The Government has clearly set out in Law what Adult Social Care and what Health services provide to a citizen, to prevent cross over between the two services. The Care Act (2014) states that the NHS provides health services to people. This means that Social Care, provided by local authorities, cannot provide health care that is legal responsibility of the NHS.
Continuing Healthcare
What is Continuing Healthcare (CHC)?
Continuing Healthcare (CHC) is an NHS led service for people aged 18 and over who have significant, ongoing health needs. CHC is a package of care that is fully funded by the NHS. It is designed for people whose care needs go beyond what local authority social care services can provide and who are assessed as having a primary care health need.
CHC is does not award funding based on any specific diagnosis. It is possible for any condition to quality if the person’s needs are severe enough. CHC is often used to support people with health conditions that are complex, intense or unpredictable and go beyond what a local authority can legally provide. There is more information on what primary health needs means on the gov.uk website.
CHC can be provided in various settings, including:
- Your own home (with support from personal care and health needs)
- A care home or nursing home (with fees covered by the NHS)
You can find lots of information about NHS continuing healthcare, the eligibility criteria and how it is assessed using on these useful links below:
- NHS Continuing Healthcare
- NHS funded care National Framework (Public Information Leaflet)
- Beacon - free and independent NHS continuing healthcare advice
- Solihull Carers CHC Guide (link to PDF download)
Further Information
Birmingham Adult Social Care Dementia Citizen group have co-produced a detailed guide on how the CHC assessment works for anyone caring for someone with dementia. This contains detailed information that can help anyone preparing for a multi-disciplinary team meeting as part of the CHC process and the scoring process for determining level of needs.
LINK HERE
The headings below provide more general information about the CHC process. Click each heading to expand and read the section.
CHC helps people live safely and with dignity in the community, even when they have complex health conditions . It ensures that individuals receive the right care at the right time, without having to worry about the cost. This can include help with daily tasks like washing and dressing, specialist nursing care, or therapies tailored to individual needs.
For those who qualify, CHC can make a real difference by:
- Reducing financial stress linked to care costs
- Supporting independence and choice
- Providing consistent care across health and social care services
No.
CHC is not means-tested. This means that a person’s income, savings, or financial situation do not affect whether they are eligible. The decision is based entirely on their health needs. This is different from local authority-funded social care, which is means-tested and may require individuals to contribute to the cost of their care.
If CHC funding is agreed as needed at the end of the assessment process, it is reviewed after 3 months and again after 12 months to make sure the funding is still appropriate.
Adult Social Care teams often work closely with NHS colleagues to support people through the CHC process. Even if someone is not eligible for full CHC funding, they may still receive a joint package of care funded by both the NHS and the local authority.
A joint funding package means that Adult Social Care funds the person’s relevant social care needs, while the NHS funds that person’s relevant health needs. This working together means a person’s full health and social care needs are met.
To find out if someone is eligible for CHC, they must go through an assessment carried out by a team of health and social care professionals. This team looks at:
- The complexity and intensity of the person’s needs
- How unpredictable their condition is
- The risks to their health if care isn’t provided properly
To decide who is eligible for CHC, the NHS uses a 2-step assessment process
- Step 1 is a screening checklist tool, to identify if you require a full assessment
- Step 2 is a full assessment - undertaken by a multi-disciplinary team (MDT) of professionals
There is more information about both the screening tool and full assessment processes on Gov.uk website. The site notes that the checklist threshold is set deliberately low, to ensure that those who need an assessment have the opportunity to have one. However, this means that most people who have a positive checklist (screened in) are found not to be eligible once the full assessment is done. For example between January and March 2024 only 20% of CHC applications were approved.
Birmingham Adult Social Care Dementia Citizen group have co-produced a detailed guide on how the CHC assessment works for anyone caring for someone with dementia. While this is focused on dementia, the information it contains is helpful to anyone going through the CHC process. It contains information on the assessment process and the scoring process for determining level of needs, as well as useful tips to prepare for the full assessment.
LINK HERE
If urgent care is needed, the process can be fast-tracked. There is more information on the fast track pathway on Gov.uk website.
CHC needs can be identified at several key points in a person’s care journey. The process is designed to ensure that individuals with significant and ongoing health needs are assessed fairly and at the right time. Below are the typical points when CHC needs are identified:
1. After Hospital Discharge
After someone with complex health needs is discharged from hospital, they may be screened for CHC eligibility. This is after discharge, when the person is in a community setting, to make sure their ongoing needs are clear.
2. When Health Needs Change
If a person’s physical or mental health deteriorates significantly, and their current care is no longer adequate, this can trigger a CHC assessment.
3. As Part of Regular Care Reviews
CHC assessments may be considered during routine reviews of care plans, especially if there are signs that the person’s needs have become more health-focused.
4. When Entering a Care Home with Nursing
Before someone receives NHS Funded Nursing Care (FNC), they should be screened for CHC eligibility using the CHC Checklist. Further information about FNC can be found on the NHS website.
5. End-of-Life or Rapid Deterioration
If someone’s condition is rapidly deteriorating and they may be approaching the end of life, they can be fast-tracked for CHC without going through the full assessment process. Information on fast track assessment for Birmingham can be found on the Birmingham and Solihull ICB website.
6. Upon Request
Anyone can request a CHC assessment at any time if they believe they or someone they care for may be eligible. Health and Social Care professionals, trained in the process, can initiate the checklist screening tool. If you are already being supported by a health professional or social care professional, they can advise if this is appropriate.
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