About our teams
Our NHS Continuing Healthcare teams are made up of a wide range of professionals, including registered nurses from different parts of the register (adult, mental health, learning disabilities), occupational therapists, social workers, and skilled administrative and case worker staff.
Our team has many years of experience in assessing for NHS Continuing Healthcare and working with people with long term conditions and are here to advise and support you through this journey. The main role of the team is to ensure that people with a ‘primary health need’ are fairly and consistently assessed against the National Framework. Whilst all our staff have a general duty to manage public money appropriately, the team are not ‘gatekeepers’ of NHS funding but are focused on fairly applying the national guidance.
Within our team there is a wealth of knowledge, skills, and confidence within a variety of conditions, obtained from working in different settings across health and care, including but not limited to primary care, hospitals, and secondary care.
All staff complete training specific on NHS Continuing Healthcare, including Funded Nursing Care, Fast Track and Personal Health Budgets. All our registered nurses are required by Nursing and Midwifery Council (NMC) to revalidate every 3 years ensuring they meet standards for registration.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (also known as CHC), is the name given to a package of ongoing care which is arranged and funded entirely by the NHS for individuals outside of hospital who have ongoing health care needs.
It is free for anyone who meets the eligibility criteria through NHS National NHS Decision Support Tool (DST), the assessment process is the same whether or not you have legal representation, such as a solicitor.
You can receive NHS Continuing Healthcare in any setting outside of hospital, including your own home or in a care home. NHS Continuing Healthcare covers all your identified care costs and is not means tested. This means it is not based on what you earn, or your savings.
The NHS Continuing Healthcare process is set out in the National Framework for NHS Continuing Healthcare. The Framework is written and produced by the Department of Health and Social Care and was last revised in July 2022. The Framework sets out the principles and processes of NHS Continuing Healthcare. You can find the NHS Continuing Healthcare Framework on the GOV.UK website: National framework for NHS continuing healthcare and NHS-funded nursing care
The Continuing Healthcare Assessment Process (pictorial)
Consent for NHS Continuing Healthcare Assessments
All applications require a signed consent form, which can be completed by either yourself, or by the referring professional. A relative is only able to sign the consent form if they have Power of Attorney for Health and Welfare, and if the individual lacks capacity to consent for themselves.
Please do not worry if a Power of Attorney is required but not in place as the responsible professional can also complete a mental capacity assessment and sign the consent form as a ‘Best Interests’ decision.
The mental capacity assessment will identify whether your family member is unable to consent for themselves. A professional will be able to sign the consent form on their behalf or in their ‘Best Interests’.
The consent form also confirms that you or your relative fully understands and agrees to the NHS Continuing Healthcare pathway, as well as the sharing of healthcare information with the relevant professionals when appropriate.
Who is Eligible for NHS Continuing Healthcare?
Anyone over 18 years of age, assessed as having a ‘primary health need’, should be eligible for NHS Continuing Healthcare. It is not dependent on a particular disease, diagnosis, or condition.
If you are eligible for NHS Continuing Healthcare, your care will be funded by the NHS. This is subject to regular reviews, and should your needs change, the funding arrangements may also change.
What is a Primary Health Need?
A ‘primary health need’ is a concept, rather than a legally set definition. It was introduced by the Secretary of State for Health, to assist in identifying whether a person’s primary need is for healthcare (therefore being the duty of the NHS to provide under the 2006 Act) rather than for social care (under the Care Act 2014). A primary health need would be indicated by the nature, complexity, intensity or unpredictability of health needs, or a combination of these.
What is a Social Care Need?
There is no formal definition of social care, but it is often described as dealing with the “activities of daily living”, that means needing help with day-to-day activities like feeding, washing, and dressing, mobility, using the toilet, etc. Social Care can also include needing help in terms of maintaining independence, social interaction, protection from vulnerable situations and help in managing complex relationships.
Local Authorities are guided by the Care Act 2014 and assess a person’s eligible social care needs using assessments that focus on strengths and competencies. For more detailed information, please refer to the Care Act (2014) at: Care Act 2014
How is NHS Continuing Healthcare assessed?
In order to find out if you are eligible for NHS Continuing Healthcare a two-stage assessment process is followed:
- Stage 1: Screening via the Checklist tool
- Stage 2: Full assessment of eligibility via a multi-disciplinary team meeting
Do I have to agree to an assessment before it can be carried out?
Yes. You, or your Power of Attorney must agree to the assessment before the process begins and before any decisions are made. This is called ‘consent’.In order to be sure that you have the full information to agree to the assessment, the professional referring you should explain the process and make sure you have enough information to make your decision. Once you have given your consent, a record will be made to say that you have agreed to the assessment being undertaken.
