Delays, lack of progress and poor visibility cause considerable distress to patients and their families as they wait for funding assessment and decision, assessment completion and care provision. The Continuing Healthcare Checklist and the Decision Support Toolkit assessment process is inundated with paper-based forms filled out manually by health and social care professionals, As a result, professionals at the centre of the CHC process struggle to synthesise the information from the reams of paper, they receive adding to unnecessary delays.
NHS continuing healthcare (CHC) is a package of care provided outside of the hospital that is arranged and funded solely by the NHS for individuals aged 18 years and older who have significant ongoing healthcare needs.
When someone is assessed as being eligible for CHC, the NHS is responsible for funding the full package of health and social care.
The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years. In 2015-16, almost 160,000 people received or were assessed as eligible for, CHC funding during the year, at a cost of £3.1 billion.
Funding for ongoing healthcare is a complex and highly sensitive area, which can affect some of the most vulnerable people in society and those that care for them. If someone is not eligible for CHC, they may have to pay for all or part of their social care costs. Social care services, such as care home fees, may be paid for by local authorities, but the person may need to pay a charge depending on their income, savings and capital assets. Therefore, decisions about whether someone is eligible for CHC may have a significant impact on their finances.
The national framework for CHC states that eligibility should be based on someone’s healthcare needs and not their diagnosis. Many people that are assessed for CHC funding are reaching the end of their lives or face a long-term condition, because of a disability, accident or illness. They can have a wide range of healthcare conditions and may receive funding for just a few weeks or many years
The Department of Health (the Department) is responsible for the legal framework for CHC. This includes setting criteria for assessing eligibility for CHC through a national framework and providing supporting guidance; publishing screening (checklist) and assessment tools; and setting principles for resolving disputes.
Clinical commissioning groups (CCGs) are responsible for determining eligibility for CHC and NHS-funded nursing care (for those not eligible for CHC but assessed as needing care from a registered nurse) and for funding and commissioning this care if patients are assessed as eligible.
The CCG is legally required to provide CHC funding for all those assessed as eligible. NHS England is responsible for making sure that CCGs comply with the national framework and may arrange independent reviews of CHC decisions if requested by patients.