chc funding


CHC Funding & NHS Continuing Healthcare Checklist |  December 2023

In the UK, the National Health Service (NHS) provides Continuing Healthcare Funding (CHC). This unique package is fully funded, covering individuals with substantial and ongoing health needs.

Unlike other health care services, CHC Funding is not means-tested, and is therefore available to those eligible regardless of their finances.

Topics that you will find covered on this page

Background of CHC Funding

CHC Funding, or NHS Continuing Healthcare Funding, is a comprehensive package which provides care outside of a hospital. It is designed to support individuals with severe, complex, or unpredictable health issues, who require continuous care. This national framework was put in place by the NHS to ensure that people with ongoing care requirements receive the support they need. This type of funding is offered in variable settings, such as the patient’s own home or a care home.

The CHC Funding is rooted in the NHS’s mission to provide healthcare based on clinical need, rather than on ability to pay. It’s a component of the wider healthcare funding spectrum, including nursing care and personal health budgets. This joint package has been crucial in providing necessary care to those suffering with long-term health problems, therefore reducing a financial burden for many.

The provision of CHC Funding is carried out by the local NHS authority, also known as the Integrated care boards (ICBs). The local ICB assesses individuals for eligibility and offers the necessary funding if the individual qualifies for it. The funding is fully covered by the NHS, meaning that the individual does not have to contribute any care costs.

It’s important to note that CHC Funding differs from other types of NHS funding. For instance, NHS-funded nursing care is a single flat-rate contribution towards the cost of registered nursing care in a nursing home. Alternatively, a personal health budget is an amount of money allocated by the NHS which supports a person’s identified health and wellbeing needs.

CHC Funding

The primary aim of CHC Funding is to provide a comprehensive care and support package for individuals suffering severely in their health, covering all healthcare costs in a care home or the patient’s home. The NHS arranges and fully funds the care, relieving the individual and their family from the financial burden of care costs.

As the funding is not means-tested, it’s independent of your income or savings. This ensures that anyone eligible can receive necessary care based on health needs, regardless of their financial circumstances. 

The application for CHC Funding involves an assessment carried out by a healthcare professional. The healthcare professional uses a tool known as the Decision Support Tool (DST) to determine whether the individual has a ‘primary health need’. The DST is a systematic approach used to determine eligibility for CHC Funding. It considers various aspects of health needs, including nature, complexity, intensity, and unpredictability.

One of the great benefits of CHC Funding is that it takes a holistic, integrated approach to care. The funding aims to cover all necessary care costs, ensuring that the individual receives a comprehensive package of personalised care. The care package could include support from a social worker, nursing care, as well as other necessary health and social care.

What is CHC?

CHC is just another term used for Continued HealthCare funding.  You can read more about this below.

Here is a great video that explains more about what it is.

How Much Is Continuing Healthcare Funding?

Here are some key details on NHS continuing healthcare funding in the UK:

The NHS provides full funding for all assessed care and support needs for those eligible for continuing healthcare. This means only a very minimal contribution or none at all from the individual.

There are no fixed limits or caps on how much funding someone can receive. It depends entirely on the individual’s assessed needs. Funding covers hospital stays, nursing home care, specialized equipment, home care, etc.

On average, continuing healthcare is estimated to cost from £700 to £1,000 per week per person currently. However, this varies widely case-by-case. Some may only require a few hundred pounds if care needs are relatively limited. Others with very complex needs could receive several thousand.

Continuing healthcare funding comes from the local Clinical Commissioning Groups (CCGs) annual NHS budgets. The CCGs allocate funding to support those who qualify in their regions. National NHS England budgets also help provide funding consistency across areas.

Compared to basic social services or nursing care, continuing healthcare provides significantly more support since more health care professionals are involved and the care is typically 1-to-1 round-the-clock for those with intense needs.

Ongoing reviews happen over time. Funding may be reduced if care needs decrease due to health improvements. But funding also adapts to increasing needs if one’s condition declines. The focus is covering assessed care requirements.

So in summary, continuing healthcare funding covers all nursing and palliative care costs for those deemed eligible by NHS assessment teams. There are no standard funding limit amounts. The goal is supporting an individual’s total care needs.

