Understanding CHC – Continuing Healthcare Funding from the NHS

Continuing Healthcare (CHC) funding in the UK is a package of care provided by the National Health Service (NHS) for individuals with complex and ongoing healthcare needs. It is designed to cover the costs of care at home or in nursing or residential care for people who have significant healthcare needs that go beyond what can be provided by routine or general practitioner services. This week, our resident expert looks at a complex and poorly understood process, that of the CHC assessment.

1. Assessment Process: To determine eligibility for CHC funding, individuals undergo a comprehensive assessment known as the Continuing Healthcare Assessment. This assessment considers various aspects of a person’s health and care needs to determine the level of support required. It’s a 2 stage process – the first stage can be completed by any professional involved in the person’s care and is a questionnaire-based exercise. If enough points are accumulated from this questionnaire process, a referral for 5 a full assessment can be made to the local CHC assessment team.
2. Criteria for Eligibility: CHC funding is generally provided to individuals who have complex, severe, and unpredictable healthcare needs. The eligibility criteria are not based on a specific medical condition but rather on the overall impact of the health needs on daily living.
3. Types of Care Covered: The funding covers a wide range of care needs, including healthcare provided in a variety of settings such as the person’s home, a care home, or a hospice. It may include nursing care, personal care, and other healthcare services.
4. Financial Assessment: Unlike social care, which may be means-tested, CHC funding is not means-tested. It is based on an individual’s healthcare needs rather than their ability to pay.
5. Care Planning: Once eligibility is established, a care plan is developed to address the specific needs of the individual. The care plan outlines the services and support required to meet the person’s healthcare needs.
6. Review Process: CHC funding is not necessarily a permanent arrangement. Reviews are conducted periodically to assess whether the individual’s needs have changed and if the level of support remains appropriate.

While Continuing Healthcare (CHC) funding in the UK is intended to provide support for individuals with complex and ongoing healthcare needs, there have been concerns and challenges associated with the system. Some of the common problems include:

1. Eligibility Criteria and Assessment Process: The criteria for determining eligibility can be complex, and there have been instances where individuals with significant healthcare needs were deemed ineligible. The assessment process may vary, and there can be inconsistencies in how different assessors interpret the criteria.
2. Subjectivity in Decision-Making: Decisions about CHC funding can be subjective, and there may be variations in assessments between different healthcare professionals. This subjectivity can lead to disputes and challenges from individuals and their families who believe they should qualify for funding.
3. Communication and Transparency: There have been concerns about the lack of clear communication and transparency in the CHC process. Individuals and their families may find it challenging to understand the criteria, the assessment process, and the reasons behind decisions.
4. Delays in the Assessment Process: The assessment process for CHC funding can be time-consuming, leading to delays in individuals receiving the necessary support. This delay can be particularly problematic for people with urgent and complex healthcare needs.
5. Lack of Awareness: Some individuals who may be eligible for CHC funding are not aware of its existence or how to apply for it. This lack of awareness can result in people not accessing the support they need.
6. Appeals and Disputes: Individuals who are dissatisfied with the outcome of their CHC assessment may need to go through an appeals process. This can be a stressful and lengthy process, and there have been concerns about the complexity of the appeals system.
7. Variability in Local Policies: There can be variations in how CHC funding is implemented across different regions, leading to inequities in access to healthcare support.
8. Integration with Social Care: CHC funding focuses on healthcare needs, but there can be challenges in coordinating and integrating it with social care services. This can result in fragmented care for individuals who require both healthcare and social support.
9. Funding Pressures: Like many aspects of the healthcare system, CHC funding may face financial pressures. Budget constraints can impact the availability and delivery of services.
10. Changes in Policy: Changes in government policies and guidelines can impact the eligibility criteria and availability of CHC funding, leading to uncertainties for individuals and their families.

Continuing Healthcare (CHC) funding in the UK is designed to cover the costs of care for individuals with significant and complex healthcare needs. While dementia is a serious and often complex condition, not all individuals with dementia automatically qualify for CHC funding. The eligibility for CHC funding is determined based on the overall impact of an individual’s health and care needs, regardless of the specific diagnosis.

The criteria for CHC eligibility focus on the intensity and nature of the healthcare needs, considering factors such as the level of dependency, the complexity of care required, the unpredictability of the condition, and the need for skilled medical interventions. It is not about the diagnosis itself but about the impact of the health needs on an individual’s ability to carry out everyday activities.

People with dementia may or may not meet the criteria for CHC, depending on the severity of their symptoms, the level of support required, and the overall impact on their health and well-being. Some individuals with dementia may have healthcare needs that are primarily met through social care or residential care services, rather than through the specific healthcare interventions covered by CHC.

Getting the most out of a Continuing Healthcare (CHC) assessment involves being well-prepared, actively participating, and ensuring that all relevant information about the individual’s healthcare needs is considered. Here are some tips to help you maximise the CHC assessment process:

1. Understand the Process:
   • Familiarise yourself with the CHC assessment process and the eligibility criteria. This information is often available from local NHS authorities or healthcare professionals.
2. Gather Relevant Information:
   • Collect and organise all relevant medical records, assessments, and documents related to the individual’s healthcare needs. This may include information about diagnoses, treatments, medications, and any recent changes in health.
3. Create a Care Diary:
   • Keep a detailed diary or record of the individual’s daily care needs and any specific challenges or changes in health. This can serve as valuable evidence during the assessment.
4. Identify Key Healthcare Needs:
   • Clearly outline the individual’s primary healthcare needs. Focus on aspects such as mobility, personal care, communication, cognition, and any medical interventions required.
5. Involve Healthcare Professionals:
   • Request that relevant healthcare professionals, such as doctors, nurses, or specialists involved in the individual’s care, provide written assessments or attend the assessment meeting. Their input can carry significant weight.
6. Prepare for the Assessment Meeting:
   • Prioritise attending the assessment meeting, and be prepared to discuss the individual’s healthcare needs in detail. Bring all relevant documents and be ready to provide specific examples of challenges faced.
7. Communicate Effectively:
   • Clearly and effectively communicate the individual’s healthcare needs, emphasising the impact on daily living and quality of life. Use specific examples to illustrate the challenges faced.
8. Ask Questions:
   • Don’t hesitate to ask questions during the assessment process. Seek clarification on any aspects that are unclear, and ensure that you fully understand the criteria and decisions being made.
9. Highlight Unpredictability and Complexity:
   • Emphasise any aspects of the individual’s healthcare needs that are unpredictable or complex. The eligibility criteria for CHC funding include considerations of unpredictability and complexity.
10. Appeal if Necessary:
    • If the initial assessment outcome is not favourable, be aware of the appeal process. You have the right to challenge decisions and provide additional evidence to support your case.
11. Seek Advocacy Support:
    • Consider seeking support from advocacy groups or professionals experienced in CHC assessments. They can provide guidance and assistance throughout the process.
12. Stay Informed:
    • Stay informed about any changes in CHC policies or guidelines. Policies may evolve, and staying informed ensures that you are aware of the most current information.

Remember that CHC assessments can be complex, and it’s important to approach them with a proactive and informed mind-set. Seeking advice from healthcare professionals and advocacy services can be beneficial in navigating the process successfully.