Advice on CHC for individuals during COVID-19

Advice for those who are/may be eligible for NHS Continuing Healthcare during the coronavirus emergency

We have compiled the following advice after carefully considering what the Coronavirus Emergency Legislation means for individuals who would normally go through the NHS Continuing Healthcare (CHC) system.

While we don’t currently know exactly what the situation will be when the emergency period ends, our advice is based on our extensive experience of CHC, and what we see as likely scenarios after the emergency. It is intended to support you in organising care that fully meets your needs during the emergency period. It will also help you prepare in case you need to enter the CHC system – or pick up unfinished assessment or appeal – afterwards.

The Government has agreed to fully fund the cost of new or enhanced out-of-hospital health and social care support packages, referred to in the Covid-19 Discharge Guidance, for people being discharged from hospital or to prevent hospital admission where possible. This is to enable quick and safe discharge and more generally reduce pressure on acute services.   Where care packages have been provided in this way, in order to expedite hospital discharge or prevent hospital admission, it is not expected that you will have to pay this money back

Our advice covers:

Preparing for hospital discharge

Summary: do as much as you can to think about and write down the care you might need after discharge. Being prepared will help you secure suitable care first time.

Read about the changes to hospital discharge under the Coronavirus Act 2020

  • If you are in hospital during the emergency period, think about whether you might be able to return back home with support or care, or whether you think you will need to go into residential care. The decision will rest with the clinicians looking after you but it is best to be prepared for your discharge, which will move quickly. If you can, ask your family to help you prepare for life outside of hospital because there will be limited time to plan for it once the hospital say that you are ready to be discharged.
  • While you are in hospital, think about the help and support you may need once you have been discharged. If possible, ask family to help you make a list and try to be realistic; thinking about how much care you might need on the ‘worst day’. A lead professional or multidisciplinary team, as is suitable for the level of your care needs, will visit you at home on the day of discharge or the day after to arrange what support is needed in the home environment and rapidly arrange for that to be put in place. If care support is needed on the day of discharge from hospital, this will have been arranged prior to you leaving the hospital site, by a care coordinator. If your needs are too great to return home, you’ll be discharged to a rehabilitation bed or care home, and a care coordinator will follow-up shortly after to ensure you can move to your long term care home as quickly as possible. Because of the pace at which all this will happen, the more you can do to prepare for their visit, the better. That way, there is a greater chance that the care and support measures that are put in place will be appropriate for your needs.

Age UK has a number of useful factsheets about care planning

Assessment for eligibility for Continuing Healthcare

Summary: full assessments for CHC will rarely take place, but Checklists might, and it should be recorded whether you’ll need a full assessment when things return to normal. Whether you have a new or existing care package, make sure good care records are kept. This will help you to get a fair and accurate CHC assessment (if required) after the emergency period, for ongoing or retrospective funding.

Read about the changes to CHC assessments under the Coronavirus Act 2020

Assessment after hospital discharge

  • At the time of writing (April 2020), some Clinical Commissioning Groups (CCGs) are still offering CHC assessments and this may continue to be the case depending upon how NHS staff are redeployed to support the system response to COVID-19. For as long as assessments continue to be carried out, this can be done remotely. If you are expecting a CHC assessment in the near future, we advise you to contact your CCG to ask whether or not the assessment will still be going ahead. If there is a possibility of the assessment going ahead, you may wish to suggest the CCG carry out an assessment via video conference or teleconference. This is easily achievable using widely-accessible technology. Care records can also be shared remotely by scanning and distributing via secure communication platforms. We are willing to offer our own technology to facilitate online or telephone assessments, where requested.