What Medical Conditions Qualify For Continuing Healthcare

There are a wide range of medical conditions that can potentially qualify someone for continuing healthcare funding in the UK. This overview covers key condition types, complex diagnoses, assessment factors, and more.

Neurological Conditions

– Brain injuries, dementia, Parkinson’s disease, motor neurone disease, and Huntington’s disease are common neurological conditions that may meet eligibility criteria.
– Both the diagnosis itself and the associated care needs it creates are considered during assessments.

Respiratory Conditions

– Severe respiratory conditions like chronic obstructive pulmonary disease, cystic fibrosis, or pulmonary fibrosis often qualify based on intense symptom management needs.
– Help with breathing, oxygen use, medication routines, and more all play major roles for those with respiratory conditions.

Cardiovascular Conditions

– Heart failure, pulmonary hypertension, unstable angina, and critical peripheral vascular disease are cardiovascular conditions that can qualify.
– Support needs like IV medications, oxygen, stenosis care, and addressing severe symptoms are considered.

Cancer And Palliative Care

– Those with cancers requiring complex symptom management and end-of-life care tend to meet continuing healthcare criteria.
– The focus is primarily on one’s total palliative care needs rather than the cancer diagnosis itself.

Stroke And Brain Injury Effects

– Strokes, brain injuries, and other trauma with neurological effects often qualify based on impacts to mobility, communication, nutrition, and cognition.
– The number of care-based problem areas is more influential than any specific diagnosis.

Progressive Conditions

– Neurodegenerative diseases, advanced heart failure, COPD, Parkinson’s, dementia, and more can qualify due to increasing needs.
– It’s based on managing the total care needs as the conditions gradually worsen over longer periods.

Multiple Interlinking Conditions

– Co-morbidities with overlapping care requirements, such as dementia combined with diabetes or immobility issues, often meet eligibility thresholds.
– Having multiple conditions leading to high total needs frequently leads to continuing healthcare.

The Eligibility Criteria for CHC Funding

The eligibility for CHC Funding is based on primary health needs of the patient. This is determined through a multidisciplinary team of health and social care professionals who assess applications. This assessment considers the individual’s health needs in the following areas.

Firstly, the ‘nature’ of the individual’s needs is considered, referring to the type of needs and the impact which these needs have on the individual’s overall health. 

‘Complexity’ is the level of skill required in managing their needs. 

Thirdly, ‘intensity’ refers to the quantity, severity, and frequency of health needs. 

Lastly, ‘unpredictability’ refers to the level of fluctuation and risk to their health if the suitable care is not sourced.

It’s important to note that the assessment does not consider specific diagnoses or conditions. Rather, it also takes into consideration how their needs impact their health. For example, those living with chronic conditions such as Parkinson’s disease or dementia might only be eligible for CHC Funding if their needs are complex, intense, or unpredictable. However, there is some nuance to this in applications, making it a good idea to check with your healthcare provider on how this applies to your individual situation.

If awarded CHC funding, eligibility is reviewed regularly, at least annually. This guarantees that needs have not changed, whilst also determining if the individual still qualifies for the same level of support.

The Application Process for CHC Funding

The leading step for the application process involves an initial checklist assessment to determine whether the patient should be referred further. This screening tool is filled out by a trained healthcare professional, such as a nurse or a social worker. Typically, this professional is already involved in the patient’s care. It can also be completed by a member of the Clinical Commissioning Group (CCG).

It’s important to note this initial assessment is not a tool to determine eligibility for CHC Funding. Instead, it’s a tool to identify individuals who might be eligible and should therefore be referred for a full assessment. It’s an important part of the assessment process, ensuring that only individuals with primary health needs are referred for a full assessment.

The checklist considers various aspects of the individual’s health needs, including behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin, breathing, drug therapies and medication, altered states of consciousness, and other major healthcare needs. Each of these aspects is scored on a scale, and the scores are used to determine whether the individual should be referred for a full assessment.

