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Continuing Health Care

What is Continuing Health Care

Continuing NHS healthcare and NHS-funded nursing care is provided over an extended period of time to meet physical or mental health needs that have arisen as a result of disability, an accident or illness. The care can be provided in a variety of settings including a hospital, nursing home, hospice or the patient’s own home. 
The care package is normally arranged and funded by the NHS and is awarded depending on whether a person's primary need is a health need. It can be provided in a care home or a persons own home.

Case Studies

 

NHS Continuing Healthcare (CHC) and NHS Funded Nursing Care (FNC) Question and Answers Fact Sheet Q What is NHS Continuing Health care A “Continuing Care” means care provided over an extended period of time to a person aged 18 or over to meet physical or mental health needs which have arisen as the result of disability, accident or illness. NHS continuing healthcare is the name given to a package of services which is arranged and funded by the NHS for people outside of hospital; this may be at home, in a care home or a specialist care home. NHS healthcare is free and there are no charges made to your savings or income. Where a person’s primary need is a health need, the NHS is regarded as responsible for providing all their needs. To receive NHS Continuing Healthcare you will need to have an assessment undertaken which will identify your health and care needs.

 

Why have I been asked to have an assessment


NHS continuing healthcare and NHS-funded nursing care changed on 1st October 2007 when the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care was implemented. This recommended that anyone whose care needs changed was now "screened" to see if they may be eligible for their care needs to be funded by the NHS rather than self-funding or by the Local Authority (Social Care) services. A change in care needs may mean that you have been admitted to hospital and your needs have changed, or that you now need care in a Care Home with a Registered Nurse rather than residential care or that you live at home but your health needs have changed. Once a change in needs has been identified a "Checklist" is completed (by a NHS Health Professional involved in your care) who forwards this to the Primary Care Trust to undertake a full assessment if this is appropriate. The checklist is not an indication that eligibility for NHS Continuing Health Care will be met, but if you meet the standard criteria on the checklist you are entitled to an assessment to consider whether NHS CHC applies to your needs. The assessment is a process where your total care needs are considered by trained healthcare professionals. This information is used to judge whether you meet the qualifying conditions for continuing healthcare.

 

 

Who makes the assessment


An Assessor will undertake a comprehensive assessment and will involve gaining collaborative information from the Local Authority and other people from multidisciplinary teams involved in your care. The assessment will take into account your physical, mental and psychological and emotional needs.
NHS CHC Fact sheet
You will be asked to consent for this assessment to be undertaken and for your permission to gather information from others involved in your care. You may invite relatives/representatives to this assessment. Where the person lacks capacity to consent then a best interest decision will have to be made whether or not to invite them (ref. Mental Capacity Act.). If the person being assessed does not have mental health capacity to consent, this will again be in the patient's best interest and in accordance with the Mental Health Capacity Act.

 

 

What is a Decision Support Tool?


A Decision Support Tool is a tool which is recommended for use by the Department of Health in conjunction with the Multidisciplinary assessment. The Decision Support Tool supports practitioners in obtaining a full picture of needs and by indicating a level of need which could constitute a primary health needs. The Decision Support Tool, combined with practitioners' own experience and professional judgement, should therefore enable them to determine evidence of a primary health need.

 

 

What happens if I do not agree with the assessment?


There is a statement within the assessment form which requests that you sign that you agree/disagree with the information within the assessment tool. This is not an indication that you will/will not agree with the final decision of eligibility but that the information relating to your needs is accurate, and it is here that you may give your written comments if you wish. If possible a Decision Support Tool will be completed at the assessment at the same time and you will also be able to give your comments to this document.

 

 

What happens when the assessment is completed?


The assessment and Decision Support Tool will be scrutinised at a Panel, who will look at the information collated and confirm whether eligibility has or has not been met. The outcome of the Panel will be communicated to you in writing as soon as possible.

 

 

What happens if I meet NHS Continuing Healthcare (CHC)


Should your needs be found to meet NHS CHC eligibility then the NHS will fund your identified care needs. An Assessor will liaise with you or your family/representative to discuss what care you need and how this can be provided and will assist to coordinate this. A Community Nurse from the Neighbourhood Team will routinely carry out a review of care needs no later than 8 weeks from the date of the decision for CHC eligibility. A review will then be undertaken annually as a minimum or as identified by the Assessor. You should be aware that NHS funding can STOP following this review or future reviews if you are then found not eligible for NHS CHC funding. At this stage, funding will cease, therefore, for patients who were reviewed for an NHS CHC package of care and the assessment of needs showed that your healthcare needs are not at a level to continue to qualify for NHS CHC, funding for your care will cease 28 days from the date of the Panel decision letter. I am resident in a Nursing Home and have been assessed as eligible for NHS Funded Nursing Care (FNC)

 

 

My local authority pays the nursing home fees, what does this mean for me?


