Advice on navigating CHC post-COVID

Advice for those affected by the reintroduction of NHS Continuing Healthcare, and new hospital discharge policy

We have compiled the following advice after carefully considering what the Reintroduction of NHS Continuing Healthcare (CHC) guidance means for individuals who are in, or are entering, the CHC system. This advice accompanies our guide to the changes to CHC processes in the post-COVID period.

Our advice covers next steps for people in various situations:

In all circumstances, if you 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 a CHC assessment or not. Nobody should be left without the care they need.

 
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 from 1 September 2020.

If you are in hospital, 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 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 case manager.

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

 

 
Next steps for people whose care is currently temporarily funded by the NHS after hospital discharge

Summary: you need to have the appropriate assessments to determine how your care will be funded. The emergency funding should not be withdrawn until this is agreed, and should not be repayable. 

Read about the changes to funding from hospital discharge from 1 September 2020.

If you were discharged between 19 March and 31 August 2020

If you had a new or enhanced care package set up after hospital discharge in the COVID-19 emergency period, and it’s being funded through the emergency COVID funds, it’s not expected that you will have to pay this money back.

However, this funding is coming to an end, so your Clinical Commissioning Group (CCG) and Local Authority will need to work with you to determine how your ongoing care should be funded.  To do this, they must arrange whichever assessments for care needs and financial status are relevant to you. This could include a CHC assessment – see Do I need a CHC assessment?

Note that if you do require a CHC assessment, this should be carried out before any assessment for Social Care. Where both assessments are carried out simultaneously, your eligibility for CHC must still be determined first.

The outcome of these assessments will determine if your care will be funded by CHC, Local Authority funding, joint funding or self-funding. This must be agreed before the emergency COVID funding is removed.

You may have had the first stage of the CHC assessment – the Checklist – when you were in hospital. Even if you did, and it was positive, your CCG may insist on Checklisting you again, to understand your current care needs.

If your care package has been fully funded by COVID money, and you go on to have a full CHC assessment, there should be no need for your past care needs to be assessed. That’s because, even if you’re not eligible for CHC going forward, you shouldn’t have to repay this past funding.

However, if you have been contributing toward the cost of your care and you are then assessed as eligible for CHC, you should ask your CCG to backdate funding to the 29th day after the original positive Checklist was carried out, or the point at which the CCG believed you to be eligible. To determine this, the CCG may need to carry out a retrospective assessment to look back at your care needs from when you were discharged to present day.

If you are found to be not eligible for CHC following your assessment, you may have to pay for or contribute towards the cost of your ongoing care.

If you were discharged on or after 1 September 2020

If you had new care or support needs after hospital discharge on or after 1 September 2020, this care should be fully funded for six weeks by the NHS.

Your CCG and/or Local Authority need to act quickly to ensure you have the assessments that are relevant to you – including a CHC assessment as necessary – so that decisions about the ongoing funding of your care can be taken. To understand whether it is appropriate for you to be assessed for CHC, see Do I need a CHC assessment?

Note that if you do require a CHC assessment, this should be carried out before any assessment for Social Care. Where both assessments are carried out simultaneously, your eligibility for CHC must still be determined first.

If it takes longer than six weeks for all the necessary assessments to be carried out, either the CCG or LA must continue to pay for your care until the assessments have been completed. If you are found to be not eligible for CHC following your assessment, you may have to pay for or contribute towards the cost of your ongoing care.

 

 
Next steps for people who were discharged back to an existing care package with no funding

Summary: check that any need for a CHC assessment has been recorded by your CCG. If you’re found to be eligible, funding should be backdated accordingly.

A CHC Checklist is often triggered when people with significant support needs but not in receipt of CHC, are admitted to hospital acutely.

If you were discharged between 19 March and 31 August 2020

You need to have whichever assessments for care needs and financial status are relevant to you – this could include a CHC assessment. These will determine how your ongoing care is to be funded; whether with CHC, local authority funding, joint funding or self-funding. To understand whether it is appropriate for you to be assessed for CHC, see Do I need a CHC assessment?

If it was identified in hospital that you required an assessment for CHC, this should have been recorded by your CCG and a Checklist may have been completed. However, as you did not receive emergency COVID funding it is advisable to check that your CCG are aware of your need for an assessment.

Even if you received a positive CHC Checklist while you were in hospital, your CCG may insist on carrying out a new one to understand your current care needs. If you have been paying for some or all of your care since discharge and you are subsequently assessed as eligible for CHC, you should ask your CCG to backdate funding to the 29th day after the original positive Checklist was carried out, or the point at which the CCG believed you to be eligible. In order to determine this, the CCG may also need to retrospectively assess your care needs from the point of discharge to present day.

If you are found to be not eligible for CHC following your assessment, you may have to pay for or contribute towards the cost of your ongoing care.

