Resumption of CHC

How Continuing Healthcare will resume post-COVID 19

In August 2020, new government guidance set out how NHS Continuing Healthcare (CHC) will be reintroduced in England from 1 September 2020, along with a new Hospital Discharge Policy.

On this page we outline:

We have also written an advice guide for people in or potentially entering the CHC system at this time, and those waiting for a delayed assessment, review or appeal.

You can read our previous guide to the temporary changes to CHC that were enacted by the emergency coronavirus legislation between March and August 2020.

Summary of post-COVID CHC procedures from 1 September 2020

  • From 1 September 2020, anybody leaving hospital and requiring new care and support will be funded for up to six weeks, during which time their longer-term care needs will be assessed and future funding determined.
  • CHC assessments restarted from 1 September, including assessments that were put on hold due to the COVID emergency.
  • People who have had their care funded by emergency COVID money between 19 March and 31 August 2020 following discharge from hospital or admission avoidance should be assessed for CHC and/or Local Authority support as necessary from 1 September. Following assessment, some people will need to self-fund their care, but NHS-funding should not be removed until the appropriate assessments have taken place.
  • Where people are found eligible for CHC and have paid for any part of their care while waiting for a CHC assessment, Clinical Commissioning Groups (CCGs) should refund the cost of that care in line with the National Framework.
  • Where new or enhanced care packages have been funded by emergency COVID money between 19 March and 31 August 2020 in order to speed up hospital discharge or prevent hospital admission, then it is not expected that you will have to pay this money back.

Hospital Discharge

From 1 September, new national hospital discharge procedures have been introduced.

If you are in hospital for any reason, your discharge will be organised as soon as it is clinically appropriate and you will not be able to stay in hospital. For most people this will mean that, where it is needed, the assessment and organising of your ongoing care will take place once you have returned to your own home. CHC assessments and social care assessments will take place after discharge in the community.

Once it has been determined that it is clinically appropriate for you to be discharged, you will be moved to a designated discharge area. Discharge should happen as soon as it is possible and safe, usually on the same day. Discharge arrangements will be discussed with you and your family/representatives before you leave hospital. You should be given leaflets explaining how your discharge will work, and clear information about how your needs will be assessed and what follow-up support will be provided.

Hospital staff should discharge you to a safe and appropriate place, in most cases this will be to your own home with support where required, such as a care package. Some people will require short term or long term residential or nursing care in a care home. People who are discharged from hospital into a care home should be tested for COVID-19 prior to their discharge.

Any ongoing care and support you need after your discharge will have been coordinated by your case manager before you leave hospital. This includes any medication supplies, transport home, any voluntary sector support and support for your immediate practical needs, such as shopping and turning the heating on. If you need care on the day of your discharge from hospital, this will also be arranged by your case manager before you leave hospital.

If you are discharged back to your own home, you will be visited either on the same day or the following day by a lead professional or multidisciplinary team to co-ordinate the support you need. Any necessary care and support should then be put in place rapidly.

If you have needs which are too great to allow you to return to your own home, you will either be given rehabilitation / short term care in a 24 hour care facility or discharged to a care home for short or long term care. This will be arranged by your case manager whilst in hospital.

 

Funding from hospital

From 1 September 2020, if you are discharged from hospital needing new care or support, you should receive NHS funding for up to six weeks, or until your long term care needs have been assessed. This is to support people to recover and to ensure that hospital beds continue to be vacated quickly when patients are clinically ready to be discharged. The funding can also be used for people who need care put in place very rapidly in the community, to prevent an admission to an acute hospital setting.

Assessment of your longer-term care needs, including CHC and Social Care assessments, should be completed within the six-week period after discharge to determine your ongoing care and how it will be paid for. All decisions resulting from these assessments should be communicated to you within the six-week period.

People with existing care packages who don’t require new or additional care after discharge from hospital, will return to their usual care and funding arrangements. It is not yet clear whether people who have been identified as needing a CHC assessment upon discharge from hospital but who don’t require additional care will have their existing care package funded whilst they wait for a CHC assessment – we are seeking urgent clarification on this issue.