What happens at the screening stage?
To help correctly identify if you require a full assessment of eligibility for NHS Continuing Healthcare, a health or social care professional involved in your care will complete a screening tool called a Checklist. They may also speak to your family or others who support you to build up a picture of your needs. This checklist is sent to us, the NHS Continuing Healthcare team at Hampshire and Isle of Wight Integrated Care Board (HIOWICB). You should also receive a copy of the Checklist tool. The Checklist is a national tool and the threshold at this stage of the process has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity. If your checklist indicates further assessment is required, this does not mean that you will be eligible to receive NHS Continuing healthcare.
Once completed, if the checklist indicates that you require a full assessment of eligibility we will arrange for a ‘multi-disciplinary team’ meeting to take place.A ‘multi-disciplinary team’ means a team drawn from a number of professional ‘disciplines’ such as doctors, nurses, therapists, and social workers. You may hear the term shortened to ‘MDT’. The multi-disciplinary team will be made up of two or more professionals who understand your care needs. They may be from health or social care services.
What happens at the full assessment?
At the full assessment, NHS Continuing Healthcare staff from Hampshire and Isle of Wight Integrated Care Board (HIOWICB) will make sure that you, your chosen representative, as appropriate, and whoever cares for you are invited to be involved. If you need an advocate to support you through the assessment process, HIOWICB can help arrange this for you.
A member of the NHS Continuing Healthcare team will contact you or your chosen representative before your assessment takes place to talk you through the process and answer any questions you may have. Your assessment can take place either in person or online. If it happens online the multi-disciplinary team will still have access to all the relevant information about your needs.
Members of the multi-disciplinary team will meet with you to undertake the assessment and complete a ‘decision support tool’. You may hear this term shortened to a DST. This decision support tool allows the multi-disciplinary team to gather a full picture of your health and care needs, and consider them against four key characteristics:
- Nature: this describes your needs and the type of needs e.g. physical, psychological, etc. Nature also describes the effects of your needs on you and the type of help you may require to help manage and meet your needs.
- Intensity: this considers the extent and severity of your needs and the type and level of support you need to meet them, which includes the need for ongoing or continuous care.
- Complexity: this describes how your needs may interact or affect each other, which may make them difficult to manage or control. It also looks at the level of skill required to monitor your symptoms, treat your condition and/or manage your care.
- Unpredictability: this looks at how your needs may vary and fluctuate and how a difficulty in predicting changes in your needs might create challenges in being able to manage or meet them. This includes the risks to your health if adequate and timely care is not provided.
If your assessment is undertaken virtually, you may ask for the meeting to be recorded.
How will the final decision be made?
Whilst there may be a number of professionals, along with you and/or your chosen representative at the meeting, the two decision makers will be the NHS Continuing Healthcare nurse and typically a social worker. They will listen and record everyone’s views and put forward their recommendation with regards to your eligibility for NHS Continuing Healthcare. A registered professional within HIOWICB will look at the recommendation made by the multi-disciplinary team, alongside the supportive evidence collected, and finalise or “ratify” the decision. This will usually be in line with the recommendation made unless there are exceptional circumstances.
Once we have made a decision, we will send you a letter confirming the outcome. This letter will also include a copy of the decision support tool.
How long will the process take?
In most cases the NHS Continuing Healthcare assessment process and eligibility decision should be completed within 28 days.
Fast Track tool
If you need an urgent package of care due to a rapidly deteriorating condition, which may be entering a terminal phase, then the fast-track tool may be used to confirm eligibility for NHS Continuing Healthcare funding. If this is the case, an appropriate clinician will complete the fast-track tool and send it directly to us at HIOWICB, who will arrange for care and support to be provided as quickly as possible.
The team will keep in touch with your or your relative, to ensure that your care package is meeting your needs and after around 8 weeks, a review of your care needs will be undertaken. If your, or your relative’s, condition remains rapidly deteriorating the NHS Continuing Healthcare team will defer the review for a few weeks, with care continuing to be provided throughout this time.
After the review of care needs, if appropriate, due to a stabilised condition, NHS Continuing Healthcare will arrange a Multi-disciplinary Team Meeting (MDT) to begin the process of assessing whether you or your family member remains eligible for NHS Continuing Healthcare. An NHS Continuing Healthcare case coordinator will be assigned for you who will provide support and guidance throughout the process.
Depending on level of needs, we may review your care and support requirements and eligibility throughout the period that you meet the Fast Track criteria.
What happens next?