After this, if the individual is found to potentially have a primary healthcare need, they are referred for the full assessment. This involves a multidisciplinary team (MDT) of health and social care professionals using the DST to determine eligibility for funding. Here, they consider various aspects of the individual’s health needs. Each of these aspects is scored on a scale similar to the initial checklist, with the scoring used to determine the presence of a primary health need. The MDT makes a recommendation to the CCG based on the DST scores.

The CCG then decides whether the individual is eligible for CHC Funding. If the individual is found to be eligible, the CCG arranges and fully funds the necessary care. The individual and their family are fully involved in the decision-making process, holding the right to appeal the decision if they disagree with it.

Free advice is often available on navigating the checklist, as well as the entire CHC Funding process. Many local council and local authority offices provide these services. Additionally, you can find information from the local integrated care board or local health board. 

Who is Eligible for NHS Continuing Funding?

Those who are over 18 with long-term, complex, or unpredictable health needs are more likely to be eligible for CHC Funding. This could include individuals with conditions such as Parkinson’s disease, dementia, or a severe physical disability.

The funding is not means-tested, meaning that eligibility is not based on the individual’s income or savings. Instead, eligibility is based on an assessment of the individual’s health needs.

However, it’s important to note that the assessment is not about the individual’s specific diagnoses or conditions. Rather, it is about how their needs impact their health. This is determined through a comprehensive assessment process that considers various aspects of the individual’s health, evaluating whether they have a primary health need. For instance, not all individuals with dementia will be eligible for CHC Funding. Instead, eligibility is determined by the impact of the individual’s needs on their health.

Benefits and Challenges of CHC Funding

One of the most predominant benefits of CHC Funding is its comprehensive support of people with various health needs. The funding covers all necessary care costs, ensuring that the individual receives the care and support they need. This package includes a wide range of services, including nursing care, support from a social care professional, and others.

Another major benefit of CHC Funding is that it’s not means-tested. This means that anyone who is eligible can receive the necessary care they need, regardless of their financial situation. For many patients and their loved ones, this is a significant financial relief as they might otherwise struggle with a burden of care costs.

However, there are also some setbacks that come along with CHC Funding. One of the main ones is the complexity of the assessment process. It is a thorough and lengthy procedure, involving a MDT of health and social care workers. Before they know if they’re eligible or not, the patient and their family may have to wait for a significant period

Another drawback is the variable nature of funding decisions. For instance,there have been criticisms that the eligibility criteria was inconsistently applied across the country. This means that a person’s eligibility may change depending on where they live.

It is important to note that if CHC funding is denied, individuals can appeal the decision. First, a local review is conducted. If the individual and their family is still unsatisfied, they can request an independent review. As a last resort, an appeals process exists through the Parliamentary and Health Service Ombudsman. Look to independent advocacy services, who can provide guidance on disputing decisions.

nhs continuing healthcare checklist

Case Studies of CHC Funding

The positive impact of CHC Funding on individuals and their families can be seen in many cases. For instance, a woman in her 80s with advanced dementia was assessed as having a primary health need and was found eligible for CHC Funding. The funding covered the cost of her care in a nursing home, working to relieve her loved ones of the financial stress of care costs.

Another case is that of a man in 60s who was diagnosed with Parkinson’s disease. He was found eligible for CHC Funding after a full assessment. This funding covered his necessary care costs from home, including social worker and nursing support, as well as other necessary care. The funding enabled him to stay in his home surrounded by his family, while still receiving the necessary care and support he required.

"There is an uncertain future of CHC Funding in the UK. The NHS is under significant financial pressure, and there are concerns about the sustainability of CHC Funding. ."

Future Prospects of CHC Funding in the UK

There is an uncertain future of CHC Funding in the UK. The NHS is under significant financial pressure, and there are concerns about the sustainability of CHC Funding. However, for the time being, the NHS is continually committed to providing Funding for those who need it.

There are also ongoing efforts to improve the assessment process for CHC Funding. This includes ensuring that  the eligibility criteria are applied consistently across the country. There are also efforts to improve the transparency of the assessment process, as well as ensuring that individuals and their families are fully involved in decision-making for their loved one.

Despite the uncertainty of the future, CHC Funding remains a crucial part of the NHS’s ethos to provide healthcare based on clinical need and not ability to pay. It provides a comprehensive package of care for individuals with severe health needs, ensuring that they receive the care and support necessary.

