Nottingham and Nottinghamshire CCG
Continuing Healthcare (CHC)
NHS Continuing Healthcare (CHC) is a care package for people aged over 18 that is funded entirely by the NHS. To qualify for CHC, you’ll need to be assessed to see if you have a ‘primary health need’ that requires healthcare, rather than social care.
If you’re eligible for CHC, the NHS will pay for your care. This will be reviewed regularly, especially if your care needs change, so there’s a possibility you might have to pay for your care in the future.
To be eligible for CHC, you don’t need to have a disability, specific health condition or illness, and it doesn’t depend on where the care will be provided.
Applying for CHC funding
There are a few steps in the process, which we’ve laid out for you below.
When you apply for CHC funding, a health or social care worker will assess your needs to see if they think you’re likely to be eligible. If they think you aren’t eligible, they’ll discuss their reasons with you (or your representatives) and this discussion will be kept on your records.
If the health or social care worker thinks you are eligible, they’ll complete a ‘checklist’ to see if you meet the criteria for a full CHC assessment. This will be done at a suitable time and place – it wouldn’t be appropriate to do this, for example, if you were in hospital or during an acute illness.
If the checklist shows you aren’t eligible for a full CHC assessment at that point, it will be held on record so we know it’s been completed. If your health changes at any time, the checklist can be repeated.
If the checklist shows you are eligible for a full assessment, a CHC co-ordinator will arrange a meeting with you, your representative(s) and a multi-disciplinary team (MDT) of health and social care professionals who are involved in your care. After the meeting, which usually takes about two hours, the MDT will make a recommendation to the CCG. The MDT can recommend:
- fully funded CHC, in your home or in a nursing or residential home;
- NHS funded nursing care in a nursing home;
- a joint funded package of care, with social care, in your home or in another location; or
- that you are not eligible for funding.
Some of these options may include means testing, or extra charges by a care home for ‘lifestyle choices’ that are outside normal health and social care costs.
Only in exceptional circumstances, and for clear reasons, will the MDT’s recommendation not be followed. However, we can ask for more evidence if we’re not able to verify the recommendation.
If you are unhappy with the CCG decision
If you are unhappy with either the process or a decision made regarding eligibility for NHS continuing healthcare, you can request a review of the decision by contacting the CCG. You can access the local resolution procedure here.
Read Flowchart Local Review Process App B here.
Read Appeal Questionnaire App A here.
Nursing care funding
If the MDT recommends that care is provided by a registered nurse in a nursing or care home, you might be entitled to a contribution towards assisted nursing. This funding is known as NHS Funded Nursing Care.
Before a decision on nursing care funding is made, you’ll need to be assessed in the same way as we’ve explained in the ‘applying for CHC funding’ section above. If you aren’t eligible for CHC funding but are entitled to nursing care funding, we’ll make the contribution directly to the nursing or care home.
The rest of the cost will be paid through the local authority, or if you are not eligible for social care support you might have to fund your care yourself.
Personal health budgets
A personal health budget (PHB) is an amount of money planned and agreed between you (or your representative) and the CCG to support your health and social care needs.
All CHC funding for care in your own home is now paid in the form of a PHB. It can be provided in three different ways, or in a combination of any of the three.
- A notional budget held by the CCGs and used to buy services on your behalf
- A budget managed on your behalf by an independent third party
- A direct payment to you so you or your representative can buy services directly
There are five key requirements for a PHB.
- You must know how much money you have for your health and care support
- You are able to choose the health and wellbeing outcomes you want to achieve in agreement with a healthcare professional
- You are able to create your own care plan, with support if you wish
- You are able to choose how your budget or direct payment is held and managed
- You are able to spend the money in ways and at times that make sense to you, as agreed in your plan