Continuing Healthcare or CHC describes healthcare that is provided by the NHS for those with long term health needs. This can include care at home, as well as institutions such as nursing homes. As with most NHS care, it is free of charge.
To qualify for CHC, your local clinical commissioning group (CCG) must decide that you have a primary healthcare need. Such a need can be distinguished from a social care need, which may not require specialist equipment or training to deliver. So for example, personal care will often be deemed a social care need. However the critical factor is the overall health of the person receiving care.
To assess whether someone has a primary healthcare need, a checklist is completed by a health professional. If this indicates there may be such a need, a full assessment is carried out, by a multidisciplinary team (MDT). They use a toolkit, which scores needs in different areas of health, before looking at the overall result. They also look at factors such as the complexity of needs and extent to which they overlap.
Assessments are meant to involve patients and their families and carers, since it is difficult to get an accurate picture of someone’s needs, without speaking to them and those providing care. Despite the use of the toolkit, the outcome of assessments can be contentious, as there is a degree of subjectivity about how needs are rated and how this feeds into whether a patient qualifies for CHC.
Whether someone qualifies is important, because social care is not provided by the NHS, unless as part of a CHC package. So if needs are not deemed serious enough to meet the CHC threshold, then they generally come within the description of social care and the local authority has to meet them. Local authority care is means tested, and often patients will have to pay for some or all of their care. Over time this can amount to a very a significant sum, sometimes requiring patients to sell their property to cover the cost.
The situation is further complicated by the possibility other arrangements, such as joint funding packages, so a mixture of NHS and local authority care, and NHS nursing care, to cover nursing needs. Generally though, these packages provide a lower level of NHS care than fully funded CHC.
Many people find the process of dealing with MDT’s quite daunting, because they don’t have the time or knowledge to understand how a decision has been reached and to challenge that if they think it’s wrong. CCG’s who ultimately make the decisions, though they are meant to follow the MDT’s recommendation, have a vested financial interest in not finding patients eligible for CHC. There is an alarming degree of difference in eligibility rates across the country, suggesting that the criteria are not being applied consistently.
There are a number of ways to challenge decisions, including internal appeals and then taking the case to external bodies, such as NHS England or the Parliamentary and Health Service Ombudsman. There is also the option of court action, via a judicial review, though this should be a last resort.
I made a special study of CHC as part of my Master’s Degree in Healthcare Law, completed in 2019, and am therefore up to date on the latest developments, including the 2018 statutory guidance. I am also able to call on the experience of colleagues within Scott-Moncrieff, including leaders in this field.
Because each case is different, it is not possible to quote a fee without knowing the specifics, but in the majority of cases I should be able to offer a fixed fee once we have spoken and, if applicable, I have reviewed some of the documents. I do not charge for an initial chat, or any document review undertaken prior to agreeing a fee, so you have nothing to lose by getting in touch.
The fact that I work under Scott-Moncrieff and have lower overheads than traditional firms, means that the charges should compare very favourbly with others in this specialist field.
Please see my video for further information.