What to do if you meet the CHC funding criteria

The first thing that you have to do is go through the continuing healthcare full assessment process. More information on this is below.

However, you shouldn’t just start the application process.  Like everything, you should approach the full assessment in a tactical manner with the aim of lessening the change that your claim is rejected.  To pursue it further will mean that you need to go through the appeals process, which can also be difficult.

What we strongly recommend is that you build your case as to why you or a loved one is entitled to continued care funding.

The reason for receiving or getting rejected for funding can be complex so its VERY important that your case is clear about why you should receive it.

This will involve many aspects, but in the main it will directly reference the criteria set out by the Department of Health for the NHS and the person’s medical records and history.

This approach of clearly building your case makes it harder for the case to be rejected.  A successful approach can easily save you over £100,000 in long term care costs!

The Role of Integrated Care Boards in CHC Funding

Integrated Care Boards (ICBs) are key players in the delivery of CHC Funding. They are part of the NHS’s new structure in improving coordination, as well as the integration of health and social care services. In the context of CHF, ICBs coordinate care services for individuals who are eligible for NHS continuing healthcare. 

ICBs work alongside CCGs, healthcare professionals, and social care staff to deliver a holistic care package for those eligible for the funding. They help to ensure that the care package is tailored to the particular patient, as well as covering all necessary care costs. 

Furthermore, ICBs play a role in the CHC assessment, again collaborating with healthcare professionals throughout the process. For individuals who are eligible for CHC Funding, they also help implement the care and support package.

It is important to note that although the ICBs play a significant role in CHC Funding, the final decision on eligibility and provision of funding is made by the local NHS authority or the CCG. 

Fast-Track Pathway for Urgent CHC Funding

In particular circumstances, an individual’s health may deteriorate quickly, calling for immediate access to CHC Funding. In such cases, a fast-track assessment pathway is available. This involves an expedited assessment process, providing immediate funding to cater to the urgent requirements of a person in need of significant care. 

The fast track assessment is carried out by a healthcare professional who is knowledgeable about the individual’s health condition. This could be a registered nurse, a doctor, or another professional involved in their care. They complete a fast-track pathway document which outlines the individual’s health needs, as well as the urgency of those needs. 

If the fast-track pathway tool indicates that the individual is rapidly deteriorating in health, entering a terminal phase, the individual is deemed eligible. The CHC Funding is then arranged and funded solely by the NHS.

Although the fast-track pathway provides immediate access to CHC Funding, the application is reviewed regularly to ensure that it continues to meet the individual’s needs, reflecting the changing state of health. 

what is chc funding

Step 1 of the CHC process– The initial screening care needs

Initially, you will have a screening to see if you’re eligible for continuing care funding. The screening is typically carried out in hospital or at home. The CHC screening is usually undertaken by a nurse, doctor, social worker or other recognised healthcare professional.

During the continued health care screening process, they will assess your general health and care needs with a simple NHS CHC checklist that will cover:

  • psychological and emotional needs
  • mobility
  • nutritional needs
  • behaviour
  • understanding of what’s going on around you
  • communication
  • continence
  • skin condition
  • breathing
  • symptom control through drug therapies and medication
  • other significant care needs

If your health, or the health of someone you care for, is getting worse rapidly, ask about a fast track assessment to bypass the initial screening.

Step 2 – The CHC assessment

The assessment process can be complex. However, we would strongly urge not to let that put you off, as ultimately it can be worth going this process both from a financial and emotional perspective.

If the initial screening shows that you may be able to get free NHS Continuing Care, you’ll need to have another assessment. This second assessment will be undertaken by a team of two or more health- and social-care professionals who are involved in your care.

The team will use the same checklist above but will go into a lot more detail. They will mark each of your care needs as:

  • priority
  • severe
  • high
  • moderate
  • low

If you have at least one priority need or two severe needs, you should qualify for continuing care funding.

If you have one severe need and a number of other high or moderate needs, you may also be eligible.

How to apply for CHC funding – How to get the NHS to pay for care?

