Continuing Healthcare

NHS continuing healthcare is a package of ongoing care that is arranged and funded solely by the NHS. It is designed to support individuals aged 18 or over who are found to have a primary health need which have arisen as a result of disability, accident or illness.

The National Framework for NHS continuing healthcare and NHS funded nursing care (July 2022) sets out the principles and processes for determining eligibility. The framework ensures that those assessing and delivering NHS continuing healthcare, do so in the same way. BLMK CCG’s CHC Operational Policy sets the local processes in line with the National Framework for CHC and FNC (July 2022).

All relevant and updated documents regarding NHS continuing healthcare and NHS funded healthcare are published under the ‘useful CHC documents’ tab below.

If you do not qualify for NHS Continuing Healthcare and are a resident in a care home with Nursing, you may be eligible for NHS Funded Nursing Care (FNC). This type of funding is available for people who have registered Nursing needs and are receiving their care in a care home with Nursing. Please note however, that being a resident in a care home with Nursing does not automatically indicate eligibility for FNC.

If you are eligible for FNC, it will be paid to the care home directly to fund your care. This means care provided, supervised, or planned by, registered Nurses that are employed by the care home. If you are self-funding your care at the Nursing home, these funds should be reflected in your care home fees. Please talk to the manager of the home to discuss how FNC affects your fees. If your placement is funded by social services, the FNC payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

If NHS Continuing Healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive ‘joint ‘ packages of care, where some services come from the NHS and some from social services. Where local social services provide your care, they will usually do a financial assessment to decide whether the person must make any financial contribution.

If you feel you may be eligible for either NHS Continuing Healthcare or NHS Funded Nursing Care and you are registered with a GP in Bedfordshire, Luton or Milton Keynes, then you will need to contact your social worker or a professional within  community services to consider whether you may have a primary health need. Please see attached operational policy that outlines the CHC Policy in BLMK.

NHS Continuing Healthcare is not necessarily for ever and everyone will need to be reviewed generally at 3 months and then annually. At these reviews your care plan will be looked at and if there are changes in your needs then it might be necessary to complete another assessment for Continuing Healthcare.

A retrospective review follows a request from an individual, or their representatives, for an assessment which may look back a number of years and is the approach adopted to deal with requests for previously unassessed episodes of care.  Whilst a review may involve an assessment of current needs, the review is predominantly a paper-based assessment for a period in the past.  It will be undertaken by an experienced CHC Assessor with access to individual’s healthcare records and Nursing/residential home care notes.  The review may be conducted because an individual has never been assessed, has not been assessed in recent years, or has passed away before an assessment was undertaken.

The deadline for submitting retrospective claims that predate 1 April 2012 has now passed and Bedfordshire, Luton and Milton Keynes Integrated Care Board can only accept requests for periods from 1 April 2012 onwards.

A Personal Health Budget is an amount of money that can be given directly to a person receiving NHS Continuing Healthcare to allow them to purchase care that is tailored to their individual needs.

• There are three forms of Personal Health Budget, which are explained in the Personal Health Budget leaflet below:
  • direct payment,
  • third party and
  • notional Budget

The allocation of this budget and the type of Personal Health Budget is agreed between yourself, your Continuing Healthcare assessor and a member of the Personal Health Budget team.

Many people have said that by using a Personal Health Budget, they have more flexibility, choice and control over how money gets spent on their care and support and makes them feel more involved and more positive.

A Personal Health Budget enables you to work with a healthcare professional to prioritise the care needs that are important to you and create a care plan that reflects your own personal health and social goals.

If you are registered to a GP in Bedfordshire, Luton and Milton Keynes and are eligible for NHS Continuing Healthcare, receiving your care at home, you can ask for a Personal Health Budget.

There are a number of steps to a Personal Health Budget:

1. Getting clear information

• If you have been referred to the BLMK Continuing Healthcare team, we can tell you how Personal Health Budgets work for people who receive Continuing Healthcare.
• If you have recently received confirmation that you are eligible for continuing healthcare funding and your care is delivered at home or in supported living accommodation, a package of care and support will be put in place for you.  The Personal Health Budget team and Continuing Healthcare team work together to discuss with you your options following the Continuing healthcare assessment which identifies your needs.

2. Working out the amount of money that may be available

• The Personal Health Budget team can work out the amount of money that will be available to you in your Personal Health Budget. The amount of money will be based on your health and wellbeing needs and what a conventional package of care would look like.

3. Making a personalised care and support plan

• The Personal Health Budget and Continuing Healthcare team will work with you to create a personalised care and support plan whatever type of Personal Health Budget you chose to have, this plan will be designed to meet your health and social care needs if you are receiving Continuing healthcare funding.
• As soon as your personalised care and support plan has been approved, your Personal Health Budget will need to be “activated” – this can be organised in a number of different ways as shown in the Personal Health Budget leaflet.

If you are dissatisfied with the outcome of your CHC assessment you or your representative, who has the authority to act, can contact us in writing to appeal the decision within 6 months of the assessment. We are also able to put you in touch with agencies that can offer support and advice. Please see the leaflet below for the details.