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Home » Your Health and Services » NHS continuing healthcare

NHS continuing healthcare

Anyone in Cambridgeshire and Peterborough with a primary health need may be eligible for NHS "continuing healthcare” (CHC) funded support. If not, “funded nursing care” may be available to anyone in care homes.  For greater choice over how their health and care needs are met, continuing healthcare recipients may like to consider a personal health budget. 
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Contact us

Call us: 0330 057 1022
Email us: capccg.complexcases-chc@nhs.net
Write to us: Complex Cases Team, Gemini House, Cambridgeshire Business Park, Angel Drove, ELY CB7 4£A

Booklets and documents

If you need any downloadable booklets, leaflets and documents, please scroll to the bottom of the page. This includes the fast track pathway tool, a brief guide to CHC and funded nursing care, the decision support tool, the national framework, and personal health budgets.

‘Continuing Care’ is the provision of care over an extended period of time to a person aged 18 years or over to meet a physical or mental health need that has arisen as the result of disability, accident or illness. NHS Continuing Healthcare means a package of continuing care arranged and funded solely by the NHS to meet a person’s health needs within the resources available.

Find out more about what NHS Continuing Healthcare and NHS funded nursing care is.

The video below was produced by NHS England and explains the framework and process for continuing healthcare [26 minutes long].

The Q&A below provides further detail about these services and how to apply. Cambridgeshire and Peterborough CCG hosts these services.

NHS continuing healthcare is a package of ongoing care that is arranged and funded solely by the NHS. It is designed to support individuals aged 18 or over who are found to have a primary health need which have arisen as a result of disability, accident or illness.

The national framework for NHS continuing healthcare and NHS funded nursing care sets out the principles and processes for determining eligibility. The framework ensures that those assessing and delivering NHS continuing healthcare, do so in the same way.

All relevant and updated documents regarding NHS continuing healthcare and NHS funded healthcare is published to the right under the ‘useful CHC documents’ tab below.  

From Monday 1 October 2018, Cambridgeshire and Peterborough CCG will only accept the following revised documentation:  

  • CHC Checklist
  • Decision Support Tool
  • Fast Track Tool

These are all in the useful CHC documents tab at the end of this page.

You will be assessed to identify whether you have a “primary health need”. This is likely to be a complex medical condition that requires substantial ongoing healthcare. Eligibility is not dependent on a particular diagnosis or disease, or determined by the location of where your care is provided. If your assessment does not identify a primary health need, you will not be eligible for NHS continuing healthcare. 

We follow national guidance and criteria in assessing your care needs and eligibility. You will be fully informed and involved throughout this process. If you wish, you can ask a member of your family, a friend, a carer or perhaps another representative, to support you during this assessment process.  We encourage you to do this.

A 'checklist' screening tool assessment may be completed initially. This will help to decide if a full assessment, known as a Decision Support Tool (DST), should be undertaken. The DST is used to collate information about your health needs and support the recommendation regarding eligibility. In some cases, an urgent decision is needed, for example those who are terminally ill, and this can be ‘fast tracked’ to provide timely NHS continuing healthcare.

Your health needs are assessed by looking at all of your care needs and relating them to four indicators:

  • Nature – the type of condition or treatment required.
  • Complexity – symptoms that interact; therefore difficult to manage or control.
  • Intensity – one or more health needs, so severe they require regular intervention.
  • Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to the person or others. 

If you are eligible, Cambridgeshire and Peterborough CCG will be responsible for identifying and funding a package of care that has been discussed and agreed with you and your family or representative. Funding is subject to regular review and if your healthcare needs change, the funding arrangements may also change. As this is a health funded service it is not dependent on savings or income.

If you do not qualify for NHS continuing healthcare and are resident in a care home with nursing, you may be eligible for NHS funded nursing care (FNC). This type of funding is available for people who have registered nursing needs and are receiving their care in a care home with nursing. Please note however, that being a resident in a care home with nursing does not automatically indicate eligibility for FNC.

If you are eligible for FNC, it will be paid to the care home directly to fund your care. This means care provided, supervised, or planned by, registered nurses that are employed by the care home. If you are self-funding your care at the nursing home, these funds should be reflected in your care home fees. Please talk to the manager of the home to discuss how FNC affects your fees. If your placement is funded by social services, the FNC payment forms part of the fees paid to the care home and does not affect or change any contribution from your pension or third party top up fees.

If NHS continuing healthcare is provided at home, local social services may still have responsibilities to provide some services for you or your carers. It is possible to receive 'mixed' packages of care, where some services come from the NHS and some from social services. Where local social services provide your care, they will usually do a financial assessment to decide whether the person must make any financial contribution.

If you feel you may be eligible for either NHS continuing healthcare or NHS funded nursing care and you are registered with a GP in Cambridgeshire and Peterborough CCG, then you will need to request a CHC checklist from your local social services:

Cambridgeshire area: 0345 045 5202 or email careinfo@cambridgeshire.gov.uk

Peterborough area: 01733 747474 (option 5)

A retrospective review follows a request from an individual, or their representatives, for an assessment which may look back a number of years and is the approach adopted to deal with requests for previously unassessed episodes of care.  Whilst a review may involve an assessment of current needs, the review is predominantly a paper-based assessment for a period in the past.  It will be undertaken by an experienced Nurse Assessor with access to patient healthcare records and nursing/residential home care notes.  The review may be conducted because an individual has never been assessed, has not been assessed in recent years, or has passed away before an assessment was undertaken.

