On 1 September, NHS Continuing Healthcare (CHC) assessments restarted, having been suspended since 19 March when the UK went into lockdown and the government introduced new arrangements for discharging patients from hospital in order to free up beds for Covid patients.
CHC assessments and reviews are carried out by Clinical Commissioning Groups (CCGs) which, with the resumption of ‘normal’ service, are now having to deal with a backlog of referrals and reviews accrued over the last five months or so as well as responding to requests for new assessments.
The government has provided an additional £588m in funding to provide six weeks of care and support following an individual’s discharge from hospital during which time a full assessment of their long-term needs is made.
What is continuing healthcare?
The principal purpose of CHC is to provide adults with a ‘primary health need’ (i.e. a need that requires medical rather than social care) with a care package funded by the NHS. Only CCGs can determine if an individual is eligible for CHC and they do so via a prescribed two-stage decision-making process, which can seem labyrinthine for those not familiar with the system. However, if an individual is assessed as being suitable for CHC, the NHS will pay for all their associated medical and social care needs including accommodation.
If the panel decides that you are not eligible for Continuing Healthcare, you will be referred to your local authority who will consider if you are eligible for their support. Depending on your needs, the NHS may contribute towards your health needs as part of a joint package of support with your local authority which may be delivered via NHS-funded Nursing Care.
Assessing eligibility for CHC
Unsurprisingly, given the financial constraints under which the NHS operates, CHC assessments are rigorous and designed only for those with a high level of need. The two-stage process involves an initial screening using a ‘checklist tool’ followed by a full eligibility assessment using a ‘decision support tool’. If you have a positive checklist outcome, you proceed to the next stage to be assessed by a multi-disciplinary panel of both health and social care experts who are familiar with your case and whose focus is on your needs, rather than your condition or diagnosis. The ‘decision support tool’ helps the panel to decide if the nature, complexity, intensity and unpredictability of your needs amount to a ‘primary health need’. If so, the CCG is likely to consider you eligible for Continuing Healthcare (the CCG does not always accept the panel’s recommendation but this is unusual).
How have CHC assessments been affected by Covid-19?
In March the government introduced hospital discharge arrangements whereby patients who no longer had a clinical need to stay in hospital were sent home or to care homes in order to free up bed capacity to cope with the influx of patients suffering from Covid-19. There was a Covid-19 discharge funding arrangement in place for care packages. During the following months, staff who would normally have been managing Continuing Healthcare assessments were re-deployed to other parts of the NHS in response to the pandemic. In mid-August, the government announced that CHC assessments would restart on 1 September and issued a new hospital discharge directive and funding to support a six-week recovery period for those requiring it, during which time CHC assessments for longer-term care needs are to be made. The government has made it clear that it expects all CHC assessments to have been made by the end of this six-week period and that there will be no funding beyond that timeframe. If no decision has been made, it is expected that local authorities and CCGs will agree an approach as any funding from week seven must come from existing budgets. If the CHC assessment is still in progress at the end of the six weeks then the NHS will continue to fund the individual’s care until the outcome is known. If found not to be eligible, the individual will be assessed by their local authority.
How we can help?
Although the process for establishing if you, or a family member, meets the ‘primary health need’ criteria is prescriptive, there is scope for challenging a negative decision if you feel strongly that your situation has not been accurately assessed, or if you feel that your views have not been fully considered. In addition, it is clear from the government guidance that there is scope for confusion over who is responsible for funding care and rehabilitation services once the six-week period following discharge from hospital is over. Budgets are very tight and neither the NHS nor local authorities will be anxious to continue funding if there is any doubt relating to eligibility. We have considerable experience of dealing with both CCGs and local authorities over decisions made relating to Continuing Healthcare arrangements and would be happy to have an initial discussion with you to see if we can help.