NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. To receive NHS CHC funding, you must be assessed by Clinical Commissioning Groups (CCGs) according to a legally prescribed decision-making process to determine whether you have a ‘primary health need’. If your GP falls within one of the 6 Borough’s that make up South West London, we will be the CCG conducting the assessment in line with the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care. You will be fully involved in the assessment and this is usually undertaken with a representative from the local authority.
For individuals that have rapidly deteriorating condition, and the treating healthcare professional considers that they are for End of Life of Care, then a Fast-Track application can be submitted, with your permission, by the healthcare professional for NHS CHC funding.
Eligibility, when a full assessment is undertaken, is not dependent on a particular disease, diagnosis, or condition, or on who provides the care or where it’s provided. If your overall assessment of care shows that you have a ‘primary health need’, you may be eligible.
If you are eligible for NHS CHC, the next stage is to arrange a care and support package that meets your assessed needs. Depending on your situation, different options could be suitable, including support in your own home and the option of a Personal Health Budget (PHB). Care and support can also be provided in a nursing home facility should the need for 24-hour care be required. Your care and support needs will be reviewed at three and twelve months. If there is a change in care needs, a full assessment of eligibility will be undertaken.
We will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, we can also take other factors into account, such as safety, cost, and value for money of the different options.
NHS England and NHS Improvement have developed a useful YouTube video that covers all the aspects of NHS CHC. Or if you prefer, the links are below to each section of the video:
- Important facts about CHC
- Before the process starts
- The Checklist
- The Full Assessment
- Planning your support
- Fast-Track Pathway
For further information and literature regarding NHS Continuing Healthcare including the decision-making process and timelines, see the below links:
- NHS CHC Information on NHS England Website
- NHS CHC Information on NHS UK Website
- National Framework for Continuing Healthcare and NHS-Funded Nursing Care
- NHS CHC Public Information Leaflet
Requesting a Continuing Healthcare assessment
To discuss your needs or make an enquiry about Continuing Healthcare, your registered GP, healthcare professional or Social Worker should be your first port of call. Alternatively, you can contact the local CHC team in your area:
- Croydon: 020 3668 1900 or firstname.lastname@example.org
- Kingston and Richmond: 020 3968 2390 or email@example.com and firstname.lastname@example.org
- Merton and Wandsworth: 020 3957 5053, 020 3957 5054 or 020 3957 5057 email@example.com
- Sutton: 020 8687 4802 or firstname.lastname@example.org
Appealing a Continuing Healthcare decision
If you are assessed and found not eligible for NHS CHC you or your representative can appeal the decision directly. If you ask a solicitor, claims firm, independent advocate or other third parties to act on behalf of the patient or their authorised representative we will need written authority for them to act.
If you choose to involve a solicitor or claims firm, you will be responsible for the payment of any fees charged and South West London Clinical Commissioning Group cannot refund those costs.
All requests to appeal a decision must be made in line with our Appeals Policy and no later than six months from the date of the initial decision. Please note the recommendation remains in place throughout the appeals process.
NHS England recognises that information and support are vital to all individuals involved in the CHC process and so has funded an independent information and advice service through a social enterprise called Beacon. This service is supported by a consortium of leading voluntary sector organisations including Age UK, Parkinson’s UK, and the Spinal Injuries Association.
Information and advice are accessible in the form of free and comprehensive written guidance, and individuals are also able to access up to 90 minutes of free advice with a trained NHS Continuing Healthcare adviser by calling 0345 548 0300. For more information visit the Beacon website.
Fast-Track Continuing Healthcare
If your health is deteriorating quickly and you’re nearing the end of your life, you can be considered for the NHS CHC fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours. Your healthcare professional will need to make a referral on your behalf to the local CHC team in your area.
NHS Funded Nursing Care (FNC)
If you’re not eligible for NHS CHC, but you’re assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you’ll be eligible for FNC.
This means that the NHS will contribute towards the cost of your registered nursing care. FNC is available irrespective of who is funding the rest of the care home fees. Payments are made directly to the care home and are an amount set each year by the Department of Health and Social Care.
If you are eligible for NHS CHC and receiving a care and support package from a provider, NHS South West London CCG has a responsibility as the responsible commissioner to ensure the provider is appropriately registered, regulated and submits regular pseudonymised quality information to us.
Upon eligibility, and whereby no current care provider is already in place, we will aim to use a provider registered on the Pan-London CHC Domiciliary Care AQP framework or the Pan-London CHC Nursing Home AQP framework. The providers on this framework must meet strict quality and reporting standards which give us a better level of assurance around the care they provide.
However, if you already have your care arrangements in place, particularly in cases of end of life care, providing it’s clinically safe, you can continue to use these.
We encourage you as a service user, to inform us of any issues that may arise with a provider. This will enable us to investigate your concerns and act appropriately. To raise an issue, please get in contact with your local CHC team in your area using the contact details above. Similarly, if we are notified by the provider of any concerns or incidents, we may conduct a wellbeing call or visit.
We send our contracts for Nursing Care and Residential Care Homes, Domiciliary Care and Children’s Services via DocuSign for electronic signatures and processing. Providers can use the links below for support: