The National Health Service (NHS) Continuing Healthcare (CHC) is a funded care package arranged and paid for by the NHS for adults with severe, complex or unpredictable long-term health needs. It is not means-tested meaning that eligibility depends entirely on the person’s health needs rather than his/her financial savings/income. Persons granted NHS CHC are protected from charges for the services funded under the scheme and the NHS has a duty to meet all assessed eligible needs.
The rules, principles and procedures for obtaining NHS CHC are set out in a policy document called the National Framework here.
Where to start?
The first step to obtain NHS CHC is by completing an initial screening with the CHC Checklist, which is a screening tool used to identify individuals who may require a full assessment. It should be completed by a health or social care professional who is trained in the CHC process, is familiar with the person’s care needs and has enough evidence to score each domain properly.
When the NHS Checklist should be completed?
It is not necessary to complete the CHC Checklist in every case, such as when practitioners are satisfied that there is no need for NHS CHC at the time and when the person has short-term health needs only. It only needs to be completed when it appears that the person may require NHS CHC, particularly where there is evidence of significant care needs and there is uncertainty about the division of responsibilities between the NHS and local authority.
How the CHC Checklist is scored?
The CHC checklist covers 11 care domains each scored at the levels A (high), B (moderate) or C (low) with A being the highest level of need.
A positive CHC Checklist outcome – meeting the criteria for a full assessment – requires the person to score one of the following combinations:
- Two or more As;
- Five or more Bs;
- One A and four Bs; or
- One A in certain domains (i.e. behaviour, breathing, medications or altered states of consciousness).
The threshold is intentionally low to ensure all those who may be eligible for NHS CHC are referred for a full assessment.
What are the common errors in scoring?
Common errors are:-
- Misinterpretation of domain descriptors;
- Underestimating well-managed needs;
- Basing scores on diagnosis, setting or input rather than needs; and
- Insufficient evidence or rationale.
What happens if the CHC Checklist outcome is negative?
The person may request the Integrated Care Board (ICB), who makes the final decision on NHS CHC, to reconsider the outcome. The ICB should give due consideration to such request but is not obliged to complete a further CHC Checklist unless new information justifies it.
There is no requirement to review/repeat a negative CHC Checklist after a particular period. However, if needs change, it may be appropriate to complete a new CHC Checklist.
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