If you are found eligible for NHS Continuing Healthcare, a case worker will be assigned for you. They will be your main point of contact whilst you are receiving NHS Continuing Healthcare.
Your case worker will talk to you about:
- Your health and wellbeing goals
- The care and support you need in your day-to-day life.
- Writing a care and support plan
- How your needs will be managed?
- Where your care will be provided, e.g., in your own home or in a care home. The Continuing Healthcare team at HIOWICB will consider your wishes in organising the care you require.
All Age Continuing Healthcare eligible individuals are entitled to have a Personal health Budget. A Personal Health Budget (PHB) is an amount of money that is allocated to you based on your health and wellbeing needs to enable you to have greater choice and control over the care and support you receive.
There are three options available:
- A direct payment (DP) where you (or your representative) would manage the budget and organise the care you require with NHS Continuing Healthcare support.
- There are 3rd party support options available if you choose a direct payment, including payroll and employment advice services. A 3rd party budget where an independent organisation of your choice can manage the budget on your behalf.
- A notional budget where the ICB will remain responsible for commissioning your care, but with more transparency for you on the budget spend and agreed health outcomes.
Please check our PHB section for more information.
What if I’m not eligible and disagree with the outcome?
If you receive a letter saying you are “not eligible” for NHS Continuing Healthcare funding and you feel that the appropriate procedures have not been followed, for example, that our team at HIOWICB have not applied the National Framework appropriately in making this decision, or your needs have been misrepresented, you have a right to appeal. You cannot appeal solely on the basis that you do not agree with the outcome of the assessment. In these circumstances you can ask us to undertake a review within six months of the decision. Once we receive your request, we then will aim to complete the appeals process within 90 days. All the information you need about the appeal process can be found on the letter where we confirm the outcome of the assessment.
How will my care be reviewed?
A review of your care package will be completed within three months of being found eligible. Afterwards you should have further reviews at least once a year.
These reviews should focus on whether your care plan, and care arrangements continue to meet your needs. If your care plan no longer meets your needs, we will work with you to make amendments to ensure all your care needs are safely met.
If your needs have changed to such an extent that they may impact on your eligibility for NHS Continuing Healthcare, then we may arrange a full reassessment of eligibility. This is called a Review DST. If you have any queries or need to discuss your care needs in between review dates, please contact your case worker.
What happens next if I am not eligible for NHS Continuing Healthcare?
Whether or not you are eligible for NHS Continuing Healthcare, you are still able to make use of all the other services from the NHS in your area in the same way as any other NHS patient.
If you are not eligible for NHS Continuing Healthcare and you live in a care home that is registered to provide nursing care, you may be eligible to receive NHS-funded nursing care. This will be considered during your CHC assessment.
If funding is not agreed, will it be possible in the future?
Yes. If you or those caring for you feel your own/your relative’s health has got worse, you can ask for a re-assessment of their eligibility for NHS Continuing Healthcare.
What is a shared package of continuing healthcare?
If someone does not qualify for NHS Continuing Healthcare, it may still be the role of the NHS to contribute towards their health care, if the assessment indicates that they have both health and social care needs. An example of where the NHS can contribute towards health needs is ‘funded nursing care’; where there is joint funding it is called ‘a shared package’.
If my relative has a diagnosis of Alzheimer’s/ Dementia, do they automatically get full continuing health care funding from the NHS?
NHS Continuing Healthcare is not based on a specific diagnosis, but on the level of health care needs which considers the nature, intensity, complexity, and unpredictability of the health needs.
What is NHS-funded Nursing Care?
NHS-funded Nursing Care is an NHS paid contribution towards the nursing care element of your nursing home fees. This covers nursing care provided by a registered nurse.
You may be eligible for NHS-funded nursing care if:
- you live in a care home that is registered to provide nursing care; and
- you do not qualify for NHS Continuing Healthcare but have been assessed as requiring the services of a registered nurse.
In all cases you should be considered for eligibility for NHS Continuing Healthcare before any decision is reached about the need for NHS-funded nursing care. Most people will not need to have a separate assessment if they have already had a full multi-disciplinary assessment for NHS Continuing Healthcare, as this process will give sufficient information to judge the need for nursing care.
If direct payments are in use, can they continue if the care becomes fully funded by the NHS?
Yes. For further information please discuss with your assigned case worker.
What is Enduring/Lasting Power of Attorney?
A lasting power of attorney (LPA) is a legal document that lets you appoint someone you trust as an ‘attorney’ to make decisions on your behalf. It can be drawn up at any time while you have capacity but have no legal standing until it is registered with the Office of the Public Guardian. A registered LPA can be used in accordance with the statutory principles of the Mental Capacity Act 2005.