Healthcare

If your health is getting worse rapidly and you’re nearing the end of your life, you should be considered for the fast-track pathway for NHS Continuing Healthcare. This means that a suitable elderly care and support plan should be arranged quickly – usually within 48 hours.

FAQs

1. Is NHS continuing healthcare meant to be tested?

NHS continuing healthcare is assessed, not tested. It’s provided solely based on healthcare needs, regardless of financial status. Eligibility is determined by an assessment of an individual’s care needs, not their financial situation.

2. How do I apply for NHS continuing healthcare?

To apply for NHS Continuing Healthcare, contact your local Clinical Commissioning Group (CCG) or healthcare provider to request an assessment. They will guide you through the application process and arrange for a multidisciplinary team to assess your eligibility based on your care needs.

3. What is the national framework for NHS continuing healthcare?

The National Framework for NHS Continuing Healthcare provides guidelines and criteria for assessing eligibility and providing funded healthcare services to individuals with complex needs. It outlines the assessment process, eligibility criteria, and responsibilities of healthcare organisations involved in delivering NHS CHC.

4. Does dementia qualify for NHS continuing healthcare?

Having dementia doesn’t automatically mean you’ll get NHS Continuing Healthcare; it depends on how serious your needs are. To see if you qualify, healthcare professionals need to assess you.

5. How much is NHS continuing healthcare?

The NHS fully funds Continuing Healthcare, so there’s no cost to individuals for the care provided. The funding covers all necessary healthcare services for eligible individuals with complex needs.

6. Can I decline an assessment for NHS Continuing Healthcare?

If you’re worried about changes to your care due to Continuing Healthcare, the Integrated Care Board (ICB) should discuss options to maintain your choice and control. This might involve a personal health budget, like direct payments for healthcare, to help you manage the transition without major changes.

7. Can I decline an assessment for NHS Continuing Healthcare?

You can’t refuse an assessment for NHS Continuing Healthcare, but if you do, you may still receive services from your local authority. However, there are limits to the types of services they can provide, and they’ll try to address any concerns you have about the assessment process.

8. Is it possible to pay top-up fees for NHS continuing healthcare?

No, you cannot top-up NHS continuing healthcare. It fully covers your assessed needs, but you can pay extra for private services on top.

Wrapping Up

To sum it up, NHS Continuing Healthcare provides important help for people with complex health needs, ensuring they get the care they need without worrying about money. Knowing “What is NHS Continuing Healthcare?” is really important for getting this help and making sure people get the best care possible when they need it.