NHS Continuing Healthcare

Enabled City has worked with Greenwich CCG and NHS England to create a motion graphics film about NHS Continuing Healthcare (NHS CHC). The film aims to explain better to people and families how the NHS decides if someone is eligible for NHS CHC.

There is a national version with an introduction by NHS England, and NHS England is making this version freely available for all CCGs and NHS Trusts to use, with permission to embed on their web pages.

Greenwich CCG has customised a version for its own local use, with a Greenwich intro and close, and Greenwich CHC staff interviews (see version below). Other CCGs or NHS Trusts wanting to add local branding such as introductions and staff interviews should visit the ‘How to embed NHS England’s CHC‘  page or for other projects visit our film page.

CHC full version (no menu)

Playlist version ( with menu You Tube menu button )

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Introduction

This film is a guide for people who may need ongoing care and support because of complicated, intense or unpredictable healthcare needs from a disability, accident or illness. It will explain how the NHS decides if someone’s care should be paid for entirely by the NHS. Care that is paid for entirely by the NHS is called NHS Continuing Healthcare. How NHS Continuing Healthcare works is described in the National Framework for NHS Continuing Healthcare, which is written by the Department of Health.

Because NHS Continuing Healthcare is such a long name, we will call it CHC.

This script is divided into sections. These are:

Introduction
Some important facts about CHC
Before the process starts…
Step 1 – The Checklist
Step 2 – The Full Assessment
Planning your support
Reviews, and
NHS Continuing Healthcare Fast-Track Pathway

If you want to move between sections, please use the menu.

Some important facts about CHC

CHC is available only for people who:

  • are 18 or older,
  • live somewhere like a care home or their own home, but not in a hospital setting,
  • and who have a ‘primary health need’.

CHC criteriaIt’s difficult to explain in a simple way what we mean by a ‘primary health need’, as it’s very complicated, with lots of different parts. One part is about your main need for care. Your main need for care should be because you have complicated, intense or unpredictable health needs from a disability, accident or illness. So if you have difficulty with things like breathing, eating and drinking, taking medicines, moving about, memory and thinking, or other difficulties, you may be eligible for CHC.

To find out if you are eligible for CHC, you need to go through a process with two different stages. Stage 1 – the Checklist – will be used to decide if you need to move on to Stage 2. Some people will not move on to Stage 2. Stage 2 is a full assessment, which should not take longer than 28 days, but sometimes there may be delays.

Before the process starts…

To start with, the person – or you – needs to give informed consent for the CHC process to happen, and for information about you to be shared between the health and social care workers involved. Informed consent means agreeing to something when you have full understanding of what could happen, and know all the possible risks and benefits. Your consent may be checked again, or you may be asked for your consent again, later in the CHC process.

It’s important that you understand as much as you can about CHC before deciding if you want to consent. For example, you need to know that if you are eligible for CHC, the NHS will become responsible for and will pay for all your care and support, but you might lose some welfare benefits.

If there are worries that you can’t give informed consent for any reasons, the Mental Capacity Act has to be used to prove you are not able to give consent.

If you can consent, then you decide whether you want the CHC process to happen.

If you can’t consent, a health or social care worker will normally be the decision-maker.

The decision-maker should talk with all the people who have real interest in you, like family, friends and care staff. The decision-maker listens to everyone and then decides if asking for CHC funding is the best thing for you. This is called a ‘best interests’ decision. Asking for CHC funding is usually the best thing to do, as if you are eligible, you do not pay anything towards the costs of your care.

The ‘best interests’ decision must be written down. The CHC process can only begin if the ‘best interests’ decision is that the process should start.

Step 1 – the checklist

CHC stage 1Step 1 in the CHC process is to complete the checklist.

This has to be completed by a social care worker or a health worker, like a nurse. They will meet with you to discuss your needs.

You can have an advocate with you, and friends or family, whoever is important.

The worker will ask about your health and the help you need.

If you have a person-centred plan or another plan, you can use this to help explain your needs.

The worker will need to talk to other people about your care needs, like your family or others who support you, and other health or social care workers who work with you.

The worker will use all the information to fill in the checklist. You should get a copy of this.

The results of the checklist show if you can go on to the next stage or not.

The checklist should be sent to the Clinical Commissioning Group, even if you are not eligible to go on to the next stage. We call the Clinical Commissioning Group the CCG.

If the checklist results show you are not eligible to move on to the full assessment, you can ask the CCG to think again about their decision.

Step 2 – the full assessment

The CCG will choose someone to co-ordinate the full assessment, so that you have a named person to check things with.