Assessments will be carried out as promptly as possible, and you will not be able to delay. However, if it takes longer than six weeks for these assessments to be completed, CCGs or Local Authorities (LAs) must continue to fund your care from their own resources. If your CHC or NHS-funded Nursing Care assessment is delayed, the CCG must continue to pay for your care. After completion of these health assessments, if you are not eligible for CHC then responsibility for funding your care will sit with the LA until they have completed their Care Act assessment.

You should not be asked to pay for your care until the necessary assessments have been carried out and you have been informed of the outcome.

Funding for people discharged between 19 March and 31 August 2020

People who were discharged from hospital between 19 March and 31 August 2020 with a new care package or an enhancement to an existing care package should have had this care paid for using emergency COVID funding. You should continue to receive that funding until relevant assessments to establish your ongoing funding arrangements have been carried out.

This also applies to people who would have been admitted to hospital were it not for new care having been put in place. It is assumed, under the emergency COVID guidance, that these people will have had their care paid for using emergency COVID money for as long as they required that care, and may still be receiving it.

You should be assessed for NHS continuing healthcare (CHC) and/or Social Care funding as necessary by your CCG/Local Authority as soon as possible after 1 September. As a result of these assessments, some people will continue to have their care funded by the NHS (in the form of NHS Continuing Healthcare), some by the Local Authority, some via a joint funding arrangement, and some will have to pay for their own care.

If, following an assessment, you are found to be eligible for CHC and have paid for any part of your care whilst waiting for a CHC assessment, your CCG should refund the cost of your care in line with the National Framework.

Reimbursement should be made according to the following principles;

  • If you were screened for CHC using the CHC checklist, the costs of your care from day 29 of the CCG receiving the completed Checklist should be reimbursed (see Annex E, paragraph 9 of the National Framework)
  • If you were screened for CHC using the CHC checklist but your needs have changed by the time the full CHC assessment is completed, then the CCG should reimburse back to the point in time from which you are deemed to be eligible (ie. from when you had a primary health need).
  • If no CHC checklist was used then the CCG should reimburse back to the point in time from which you are determined to be eligible (ie from when you had a primary health need).

We understand that there is an expectation that CCGs will assess the current needs of people who have had their assessment delayed during this period, and backdate funding as appropriate for those who are eligible. However, this expectation is not part of the published guidance. See our advice section for further information.

 

When and how CHC processes will resume

During the level 4 emergency, CHC assessments stopped in most parts of England. A backlog of assessments has built up – this includes assessments for people who were already waiting for one when the emergency began, those who requested an assessment during the emergency period, and many of those who have been discharged from hospital with emergency funding.  It is estimated that there is a waiting list of 25,000 people to be assessed.

From 1 September, CHC assessments, reviews of eligibility, and appeals have resumed across England. This affects both people who have had their assessment, review or appeal delayed between 19 March and 31 August, and also new referrals for assessment from 1 September.

If you received a positive CHC Checklist but your full CHC assessment was delayed due to the COVID emergency, be aware that CCGs are within their rights to complete a new Checklist to assess your current needs.

To help get through the backlog of assessments as rapidly as possible, CCGs and Local Authorities may carry out CHC assessments and Social Care (Care Act) assessments at the same time.

Assessments can be carried out in the normal way, but CCGs are also permitted to use the ‘Trusted Assessor’ model. This involves using one professional to coordinate the assessment process, usually a healthcare professional who has been trained to carry out CHC assessments and is ‘trusted’ by relevant agencies. Beacon are supporting the training programmes to encourage the highest standards, and all CHC assessments must comply with the law and follow the National Framework.

Digital assessments will also be used to speed up progress. This involves assessments being completed remotely – for instance via video conference – and can work well as long as the Assessor has access to all the care records.

People at all stages of the CHC process should be at the heart of the CHC restart and CCGs are being encouraged to ensure there is good communication with individuals and their families, especially around future funding arrangements for long-term care. This includes effective communication to people who may have a disability, impairment or sensory loss.

 

If you need help to navigate Continuing Healthcare post-COVID, please get in touch. Our CHC Information and Advice Service, provides 90 minutes of free advice, and we offer affordable casework and advocacy services if you need more support.

Find out how we can help you navigate the system.