In this section you will hopefully find everything you need to know about Enfield CCG’s continuing healthcare service and team. This includes information about:
- Continuing healthcare
- Funded nursing care
- Personal health budgets
- How to contact our team
NHS continuing healthcare (CHC) is a package of care provided outside of hospital. It is arranged and funded by Clinical Commissioning Groups (CCGs) for people aged 18 years and over who have significant ongoing healthcare needs and have been assessed as having a ‘primary health need’.
People who are assessed for CHC include those who need a very high level of support. Some people may be reaching the end of their lives, or have long-term conditions as a result of a disability, accident or illness. When someone is assessed as eligible for CHC, their local CCG is responsible for funding their full package of health and social care.
This means that the CCG will find suitable care to meet someone's assessed needs. The CCG will always try to give options and choices that best match the patient and family’s preferences for the type and place of care provided.
Who is eligible for NHS continuing healthcare?
NHS continuing healthcare is for adults (18 and over). To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:
- what help you need
- how complex your needs are
- how intense your needs can be
- how unpredictable they are, including any risks to your health if the right care isn't provided at the right time
- The nature of your needs
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted.
A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
If you aren't eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them.
If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a "joint package" of care.
Further information about eligibility can be found in the national framework for NHS continuing healthcare.
NHS continuing healthcare assessments
Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it.
For most people, there's an initial checklist assessment, which is used to decide if you need a full assessment. This is called a screening tool checklist. However, if you need care urgently – for example, if you're terminally ill or have a condition which is rapidly deteriorating – your assessment may be fast-tracked.
Initial assessment for NHS continuing healthcare
The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you're being assessed, and be asked for your consent.
Depending on the outcome of the checklist, you'll either be told that you don't meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you'll be referred for a full assessment of eligibility.
Being referred for a full assessment doesn't necessarily mean you'll be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist.
You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK.
Full assessment for NHS continuing healthcare
Full assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care.
You should be informed who is co-ordinating the NHS continuing healthcare assessment.
The team's assessment will consider your needs under the following headings:
- nutrition (food and drink)
- skin (including wounds and ulcers)
- psychological and emotional needs
- cognition (understanding)
- drug therapies and medication
- altered states of consciousness
- other significant care needs
These needs are given a weighting marked "priority", "severe", "high", "moderate", "low" or "no needs".
If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare.
You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.
In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision.
Fast-track assessment for NHS continuing healthcare
If your health is deteriorating quickly and you're nearing the end of your life, you should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
Care and support planning
If you're eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
Depending on your situation, different options could be suitable, including support in your own home, care in a care home and the option of a personal health budget (PHB) so you can arrange your care.
If it's agreed that a care home is the best option for you, there could be more than one local care home that's suitable.
We do not have many care homes in the borough so while we will endeavor to find a care home in the borough, you are likely to be placed in a care home outside of the borough.
Enfield CCG will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, we can also take other factors into account, such as your assessed needs as opposed to wants, and the cost and value for money of different options. The CCG has a duty to ensure that public funds are used carefully to meet the needs of all patients.
Refunds for delays in NHS continuing healthcare funding
Enfield CCG will normally make a decision about eligibility for NHS continuing healthcare within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.
If the CCG decides you're eligible, but takes longer than 28 days to decide this and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.
If you're not eligible for NHS continuing healthcare
If you're not eligible for NHS continuing healthcare, but you're assessed as requiring nursing care in a care home (in other words, a care home that's registered to provide nursing care) you'll be eligible for NHS-funded nursing care.
This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees.
NHS continuing healthcare reviews
If you're eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you're still eligible for NHS continuing healthcare.
Continuing healthcare service
To find out how to request an assessment of eligibility and apply for continuing healthcare, please contact the CHC team:
Continuing Healthcare Team
Herts EN4 0DR
Tel: 020 3688 2174
Our team can be contacted Monday – Friday, 9am – 5pm
What you can expect from us
- Make a decision on eligibility for a full assessment within 28 days of receiving a positive checklist – we aim to do this for every checklist we receive but our target is to make a decision on 80% of cases within 28 days.
- Make a decision on fast track cases within 48 hours of receiving a referral
- Respond to a request for setting up a care package within 24 hours.
- Acknowledge any appeals within 5 working days and process the full appeal within 90 days
- Enfield CCG’s Continuing Healthcare Policy
This policy describes the way in which Enfield CCG will make provision for the care of people who have been assessed as eligible for fully funded NHS continuing healthcare (CHC)
This document sets out the standard operating procedure, roles and responsibilities for staff working within the Enfield CCG continuing healthcare clinical team.
