What is NHS Continuing Healthcare (NHS CHC) Funding?
NHS Continuing Healthcare is a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where you have a ‘primary health need’ as set out in the National Framework. This care is provided to people aged 18 or over, to meet health and associated social care needs because of disability, accident, or illness. Eligibility for NHS Continuing Healthcare is not determined by a particular diagnosis, the setting where the package of support can be offered or by the type of service delivery.
When is NHS CHC funding awarded?
To be eligible for NHS Continuing Healthcare funding you must have a ‘primary health need.’
Terminology
A document where your Health and Social Care needs are recorded. Information is gathered from your records (GP, nursing home, hospital etc.) we use this information when we complete your CHC assessment.
This is an initial assessment tool to identify if your needs indicate an NHS CHC assessment to be completed.
An MDT is: two professionals from different health professions, or one professional from a healthcare profession and one responsible for assessing people for community care services.
A DST is a CHC assessment tool which records your needs and helps the Multidisciplinary team to determine whether you have a ’primary health need’.
Eligibility for NHS CHC is based on evidence of a ‘primary health need’. This is not based on your diagnosis or the reason you need help and support. It is based on your overall day-to-day care needs.
The primary health needs should be assessed by looking at your care needs and relating them to four key characteristics:
- Nature – the type of condition or treatment required (quality and quantity)
- Complexity – symptoms that interact, therefore difficult to manage or control.
- Intensity – one or more health needs, so severe they require regular intervention.
- Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to you or others.
What is a CHC Retrospective Review?
If you have been paying for your care but have not been assessed for NHS CHC eligibility, it may be possible to request a retrospective review of these ‘previously unassessed periods of care’. (PUPoC). This can apply to both current patients and people who have died.
A request for a retrospective review can only be made for periods of care after 1 April 2012.
When you request a retrospective review for someone who is deceased you will need to provide proof of their right to make the request.
To complete a retrospective review, we will collect the person’s health and care records for the identified period of the review complete an assessment of their needs. We may need your help to gather the relevant records.
A retrospective review will be completed by your local Clinical Commissioning Group (CCG). They will aim to complete the review within 12 weeks of the request being made, but it can take longer particularly if there are any delays receiving records.
Why would a request to complete a retrospective review be declined?
When we have checked an application, it is not always possible to go ahead with a retrospective review. For example, the period of care may have been previously assessed.
Sometimes, we can’t get all the patient records we need. Usually, this is because they have been destroyed by the record holder. There is guidance about long records need to be held by NHS organisations but private companies such as Nursing Homes have their own guidance.
We will always explain to you the reason for not going ahead with a retrospective review.