The full assessment has two parts – an assessment of your care needs, and the Decision Support Tool.

The care needs assessment must give accurate and up-to-date information about your health and social care needs. This information should come from you and your family, and a multi-disciplinary team involved in your care. (A multi-disciplinary team is a group of 2 or more professionals, who are different types of health and social care workers, like psychiatrists, nurses, social workers, care managers, occupational therapists, and so on, who work together.)

CHC Decission support toolThe multi-disciplinary team uses all of the information from your care needs assessment to complete the Decision Support Tool.

The finished Decision Support Tool helps the CCG decide if you should get CHC or not.

The Decision Support Tool has 12 sections, called Domains. Each domain helps you think about a different care need, and consider the sort of support and how much support is needed to manage it. The domains are:

  1. Behaviour – This is about the way you behave, like being aggressive or noisy, or being frustrated because you have difficulty communicating with others. Some behaviour is difficult for others to cope with, which is called ‘challenging’ behaviour, or some behaviours could be a risk to you, or other people, or things, and will need special support and care.
  2. Cognition – This is to do with brain skills, like memory, understanding risks, decision-making, understanding where you are, and road safety. This affects the type of support you need to manage your day-to-day life and stay safe from harm.
  3. Psychological and emotional needs – This is about your mental and emotional health, including things like mood disturbances, hallucinations, or anxiety. It’s also about the effects of these, like when people have depression they may get very withdrawn and refuse to accept help from others, which makes it harder for them to get better.
  4. Communication – This is about whether you can express your needs and understand others, in ways like talking or signing, use of pictures or Braille, hearing aids or other communication technology.
  5. Mobility – This is to do with how well you can move and control your body, and if you can stand or walk. It’s important to think about your safety, and if you are at risk of falling and need support.
  6. Nutrition – This is about whether you can eat and drink, and if you need help with this, like feeding by PEG, or if you have problems swallowing, like dysphagia.
  7. Continence – This is about your needs with using the loo, like whether you can control this, or if you need help with things like managing constipation, catheters, urinary tract infections, and so on.
  8. Skin – This is about looking after your skin. Some people are more at risk because they have a skin condition, which can break their skin down, or they may have pressure damage or wounds that take a long time to heal.
  9. Breathing – This is about your needs with any breathing difficulties you may have, like breathlessness, asthma, or Chronic Obstructive Pulmonary Disease.
  10. Drug therapies and medication – This is about your experience of your symptoms and the medication you need. This could mean things like coping with pain, insulin injections, any side effects, or if you need prompting and supervision with medication.
  11. Altered states of consciousness – This is about the conditions that affect consciousness, like having epilepsy or Transient Ischaemic Attacks (TIAs) which are like mini strokes.

Section 12 is for ‘other significant care needs’ that are not described in the other domains, if the care needs are really important for you.

The order in which you think about the domains doesn’t matter, as long as you think about ‘other significant care needs’ last.

Workers from the multi-disciplinary team write about your care needs for each domain. They also measure your needs with these weightings: ‘No needs’, ‘Low’, ‘Moderate’, ‘High’ and – for some domains – ‘Severe’, or ‘Priority’.

The domains and weightings are shown in a chart, called a matrix. This can give a good picture of all your needs together.

If all your care needs are measured as ‘No need’ or ‘Low need’, this shows that you are not eligible for CHC.

However, if your care needs include one ‘Priority’, or two or more ‘Severe’ weightings, then you are very likely to be eligible for CHC.

If your matrix shows a mix of different weightings, you may still be eligible for CHC because we also consider the Nature, Intensity, Complexity and Unpredictability of your needs.

CHC matrixNature: This describes what your needs are like, and the effect they have on you, including the type of support or treatment that works best to manage those needs.

Intensity: This describes how much (like how often) and how severe your needs are. It also describes the support needed to help you, including the need for ongoing care.

Complexity: This is about how your needs affect each other, like if one of your needs makes another need change or get worse, and become difficult to manage. It also describes the level of skill needed to check your symptoms, treat the condition and/or manage your care.

Unpredictability: This is about how much and how often your needs can change, and what the challenges are for the people who give you care and support. It should also explain the risk to your health if the right care is not given at the right time. Someone with an unpredictable healthcare need is likely to have a changeable and unstable condition, or a quickly deteriorating condition.

The Decision Support Tool helps health and social care workers identify and describe your needs. With this knowledge and their skills and professional judgement, they work out if you have a primary health need, and if they think you are eligible for CHC. This is called their recommendation.