The advice that follows assumes that NHS CHC assessments are no longer being carried out during the emergency period:

  • During or very soon after hospital discharge your care and support needs will be assessed. At this time, make sure an NHS or social care representative makes a record that you may need an NHS Continuing Healthcare assessment when the emergency period is over if it is appropriate. If a CHC Checklist is used it should be sent your CCG so that you can be recorded on their system ready for follow-up at the end of the emergency period. You should ask for a copy of the completed Checklist. A further Checklist may be required at the end of the emergency period.
  • If, at the end of the emergency period, it is determined that you require a full assessment for CHC, this should be arranged by your CCG when things return to normal. We expect that CCGs will continue to fund new and enhanced care packages after the emergency period until they are able to carry out an assessment. There is no guarantee that you will eventually be eligible for CHC even with a positive Checklist.
  • Where new or enhanced care packages have been funded using the Government’s Covid-19 funding in order to expedite hospital discharge or prevent hospital admission then it is not expected that you will have to pay this money back. If you are found to be not eligible for NHS CHC after the emergency period, you may have to pay for or contribute towards the cost of your ongoing care.
  • If, during the emergency period, you are identified as not requiring an CHC assessment, but you subsequently feel your care needs have changed, we recommend that you request another Checklist after the emergency period.
  • If you contributed toward the funding of an existing care package during the emergency period, but you didn’t agree with the original Checklist decision (completed before the emergency period), you should be entitled to request a review of that decision.
  • If a different system is in place where you live, meaning that CHC Checklists are not used, make sure that a decision is made and recorded about whether or not you will require a Checklist at the end of the emergency period. Make a note of the date on which that decision was taken, and by whom.

Assessment if you haven’t been in hospital

  • If you are not going into hospital, but think you may have a need for an NHS CHC Assessment, you can proceed to request a Checklist in the usual way. You may find that you are unable to get a Checklist completed due to pressures on the workforce and, if you do, you are unlikely to be offered a full assessment until after the emergency period has ended. If this is the case, we recommend that you write to your CCG stating that you believe you need an assessment for NHS CHC and have attempted to obtain a Checklist without success, so that your request can be logged and followed up once things return to normal. Make sure you date your letter.
  • If you are not going into hospital but require care either at home or in a residential care home and you cannot afford to pay for it yourself, you should contact your Local Authority to make them aware. This applies whether you think you may need an NHS CHC assessment or not. Nobody should be left without the care they need during the emergency period.

Retrospective assessments

Please note that the following predicted scenarios about CHC assessments after the emergency period are based on our experience. The final arrangements for carrying out assessments of people who were identified as needing one during the emergency period will be subject to NHS CHC handling plans, which are in development.

  • If you had a positive Checklist before 19 March, or have requested an assessment, but have not yet had your full assessment, it’s likely you will now have to wait until after the emergency period. If you have been funding your own care, when you do eventually get your full CHC assessment, it should assess the whole period from when the Checklist was completed. This is a ‘retrospective’ assessment. Your current care needs should also be assessed. This situation also applies to individuals who did not have their care paid for by the NHS after being discharged from hospital during the emergency period, because they had a pre-existing care package.
  • In the case of retrospective assessments, you may be found eligible for the whole period, part of it or none of it. If you are found eligible for any part of the retrospective period in which you paid for your care, funding should be retrospectively applied. If you are eligible for NHS CHC because of your current care needs, a fully-funded ongoing package of care should be arranged, as per the standard process.
  • We strongly recommend that you check that your care provider is keeping good, accurate and up to date records about your care needs. This is particularly important for those people who are self-funding or part-funding their own care in the emergency period (because your care package was commissioned before the 19 March 2020). You may have already requested a CHC Assessment, or may request one during or after the emergency period. Care records are important and may be needed to inform a retrospective assessment once normal service resumes, so it is really important these are good quality. You can ask to see your care records at any time and you can also ask to be involved in care plan reviews, although please be mindful of the additional pressures on care homes which may be short-staffed as a result of the COVID-19 emergency.
  • For the same reason, we also recommend that you keep your own care diary during the emergency period. If you are able, note down how you feel physically and emotionally each day, and what kind of support you have needed. If you are a family member or representative, each time you speak to the individual make a short and succinct record of how the person appeared to be – physically, mentally and emotionally. Did they greet you? How did they look? Were they verbally aggressive at all? Did they seem agitated? Did they appear tearful or anxious? Did they communicate with you verbally or through gestures? Did you notice anything unusual?
  • If your care package has been funded using the COVID-19 Government funding after discharge from hospital, it may be appropriate for just a ‘current’ NHS CHC assessment to be carried out, to consider your current care needs. There will be no requirement to assess your care needs retrospectively if they have already been paid for.
  • Once the emergency period has ended, if, after a period of time, you have not heard from your CCG in relation to your awaited NHS CHC assessment, we recommend contacting them to check that you are still on their list for assessment. Bear in mind that there may be thousands of people across England waiting for an assessment so there is likely to be a delay.

