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NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) specifically for the relatively small number of individuals (with high levels of need) who are found to have a ‘Primary Health Need’ (see more in Primary Health Need section below). Such care is provided to an individual aged 18 or over to meet health and associated social care needs that have arisen as a result of disability, accident or illness.
NHS Continuing Healthcare is free, unlike support provided by local authorities, which may involve the individual making a financial contribution depending on income and savings. It is the responsibility of the NHS Derby and Derbyshire Integrated Care Board to decide the appropriate package of support for someone who is eligible for NHS Continuing Healthcare.
Contact for all continuing health care enquiries for Derby and Derbyshire
- Tel: 01332 401821
What is NHS continuing healthcare?
NHS continuing healthcare is NHS funded care provided outside of hospital. It is arranged and funded by Integrated Care Boards for people aged 18 years and over who have significant ongoing healthcare needs who are either receiving long-term care or who may be at the end of their life and need care and support to meet their palliative care needs.
To establish whether a person is entitled to have their care paid for with NHS continuing health care, they first need to be assessed to determine whether they have a primary health need and are therefore eligible to receive NHS continuing health care funding. The process to determine eligibility is nationally defined, so we follow a standard process and use standard assessment tools to collect information to decide whether someone is eligible. The national assessment tools can be found on the Government website.
Who is eligible for continuing health care?
There is a National Framework which states that eligibility should be based on someone’s healthcare needs and not their diagnosis. It is not linked to savings or income levels.
Many people who are assessed for continuing health care 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 for many years. This includes people with physical disabilities, learning disabilities, older adults with complex physical and psychological needs as well as young people transitioning from childhood to adulthood who become entitled to receive NHS continuing health care, if eligible, at the age of 18.
NHS continuing health care is not forever, only for as long as someone has complex care needs that result from their having a primary health need.
How is continuing health care assessed?
For most people, the assessment process for continuing health care involves an initial screening and then a full assessment. After the full assessment, a recommendation will be made to the Integrated Care Board about whether the patient is eligible.
The initial screening is usually carried out by a health or social care professional who knows the individual and uses the checklist to decide whether people need a full assessment. The person who completes the checklist will send it to the continuing health care team.
The full assessment is usually carried out by a registered nurse employed to work for the NHS along with a group of health and social care professionals who have been involved in the patient’s care. They are known as a multidisciplinary team. Health and social care professionals must use their professional judgement at both the screening and full assessment stages when undertaking an assessment. They will consider the person’s combined healthcare needs across 11 domains (areas of need) to complete an initial checklist and across 12 domains to undertake the full assessment.
The multidisciplinary team will then make a recommendation to the Integrated Care Board about whether the person has a primary health need and is eligible and the Integrated Care Board will make the final decision.
In Derby and Derbyshire this assessment is led by staff employed by Midlands and Lancashire Commissioning Support Unit.
Individuals will have their care needs reviewed three months after their positive eligibility assessment and then annually. This is to ensure that the care provided is still relevant and providing the right support, as well as ensuing that continuing healthcare is still indicated. Where a care needs review identifies a change in needs that suggests continuing health care is no longer indicated a full assessment will be planned with the multi-disciplinary team to determine ongoing eligibility.
Children and young people’s continuing care
Personal Health Budgets and Continuing Health Care
If you’re eligible for NHS continuing healthcare, you have the right to a personal health budget. These allow more choice and control over the services and care you receive and can be used to pay for a wider range of items and services, including therapies, personal care and equipment.
A personal health budget is an amount of money to support your individual health and wellbeing needs, as agreed between you and your local NHS team. Your health and wellbeing needs will be set out in a personal centred care and support plan which will be developed by you together with a health care professional. How the budget will be used to support your health and well-being needs will be set out in this plan and agreed by both yourself and the local NHS team.
Arrangements for managing this budget will be agreed between yourself/ your representative and the continuing health care team.
Personal health budget support the vision of a more personalised, patient-focused NHS. NHS England’s website has more information and advice about the new scheme. Find out more about personal health budgets on the NHS website.
Currently, only individuals in receipt of NHS continuing healthcare, and in the case of children and young people, continuing care, have the right to have a personal health budget – although Integrated Care Boards can offer personal health budgets to other groups if appropriate.
Derby and Derbyshire Integrated Care Board also offers non-continuing health care personal health budgets to anyone eligible adult or child. Check out our section on PHBs for more information.
Requesting to appeal a continuing health care eligibility decision
If you wish to lodge an appeal against the outcome of a continuing health care assessment where a decision support tool has been completed, you can do so for the following reasons:
- You disagree with the outcome of the decision support tool
- You do not consider that the process used was in line with the National Framework
- You do not consider that the correct evidence was considered at the assessment.