If you were discharged on or after 1 September 2020

It is not yet clear whether, if you were identified in hospital as needing a CHC assessment but you don’t require additional care, you will have your existing care package funded while you wait for an assessment – we are seeking urgent clarification on this issue.

 

 
Next steps for people waiting for a delayed Continuing Healthcare assessment

Summary: check you’re on the waiting list, ask how you’ll be assessed, and prepare while you wait

CCGs must resume usual assessment procedures from 1 September. Read about the resumption.

If you requested an assessment before 19 March or during the COVID emergency period (up to 31 August) and/or had a positive CHC Checklist completed and submitted to the CCG, this should be followed up. However, an estimated 25,000 assessments have built up during the COVID emergency, so it may be some time before you hear anything. If you have not heard from your CCG by October 2020, we would advise contacting them to check that you are still on the waiting list and to ask for realistic assessment timescales.

We advise you to use the time you’re waiting for an assessment to make sure you are fully prepared. Download our free toolkit with information about preparing for an assessment, and read our advice below.

We understand that there is an expectation that people who have had a full CHC assessment delayed due to COVID-19 should have their current care needs assessed, with funding backdated in line with the National Framework. However this does not appear in the national guidance for reintroduction, so cannot be relied upon.

Instead, there are a number of ways in which your CCG may choose to assess you for CHC. Here we outline the three scenarios we think are most likely.

1. The CCG may retrospectively assess your needs as they were at the time of your referral, either with a full assessment or starting with a Checklist. Your needs around the time of the referral are assessed using information from the weeks leading up to date on which a referral was made for a CHC assessment. If you are found eligible, we advise you to seek confirmation from the CCG that the whole period from referral to the present day will be funded, and you will continue to be funded until your next CHC review.

2. The CCG may assess a specific period of time, for example from the date of your referral for a CHC assessment to the present day, using information from the entire period. In this scenario the CCG may decide that you are eligible for part of the period but not all of it. If you are found eligible for the present day we advise you to seek confirmation from the CCG that funding will continue until your next CHC review and not stop automatically on the last day of the assessed period.

3. The CCG may assess your current needs as they are today using up-to-date information relevant to your current needs. In doing so, they may decide to start with a new Checklist to ensure an assessment for CHC is still required. This may potentially result in one of the following scenarios:

  • A new Checklist is negative because your needs have reduced, so a full assessment is not triggered. In this situation you can ask for a retrospective assessment for the period in which the original referral was made, if you feel your care needs were different at the time.
  • If the CCG proceed with a full assessment and find you eligible for CHC, you should ask them to backdate funding to the 29th day after the original positive Checklist was carried out, or the point at which the CCG believed you to be eligible. In order to determine this, the CCG may also need to retrospectively assess your care needs from the point of referral to present day.
  • If the CCG proceed with a full assessment and find you not eligible for CHC, you can ask for a retrospective assessment for the period in which the original referral was made, if you feel your care needs were different at the time.

Variations to the above scenarios may also be used by CCGs depending on their local procedures. We strongly advise you to ask which method your CCG will use to assess you before the assessment takes place, so that you can prepare fully and discuss any concerns about their proposed method.

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, the CCG should consider whether you are entitled to any refund of the care you have paid during this time. 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.

 

 
Next steps for people intending to request a CHC assessment

Summary: make a request and check you’re on the waiting list

If you need an assessment from 1 September 2020 onwards and have not previously requested one, you should ask a health or social care professional to complete a CHC Checklist and submit it to your CCG. Alternatively, if you are finding it difficult to get a professional to complete a Checklist assessment, you can contact your CCG to request one.

Be aware that there may be a delay in the CCG processing new referrals for CHC assessments due to the backlog created by the COVID emergency. We advise you to obtain a copy of the completed Checklist. If the Checklist itself is delayed, be sure to check that you have been put on the CCG’s waiting list and they have logged the date on which your request was made.

If you are found to be eligible for CHC following a full assessment, eligibility should be backdated to the 29th day from which your positive Checklist was received by the CCG, in line with the National Framework.

 

What to do while you are waiting for your assessment

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 while waiting for their assessment. Care records are important and may be needed to inform a retrospective assessment, 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 emergency.

For the same reason, we also recommend that you keep your own care diary while you are waiting for your assessment. 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?

 

 
Reviews for individuals already receiving NHS Continuing Healthcare

During the emergency COVID period, CHC reviews may or may not have taken place. From 1 September reviews must resume.

If you are currently receiving CHC, you should be reviewed at regular intervals, usually at three months and then annually. Reviews may be carried out by telephone or video link. Reviews must focus on ensuring that your care package remains appropriate to meet your assessed needs, rather than reviewing your eligibility for CHC funding.

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.

 

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

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

CCGs and NHS England should re-start processing requests for Local Resolution and Independent Review from 1 September. We do not know what timescales CCGs and NHSE will be expected to adhere to for the completion of their respective appeal stages, but we expect significant delays due to backlogs. 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 there is a delay in processing your request.

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.

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.