Safeguarding Adults Policy
This policy describes the process for the coordination of Adult Safeguarding arrangements within Enfield CCG
Information and advice
NHS England recognises that information and support are vital to all individuals involved in the CHC process and so has funded an independent information and advice service through a social enterprise called Beacon. This service is supported by a consortium of leading voluntary sector organisations including Age UK, Parkinson’s UK and the Spinal Injuries Association.
Information and advice is accessible in the form of free and comprehensive written guidance, and individuals are also able to access up to 90 minutes of free advice with a trained NHS continuing healthcare adviser 0345 548 0300.
For further information and to access this service please see the Beacon website: http://www.beaconchc.co.uk/
If a patient or their carer is unhappy with the outcome of their CHC assessment they can ask the CCG to review their case. There are three stages to this process:
- The patient or their representative should contact the CHC team.
The first stage of the process is to let us know why you are unhappy with the decision and give a clear rationale for your appeal. This should be submitted to the Enfield CCG CHC team in writing within 6 months of the date of the decision.
Continuing Healthcare Team
Herts EN4 0DR
The CCG will acknowledge your appeal within 5 working days, and has 90 days to complete the whole appeal process.
- Independent Review Panel
Once the local review stage has been completed, the CCG should provide you with information about how to refer your case for an Independent Review Panel (IRP).
This is done through the continuing healthcare department of NHS England.
You should contact NHS England requesting an IRP to review a continuing healthcare decision, explaining that you have completed the local review process and briefly outlining your reasons for appeal.
NHS England will send you a formal IRP request form to complete. The form will ask you to explain your reasons for requesting an IRP in more details, and will encourage you to specify any complaints you have about the process of assessment
The NHS England London team can be contacted by:
NHS England London Region
80 London Road
Tele no: 0113 8070816
- Complain to the ombudsman
If a patient is unhappy with the outcome of the independent review, they can complain to the Parliamentary and Health Service Ombudsman. The ombudsman’s role is to decide whether decisions made by the NHS are in line with the national framework; it does not generally make judgements about whether the NHS has made the right decision. Contact details for the ombudsmen can be found here: https://www.ombudsman.org.uk/
Further information about continuing healthcare
Here you can find some links to other websites or documents which you may find useful:
- Information leaflet: NHS Continuing Healthcare and NHS Funded Nursing Care
A guide for people who may be in need of ongoing care and support from health and social care professionals.
- Easy read document: What is NHS Continuing Healthcare?
- National framework for NHS continuing healthcare and NHS-funded nursing care
This guidance sets out the principles and processes of the national framework for NHS continuing healthcare and NHS-funded nursing care
- Redress Guidance
This guidance is to be used when considering NHS Continuing Healthcare (NHS CHC) redress payments for individuals.
- NHS England’s Continuing Healthcare website
Funded nursing care
Funded Nursing Care (FNC) is a weekly payment made by the NHS to cover nursing care provided by a Registered Nurse. FNC is only provided if you need nursing care within a care home setting.
The nursing care contribution is paid directly to the care home by the NHS. If you pay your own care fees, this amount should be deducted from your bill. If you are funded by the local authority, this amount will be deducted from the fees paid to the care home.
Your nursing home will receive £158.16 per week, which is the figure set by the Department of Health for 2018/19 and it is reviewed each year.
Children and young people's continuing care
NHS continuing care is support provided for children and young people under 18 who need a tailored package of care because of their disability, an accident or illness. It is different from NHS continuing healthcare, which can be provided to adults who have very severe or complex health needs.
The main difference is that while continuing healthcare for adults focuses mainly on health and care needs, continuing care for a child or young person should also consider their physical, emotional and intellectual development as they move towards adulthood.
This means that if your child is assessed for NHS continuing care, it is likely that a range of organisations will be involved, such as health, education and local authority children’s services. These different agencies will contribute to your child’s care package if they are found to have continuing care needs.
If you think your child should be assessed for NHS continuing care, talk to a health or social care professional who works with them. They will make a referral to the local continuing care nurse assessment service, if appropriate.
Further information on children and young people’s continuing care:
- Enfield SEND local offer - which provides lots of information on support and services
- Children and young people’s continuing care national framework
This framework sets out the process for assessing, deciding and agreeing continuing care for children with complex health needs
Personal health budgets in NHS Continuing Healthcare and continuing care for children
Adults who are eligible for NHS Continuing Healthcare (CHC) funding, and children in receipt of continuing care have had a legal right to have a personal health budget since October 2014. By April 2019, NHS England expects that unless there are exceptional circumstances, everyone living in their own home who is in receipt of standard CHC funding will have a personal health budget.
For more information about personal health budgets in NHS continuing healthcare and continuing care for children please visit the NHS England website.