Appeal requests must be received by the Integrated Care Board continuing health care service no later than six months from the date recorded on the continuing health care outcome letter identifying non-eligibility for continuing health care funding. This time frame may be extended in exceptional circumstances.
Patient or their representative should write to Continuing Health Care Retrospective Review and Disputes (Appeals) Team, Midlands and Lancashire CSU, Jubilee House, Lancashire Business Park, Leyland, PR26 6TR
The purpose of Derby & Derbyshire ICB’s Local Resolution Appeals Process:
- To establish that the patient had been comprehensively assessed to allow full consideration in respect of their care needs.
- To establish that the procedures used in the original multi disciplinary team were compliant with those laid down in the National Framework for NHS Continuing Healthcare and NHS Funded Care.
- To ensure that the application of the criterion within the National Framework has been properly and consistently applied.
- To ensure this is a robust documentation in respect of the decisions made inclusive of the decision-making rationale.
Stage one of the appeals process is to attempt to resolve any concerns initially through an informal two-way meaningful discussion between the ICB representative and the individual and/or their representative. There will be a written summary of this for both parties. The discussion will be an opportunity for the individual or their representative to receive clarification of anything they have not understood. The ICB will explain how it has arrived at the decision regarding eligibility, including reference to the completed Decision Support Tool and primary health need assessment. Where required this will also be an opportunity for the individual or their representative to provide any further information that had not been considered.
Following this it may be necessary to proceed to stage two of the Local Resolution Process.
Stage two involves a formal meeting between the ICB the individual and/or their representative. To facilitate this, the ICB may require additional information, including records and reports. Once all the information has been gathered by the ICB the meeting will be arranged. The individual will be able to put forward the reasons why they remain dissatisfied with ICB’s decision.
The outcome of the formal meeting will be communicated to the individual and/or their representative within 4-6 weeks of the meeting. The individual and/or their representative will receive a full record of the deliberations of the meeting. Clear and evidenced written conclusions on the process followed by the continuing health care team and on the individual’s eligibility for NHS Continuing Healthcare, together with appropriate recommendations on actions to be taken.
In the event you remain dissatisfied, stage three of the appeals process is that you are entitled to submit a request for an independent review to NHS England, which is the organisation responsible for the Independent Review Process to consider your case, this would need to be submitted in writing within 6 months of the outcome of Local Resolution Panel.
Part of the appeals process is that we will ask that you complete a consent form, doing this will enable the appeals team to request the relevant health and social care records for the appeal.
Should you require assistance or advice relating to the appeal process the following organisations can offer support:
- Healthwatch
- Age UK
- The Advocacy People – can provide you with support if you wish to make a complaint regarding the Continuing Healthcare process.
- A variety of third-party advocacy service can also offer support.
Whilst you have the right to seek legal advice or advocacy support, this should not be necessary and may incur a significant cost to yourself which the NHS will not reimburse.
If a Solicitor is appointed, it is important for them to be aware that the appeal meetings are not a legal process. Chairs of appeal meetings will not allow discussions to be held on points of law.
Fast-track to continuing health care funding
If your health is rapidly deteriorating and you may be entering the terminal phase, you should be considered for the NHS continuing health care fast track funding, so that an appropriate care and support package can be put in place as soon as possible. NHS continuing healthcare fast track funding provides an urgent package of care in the last days or weeks of life.
In the fast-track pathway there is no requirement to complete a checklist or the decision support tool. Instead, an appropriate clinician will complete the fast track tool to establish your eligibility for NHS Continuing Healthcare.
This clinician will send the completed fast track tool directly to your ICB, which should arrange for a care package to be provided for you, normally within 48 hours from receipt of the completed fast track pathway tool.
How to contact NHS continuing health care
Anyone can ask for a continuing health care assessment.
If you feel that you, a family member or someone you care for might be eligible for NHS continuing health care, then you can speak to:
- a member of the clinical team involved in your/their care
- your social worker (if applicable)
- contact the CHC team
The Council House, First Floor, Corporation Street, Derby, DE1 2FS
Tel: 01332 401821 or email mlcsu.derbyshirechcreferrals2@nhs.net
Our website is: https://www.midlandsandlancashirecsu.nhs.uk/
Continuing health care for adults commissioning policy
The continuing health care for adults commissioning policy describes the way in which the ICB will plan and commission services for people who have been assessed as eligible for an episode of fully funded NHS Continuing Healthcare, and patients who are eligible for continuing health care who wish to have a personal health budget. It also sets out ICB principles for joint funded packages of health and social care.
