7.5 Continuing Healthcare (NHS) – Lancashire Adult Social Care Policy Portal

CQC Quality Statements

Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions

We statement

Lancashire County Council work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.

What people expect

When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

I feel safe and supported to understand and manage any risks.

KEY POINTS

NHS Continuing Healthcare (CHC) is arranged and funded by the NHS and provided to adults who have been assessed as having a ‘primary health need’.
Deciding whether an adult has a primary health need and is eligible for NHS CHC involves a multidisciplinary team (MDT) assessing all the adult’s relevant needs using the Decision Support Tool (DST). A checklist tool is also available, and this can be used initially to identify adults who may need a full assessment of eligibility for NHS CHC.
The Integrated Care Board (ICB) will review the assessment of eligibility completed by the MDT. Only in exceptional circumstances, and for clearly stated reasons, can the MDT’s recommendation not be followed.
Where an adult receives NHS CHC, a review should be undertaken within three months of the decision being made. After this, further reviews should be undertaken on at least an annual basis.

1. Introduction
2. What is Continuing Healthcare?
3. Who is Eligible?
4. When should NHS Continuing Healthcare be Considered?
5. Further Reading
Appendix 1: Flow Diagram which sets out the Process for NHS Continuing Healthcare

1. Introduction

This policy statement sets out how Lancashire County Council will work, in accordance with the Care Act and the National Framework for NHS Continuing Healthcare (CHC), with the NHS to ensure that individuals are assessed if they are eligible for funding from the NHS.

The revised National Framework sets out the principles and processes of NHS Continuing Healthcare and NHS funded Nursing Care.

This guidance replaces the previous version (March 2018) and takes into account the legislative changes brought about by the Health and Care Act 2022 which established Integrated Care Boards (ICBs) as the statutory bodies with responsibility to provide NHS Continuing Healthcare.

The National Framework also reflects Section 22 of the Care Act 2014 which preserves the existing boundary and limits of Lancashire County Council’s responsibility in relation to the provision of nursing and or health care.

2. What is Continuing Healthcare?

NHS continuing Healthcare is a free package of care if you have significant and ongoing healthcare needs. It’s often referred to as CHC funding. If you have long-term complex health needs, you may qualify for free social care arranged and funded solely by the NHS.

If you receive care in your own home the NHS covers the cost of the care and support you need to meet your assessed health and associated social care needs, which includes personal care such as help with washing and getting dressed.
If you receive NHS continuing Healthcare in a care home the NHS pays your care home fees.

3. Who is Eligible?

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.

4. When should NHS Continuing Healthcare be Considered?

If you have ongoing health needs, there are times when it should be considered whether you may be eligible for CHC funding.

These include:

when you are ready to be discharged from NHS care for example after a hospital stay.
following a hospital discharge and rehab or intermediate care, if it’s then agreed your condition has reached its optimum and is unlikely to improve further.
during reviews of your health or social care needs by Adult Social Care.
if in a nursing home, whenever your nursing needs are reviewed (this should be at least annually).
if your health deteriorates significantly and any current care seems inadequate.
if you have a rapidly deteriorating condition and may be approaching the end of your life.

Your GP, social worker, or the staff coordinating your care should talk with you about NHS continuing healthcare. If they don’t, you can ask them for an assessment.

Find out more – You can find out more about NHS continuing healthcare, and see if you’re eligible, on the NHS website.