NHS Continuing Healthcare (CHC) means a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a primary health need as set out in this National Framework. Such care is provided to an individual aged 18 or over, 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 NHS Continuing Healthcare before a decision is reached about the need for NHS-funded Nursing Care. 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. 

CHC in NCL (Barnet, Camden and Enfield)

CHC services for Barnet, Camden and Enfield are commissioned and delivered by NCL ICB directly. 

Services provided by the CHC team for those who are in receipt of CHC funding 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
• work with NHSE once a referral has been made to the Independent Review Panel following an appeal. 

Application for CHC assessment

The first step to the CHC application process is to screen if an individual requires a full CHC assessment. This is done by completing an NHS CHC Checklist, which is a screening tool to help identify those people who are eligible for a full assessment for NHS 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
• other healthcare professionals.

If the completed checklist shows that a CHC assessment is required by the Whittington Health (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 CHC team using the email address provided below.

All checklists should be logged by the 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 multi-disciplinary team (MDT) members, the Decision Support Tool (DST) and relevant papers must be submitted to the WH CHC Team, who will then present the assessment to NCL ICB for ratification.

In instances where the MDT have been unable to reach an agreed MDT recommendation, NCL ICB 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 ICB 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 is made

Email DST and relevant papers to: nclicb.chc@nhs.net

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 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
• registered nurse or a registered medical practitioner.

Discharge to Assess (D2A)

The Discharge to Assess (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 which do 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 (ASC) for 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(s) that may meet the criteria to be managed by the CHC service whilst an assessment for longer-term care is completed. 

CHC contact details

Main office number: 020 3198 9743 (option 1 for CHC)

Main team email: nclicb.chc@nhs.net

Eligibility Criteria

Inclusions

• aged 18+
• registered with a Barnet, Camden or Enfield GP.

Exclusions

• 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