Reviews for individuals already receiving NHS Continuing Healthcare

Summary: Continuing Healthcare reviews may or may not take place, and should be about checking your care package is appropriate. If your care package is not suitable, request a review.

Read about the changes to CHC reviews under the Coronavirus Act 2020

  • Where an individual is currently eligible for, and in receipt of NHS CHC, they should be reviewed at regular intervals, usually at three months and then annually. During the emergency period, CCGs are expected to adopt a proportionate approach to carrying out reviews. Where reviews do take place, they may be carried out by telephone or video link during the emergency period. As in normal circumstances, reviews must focus on ensuring that the individual’s care package remains appropriate to meet their assessed needs, rather than reviewing their eligibility for NHS CHC funding. We do not expect eligibility reviews to be carried out during the emergency period.
  • If you feel that your care needs have increased, making your current package of care inadequate, you should raise this during your review so that appropriate action can be taken.
  • If you have not been contacted at the appropriate interval to arrange a review and you have concerns about the suitability of your existing care package, we recommend that you contact your CCG to discuss these concerns. Whilst resources will be diverted to manage the COVID-19 emergency response, it is still important that care packages are suitable to meet your care needs.

Appeals (Individual requests for a review of an eligibility decision)

Summary: If you wish to appeal a CHC decision, proceed as normal, but expect significant waits. Do not delay making decisions about care.

Read about the likely changes to CHC appeals during the emergency period

  • The timescales by which CCGs and NHS England should deal with requests for Local Resolution and Independent Review, respectively, will be relaxed. However, we must assume that individuals who wish to appeal still need to adhere to national appeal timescales. This means putting your appeal in writing to your CCG within six months of the date on your eligibility decision letter. Taking this action means that your appeal will be registered within appropriate timescales even if no further action is taken during the emergency period.
  • We expect there to be significant delays in the processing of appeals at local CCG level. The timescales for Local Resolution procedures are relaxed for the duration of the emergency period. This could mean pre-scheduled meetings and panels being cancelled and delays in processing other elements of appeal work, such as obtaining care records, producing Needs Portrayals and processing Questionnaires. Where meetings and panels, including NHS England’s Independent Review Panels, do proceed, we anticipate these moving to virtual platforms such as video link or teleconference, with case files distributed electronically. We stand ready to offer our own technology to facilitate such meetings and panels, where requested.
  • When things do return to normal, we anticipate CCGs will prioritise the backlog of assessments above appeals which may well cause further delays. It is our reasonable expectation that, where appeals are upheld at Local Resolution level or Independent Review (meaning the original eligibility decision was found to be incorrect), funding will be backdated, as is usually the case.
  • Bearing in mind the delays that individuals are likely to experience in appealing, we recommend that individuals and families do not delay making key decisions, and put in place appropriate care arrangements, rather than waiting for the appeal to be resolved.

 

Please note that Beacon, and the CHC Information and Advice Service, will remain fully operational during the coronavirus emergency.

You can get in touch in the normal ways, for free advice or casework support.