NHS Continuing Healthcare (CHC) refers to a package of ongoing care that is arranged and funded solely by the NHS where the individual has been assessed and found to have a ‘primary health need’ as set out in the National Framework (see External Links). Such care is provided to an individual aged 18+ to meet health and associated social care needs that have arisen as a result of disability, accident or illness.
NHS-funded Nursing Care (FNC) is a flat rate contribution provided by the NHS to care homes with nursing to support the provision of nursing care by a registered nurse. In all cases, individuals should be considered for eligibility for CHC before a decision is reached about the need for FNC. Nursing homes should inform the CHC team of any new admissions so that the necessary assessments can be undertaken in a timely manner and eligibility for any funding determined.
NHS CHC in Islington and Haringey
The CHC service for Islington and Haringey is delivered by the Whittington Health (WH) CHC team.
Services provided include:
- complete CHC assessments
- case management of individuals with complex care needs
- support individuals in self-management of care needs
- set up personal health budgets
- mental capacity assessments
- complete relevant assessments and documents in relation to application to the courts for Deprivation of Liberty in the community
- carry out regular reviews of care packages in and out of borough
- order specialist equipment which is outside of commissioned NHS care
- monitor the performance and quality of care delivered by commissioned care agencies and care in nursing homes
- work with acute hospitals in facilitating timely and safe discharges
- provide CHC training to relevant partners
- work in collaboration with local authorities and other relevant clinicians to review individuals’ care needs
- hold local resolution meetings to hear appeals
- work with safeguarding services within and outside of the borough
- work in conjunction with the local integrated discharge teams to support safe discharge and identifying those cases that may require CHC input.
Application for CHC assessment
The first step to CHC application process is to screen if an individual requires a full CHC assessment. This is done by completing a NHS Continuing Healthcare Checklist (see Downloads), which is a screening tool to help identify those people who are eligible for a full assessment for CHC.
This initial checklist can be completed by a variety of professionals who are knowledgeable in the checklist screening assessment, which may include GPs, social care workers and other healthcare professionals.
If the completed checklist shows that a CHC assessment is required by the WH CHC team, a referral must be made to the CHC team using the completed checklist as the referral document.
How to refer for a CHC assessment
A completed checklist, regardless of the outcome, should be sent to the relevant borough CHC team (see CHC contact details, below).
All checklists should be logged by the relevant borough CHC team in order to keep a record of those that have been considered for a CHC assessment.
How to submit a completed Decision Support Tool (DST) to the CHC team
If a CHC assessment is completed by any other multidisciplinary team (MDT) members, the DST (see Downloads) and relevant papers must be submitted to the WH CHC team, who will then present the assessment to NCL CCG for ratification.
In instances where the MDT have been unable to reach an agreed MDT recommendation, NCL CCG will be responsible for organising a CHC panel in order for a decision to be reached on eligibility. Panel members will comprise of a representative from both NCL CCG and the responsible local authority. They may ask for MDT members to attend if they feel more information is required.
To avoid delays, when submitting a DST for ratification, please ensure the following are provided:
- copy of signed consent for the assessment and information sharing
- if applicable, mental capacity assessment form
- names of MDT members, their signatures and date of signatures
- a clear MDT eligibility recommendation.
Email DST and relevant papers to the relevant borough CHC team (see CHC contact details, below).
Fast track pathway
A fast track referral can be made to the CHC team for an individual who has a rapidly deteriorating condition and the condition may be entering a terminal phase.
The purpose of a fast track application is to enable an individual to receive full NHS-funding for a care package to provide appropriate end-of-life support, either in their own home or in a care setting. The CHC team will consider the application urgently to enable funding is approved for a relevant care package to meet the individual’s care needs.
To refer via the fast track pathway, a Fast Track Tool and Care Plan (see Downloads) must be completed by an 'appropriate clinician' and emailed to the directly to the responsible CHC team.
An 'appropriate clinician' is defined in the framework as a person who is:
- responsible for the diagnosis, treatment or care of the individual under the 2006 Act in respect of whom a Fast Track Pathway Tool is being completed; and
- a registered nurse or a registered medical practitioner.
Discharge to Assess (D2A)
The D2A pathway aims to enable CHC assessments to be completed in the community instead of in the hospitals.
The hospital setting is recognised as an institutional and unfamiliar place that can disable people, limiting their abilities to manage their activities of daily living independently in a way that does not reflect a true picture of the individual’s health and care needs.
As part of the D2A pathway, up to four weeks of funding can be given to an individual whilst the necessary assessments are completed. This should include CHC assessments (where required) and Care Act Assessments.
Once an individual is identified by the hospital as being medically safe for discharge, the Integrated Discharge Team (IDT) will refer to either CHC or Adult Social Care to organise and manage the care during this four weeks. A CHC checklist should be completed within two weeks of discharge by the service providing care. If the checklist indicates a full assessment is required, this will be co-ordinated by the CHC team.
Referrals for D2A funding can only be made at the point of discharge from a hospital setting and should be agreed by the local IDT. CHC clinicians form part of the IDT and can advise on any case that may meet the criteria to be managed by the CHC service whilst an assessment for longer term care is completed.
CHC contact details
Whittington Healthcare Continuing Healthcare Team
Hornsey Rise Health Centre
Main office numbers:
Haringey: 020 3316 8740
Islington: 020 3316 8706
Main team emails:
- aged 18+
- registered with an Islington or Haringey GP.
- eligible for S117 and their primary care needs are mental health
- still undergoing active treatment or rehabilitation and have not reached their optimum recovery.
How to refer