When the care needs assessment and Decision Support Tool are complete, you need to check if you agree with what has been written about you.

The multi-disciplinary team can give you a copy of all the forms and documents that have been written.

The documents and the recommendation are also shared with the CCG, and the CCG decides if they agree with the recommendation. The CCG usually agree with the recommendation from the multi-disciplinary team, unless there are very strong reasons why they can’t. You will then get a letter from the CCG saying whether you are eligible for CHC.  If you are not eligible, the CCG should explain why.

If the CCG decides you should not have CHC, you can ask them to think again about their decision. And if you’re still unhappy with the CCG decision, you can then ask for an independent review from NHS England.

If you aren’t eligible for CHC, the NHS may still have a responsibility to provide you with care and support to help you manage your health needs, like by commissioning services, or paying for some of your help and support.

Care that is commissioned or paid for by a local authority and a CCG is called ‘joint-funding’ or a ‘joint package’.

If your care is paid for by the CCG and the local authority together, you may have to pay a contribution (or part of the cost) for your social care. The CCG will not charge you for the NHS care you need.

If you’re not eligible for joint funding, you may be eligible for support from your local authority.

Planning your support

If you are eligible for CHC, the next step is to agree on your health and wellbeing goals, and the care you will get. This is called ‘planning your support’. A CHC nurse will work with you to make your Support Plan. They will talk with you about:

  • the health and wellbeing goals you want to achieve
  • the care and support you need in your day-to-day life
  • how your needs and care will be managed
  • where your care will be given, like, in your own home or in a care home, and
  • which organisation/s will be responsible for meeting your needs

CHC support plan

Your wishes should be an important part of the decisions that you both make together.

It is possible to use CHC funding to continue with any care or support you were already getting. You would only do this if the care you had was good quality, and met your needs.

It’s also important that any support or care is what you would choose for yourself, as long as it doesn’t cost more than the NHS can afford to pay. For this reason, anyone eligible for CHC has the right to have their CHC funding as a personal health budget.

Personal health budgets give people real choice and control over how to meet their health and care needs.

Personal health budgets work in a similar way to personal budgets from social care services. They work in 3 ways (or a mix of these), which are:

  1. The money can be held by the NHS
  2. The money can be held by an organisation that you choose or agree to
  3. The money can be held by you as a Direct Payment for healthcare, so you buy and manage your own care.

A personal health budget is not new money. It just allows you to use NHS funding to plan your care in different ways, ways that work better for you.

Reviews

If you are eligible for CHC and your care package is started, the CCG will check things with you after 3 months. They will check to see if the care you get is meeting your needs and goals, and if CHC is still needed. This is called a review.

After that, the CCG will meet with you every year for a review. Each review will check to see:

  • if your needs and goals are being met
  • if your care package still fits your needs, and
  • if you are still eligible for CHC.

NHS Continuing Healthcare Fast-Track Pathway

If you have a health condition that is getting much worse quickly, and you are near the end of your life, you may be eligible for the CHC fast-track pathway. This is when things are done very quickly, so you can get treatment and support as urgently as possible.

To get your care fast-tracked, a doctor or other health professional has to complete one referral form called the Fast-Track Pathway Tool. This form is used to explain that you have a quickly deteriorating health condition, and that you may be near the end of your life. This form goes to the CCG.

CHC fast-track

Fast-track referrals from health professionals are usually accepted straightaway, but the CCG may need to check some information, if they have any questions.

The Checklist, Health Needs Assessment and Decision Support Tool are not used if you need fast-track care. But if your health improves or stabilises while you’re on the fast-track pathway, a full CHC assessment will be completed. This helps the CCG check if you still need CHC.
To find out more about NHS CHC in Greenwich, email or phone the CHC team at Greenwich Clinical Commissioning Group.
Email is greccg.continuingcare@nhs.net
Phone number is 020 3049 9000
Greenwich CCG

NHS Greenwich CCG would like to thank the following people from or for Enabled City, Greenwich Association of Disabled People, NHS England, NHS Greenwich CCG, The Royal Borough of Greenwich and Symbi Consulting for their help and advice in making this film.

Alan Colhoun, Aissa Damree, Mary Donkor, Alan Kerr, Jim Ledwidge, Alick Mackenzie, Lisa Mackenzie, Jason McCulloch, Gary McKenzie, Colette Meehan, Elaine Newman, Trish O’Gorman, Buki Omopariola, Rosie Robinson, Karen Scarsbrook, Vee Scott, Simon Shenton-Tan, Smriti Singh and Jason Yates.