The CHC funding criteria can be applied for by speaking to your social worker or any person who is in charge of your care – as a friend, relative or carer may be able to apply on your behalf or assist you in submitting your application.

You can also speak directly to your GP or the person who is dealing with your care at hospital, such as your doctor or consultant about NHS continuing care funding.

The NHS care package – What costs will be covered

NHS continuing healthcare covers your assessed personal (social) care and healthcare costs, such as help with washing, dressing, medication, continence care, skin care, therapies and complex health needs.

It may also include accommodation if your care is provided in a care home, or support for carers if you’re being looked after at home.

If you do not meet the criteria and you receive care in a nursing home, you might be able to receive NHS-funded nursing care. This is a small contribution to the cost of care provided by a registered nurse, paid by the NHS. The level of continuing care funding is reviewed regularly.

Local Health Landscape and CHC Funding

Applicants for CHC funding must, in our experience, be familiar with the local health landscape to be eligible for funding. Local councils and Integrated Care Boards (ICBs) significantly coordinate care and support services within their respective regions. 

By understanding local health structures and resources, individuals can more effectively advocate for their needs during the NHS continuing healthcare assessment and ensure that their care and support package is tailored to their specific situation.

Eligibility and Independent Review for CHC Funding

Our research indicates that determining eligibility for NHS continuing healthcare funding can be complicated.

Individuals who disagree with a Clinical Commissioning Group (CCG) decision can request an independent review. 

A panel composed of experts who were not involved in the original decision will reevaluate the case and make a final determination. This procedure can help ensure that all pertinent information is considered and that the individual’s care needs are assessed fairly.

Top-up Fees and Care Home Fees in CHC Funding

When we investigated nursing home fees and the CHC funding procedure, we discovered that supplemental fees may occasionally be applicable. 

Suppose a person is determined to be eligible for NHS continuing healthcare funding but wishes to reside in a care home that costs more than the NHS funding covers. In that case, they or their family may be required to pay additional fees to cover the difference. 

When arranging and funding a care and support package solely with CHC funding, it is crucial to understand the financial implications of care home fees and the potential need for additional fees.

Navigating Integrated Care Boards for CHC Funding

When we evaluated the effectiveness of integrated care boards in the context of CHC funding, we discovered that they play a crucial role in coordinating and supervising healthcare services within a particular region. 

These boards bring together healthcare providers, local councils, and other relevant stakeholders to effectively meet the needs of the local population.

Individuals and their families can better navigate the local health landscape and advocate for their specific care and support package needs if they comprehend the function of integrated care boards.

Personal Health Budgets and CHC Funding

According to our research, personal health budgets can benefit individuals eligible for NHS continuing healthcare funding. 

A personal health budget is an allotted sum that gives individuals greater control and flexibility over their healthcare and support services. Individuals can create a personalised care plan that caters to their specific health needs and preferences by collaborating closely with their healthcare team, resulting in a more tailored and effective care experience.

The Role of Registered Nurses in CHC Funding Assessments

Upon testing the CHC funding assessment procedure, we determined that the participation of a registered nurse is essential. Registered nurses are important in conducting comprehensive assessments of a person’s health needs, ensuring that all care requirements are identified and documented accurately. 

They collaborate with other healthcare professionals and local council representatives to develop an individualised care and support plan that meets each individual’s specific needs. This collaborative approach is essential for determining whether the NHS should fund the care alone or in conjunction with the local council.

Local Councils and their Contributions to CHC Funding

Local councils are essential partners in providing care and support for individuals with complex health needs, in our experience. 

Local councils provide essential social care services such as personal care, assistance with activities of daily living, and access to community resources. At the same time, the NHS is responsible for meeting the healthcare needs of eligible individuals. 

Local councils may be involved in the care planning process even when care is arranged and funded solely by the NHS to ensure that the individual’s social care needs are effectively met alongside their health care needs.

This collaborative approach creates a seamless care experience that addresses all aspects of an individual’s health.

Meet the author

Jane Parkinson

Jane Parkinson

Jane is one of our primary content writers and specialises in elder care. She has a degree in English language and literature from Manchester University and has been writing and reviewing products for a number of years.

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