The NHS pays for your Registered Nursing care and your Local Authority pays towards your social care. The Funded Nursing Care (FNC) is a payment for the Registered Nursing care part of the nursing home fees and therefore your Local Authority will have taken both these payments into account when assessing your personal contribution or any additional top-up fees you pay.

 

 

I pay the nursing home fees myself with no funding from my local authority


A Nursing homes will have their own methods to either refund or deduct payments. This information is not known to the Primary Care Trust and therefore you should discuss this with the nursing home direct to confirm how they deal with reimbursement of the FNC.

 

 

My Nursing Homs is not in Wiltshire PCT, how to I claim the FNC payments?


The PCT where your GP is located will determine which PCT is responsible for payment of NHS Funded Nursing Care (FNC). The nursing home will be able to explain how this is arranged in your area.

 

 

My Home Care or Nursing Home fees are already funded by the Local Authority. What does this mean for me?


If you are eligible for NHS Continuing Healthcare funding, Wiltshire Primary Care Trust (PCT) takes over responsibility for funding all your care needs.

 

 

Do I still pay my personal contributions?


No, the NHS is now responsible for the funding of your care whilst you remain eligible.

 

 

Q Does funding affect my benefits?


Yes, CHC funding may affect your benefits. You will need to seek advice from the benefits agency alternatively if you have a social worker they may be able to help you with this. The benefits enquiry line can be contacted on 0800 88 2200 or the Department of Works an Pensions on 0845 712 3456.

 

If I am in a residential care home (without Registered Nursing), why don’t I qualify for NHS funded nursing care (FNC)?


If you are in a residential care home, any nursing needs would be met by the Community Nurse. This service is free from the NHS.

 

 

If I am currently in a nursing home (care home with Registered nurses) but my letter says I don’t qualify for any funding. Why is this?


FNC is to pay for the Registered Nurse employed by the Care home. People in Nursing Homes are paying fees which include the employment of Registered Nurses for your nursing needs and therefore the NHS pays a contribution to a nursing home for people who are assessed as eligible for NHS Funded Nursing Care. However, eligibility is based on your health needs not the type of care home you are resident in. If you are not eligible for any funding this indicates that you either have no registered nursing needs or that you have few nursing needs. These needs could be met in another setting such as a residential care home or your own home and therefore you do not qualify for registered nursing funding. What can I do if I am not eligible for NHS Continuing Healthcare or disagree with the decision?

 

 

If I am not eligible for NHS Continuing Healthcare funding how do I find out if I am eligible for funding from my Local Authority (Social Care)?


If you want to find out if you are eligible for funding from your Local Authority, you can call Wiltshire Council, Social Care Helpdesk on 0300 4560111 who will be able to advise you on what to do next.

 

 

What can I do if I disagree with the Panel decision?


If you disagree with the NHS CHC Panel decision and want to appeal you should write to the Continuing Healthcare Team within 28 working days of the date of the decision letter and send to:
Continuing Healthcare Team
Southgate House
Pans Lane
Devizes
Wiltshire
SN10 5EQ

Should you wish to appeal against the Appeal Panel’s decision the next step would be to apply in writing to the South West Strategic Health Authority within 14 working days of the date of the appeal decision letter.
Contact details are:
Eileen Roberts
Continuing Healthcare South West Strategic Health Authority
South West House
Blackbrook Park Avenue
Taunton
Somerset
TA1 2PX

Eileen will then advise you of the process.
You may find it helpful to refer to the Continuing Healthcare Leaflet or the National Framework for NHS Continuing Healthcare which are available on the Department of Health website. CONTACT DETAILS: Wiltshire Primary Care Trust, CHC Team, Southgate House, Devizes, SN10 5EQ, Tel 01380 733865 Fax 01380 733796, This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

What happens with funding if the appeal for NHS CHC eligibility is successful?

 

Funding is to be reimbursed to Social Care or the patient/patient representative following subsequent Appeal panel if appropriate. Please notify us if:
-You move to a new care home
-You change from a residential placement to a nursing placement even if its within the same care home
-You are discharged from the care home
-There is a change in health needs and would like a new assessment
-If you would like to appeal