Following the deadlines announced by the Department of Health for the receipt of claims for retrospective reviews for the period 1 April 2004 - 31 March 2012, Cambridgeshire and Peterborough CCG, received an unprecedented number of requests for reviews. All requests have been acknowledged and recorded in chronological order of receipt by the CCG and are being progressed through each stage of the review process.  

Unfortunately, the high volumes have meant that we are unable to process all of the claims as quickly as we would have hoped and there are inevitable delays caused by the number of claims reaching each stage at the same time. We estimate that claims may take between two to three years to complete, although this estimate is only a guide. This is a national issue and Cambridgeshire and Peterborough CCG are currently reviewing processes and aligning resources to reduce the time taken in the medium term.

The deadline for submitting retrospective claims that predate 1 April 2012 has now passed and the team can only accept requests for periods from 1 April 2012 onwards.

The retrospective process initially involves the collecting of information by completion of a questionnaire and consent; this will include obtaining confirmation of authority to act on behalf of the individual evidenced by production of a Power of Attorney or Grant of Probate or will detailing the executors of an estate if the individual is deceased.  The CCG also required certified copies of ID to support the consent.

Once all of this information is received, the paperwork which has been submitted will be reviewed by an experienced Nurse Assessor who will complete a screening process.  This will look at the initial evidence to consider whether a full assessment for NHS CHC is necessary.  We will normally write to the applicant following this initial screening to advise of the next stage in the claim process.

If an individual is still alive, the initial screening may highlight that a current assessment of needs is required, this will be arranged, and the individual’s representative will be invited to attend.  Once the outcome of any assessment is known the effect of the outcome on the retrospective request will be reviewed and the team will contact the applicant to advise the next stage.

If on completion of the initial review, it is determined that a full assessment for NHS Continuing Healthcare is necessary, then the CCG will need to collect the relevant evidence relating to the claim period from a number of different sources.  It is difficult for us to determine at this stage how long the review will take to complete as it will depend on the availability of this evidence, the length of the claim and the availability of Nurse Assessors at any given time to undertake the review itself. 

All claims that have been acknowledged will be progressed and there is no need for you to chase to ensure it is progressed.  All claims are being handled in chronological order of receipt of completed paperwork as this is the only fair and equitable way to proceed. The team is happy to discuss your claim with you; we must advise that we will not be able to provide timescales for progression and completion, other than to confirm that at any specific time we have received all necessary information from you for the stage at which your claim is.

Once all of the required evidence is held the case will be allocated to a Nurse Assessor who has the appropriate skills and is trained in continuing healthcare. Due to the number of claims received there may be a considerable delay between receipt of all required evidence and allocation to a Nurse Assessor.  The assessor will scrutinise the evidence and compile a Needs Portrayal Document, pulling together all the relevant information from the different sources of evidence to build up a comprehensive picture of the individual’s needs across the whole time period.  Once completed the assessor will share the Needs Portrayal Document with the applicant and request confirmation of the content and invite any comments the applicant wishes to add.

Once completed and returned, the information will be used to apply the eligibility criteria.  If a claim period spans a number of years, then the eligibility criteria may need to be applied several times.  A recommendation will be made by a multi-disciplinary team (MDT) to the CCG, as to whether the patient has a primary health need during the period under review.

If the CCG decide that the individual was eligible for all, or part of the period under consideration, the CCG will make arrangements to make a restitution payment inline with the Department of Health Redress Guidance.  Cambridgeshire and Peterborough CCG calculates Redress by use of Retail Price Index.

If the CCG decide that the individual was not eligible for CHC funding for all or part of the period being considered, the decision will be sent to the applicant with details of who to contact should the applicant disagree with the decision.

The deadline for submitting retrospective claims from before 1 April 2012 has now passed and the team can only accept requests from 1 April 2012 onwards.

If you have any queries with regard to Retrospective Reviews please contact the team by email at capccg.complexcases-chc@nhs.net or telephone 0330 057 1022.

A personal health budget is an amount of money that can be given directly to a person receiving NHS care to allow them to purchase care that is tailored to their individual needs. The allocation of this budget is agreed between the individual and their continuing healthcare team, based upon a detailed care and support plan which identifies both healthcare and wellbeing outcomes.

We believe everything we do should focus on people’s individual health and wellbeing needs. That’s why wherever possible we are trying to personalise the things we do.

Many people have said that by using a personal health budget, they have more flexibility, choice and control over how money gets spent on their care and support and makes them feel more involved and more positive. A personal health budget enables you to work with a healthcare professional to prioritise the care needs that are important to you and create a care plan that reflects your own personal health and social goals.

If you are registered to a GP in Cambridgeshire and Peterborough CCG, are eligible for NHS Continuing Healthcare and are receiving your care at home, you can ask for a personal health budget.

There are six basic steps to organising a personal health budget:

1. Getting clear information

Start by talking to the NHS team who currently look after you to find out if you would be eligible for a personal health budget. If you have been referred to the C&PCCG Complex Cases Team, we can tell you how personal health budgets work for people who receive Continuing Healthcare.

If you have recently received confirmation that you are eligible for continuing healthcare funding, a package of care and support will be put in place for you.  Your needs will be reviewed after three months, and if you are still eligible for continuing healthcare funding at this time, the continuing healthcare nurse will talk to you about the potential benefits of a personal health budget and whether you would be interested in having one.

2. Understanding your health and wellbeing needs

Your health and wellbeing needs will be assessed by your multi-disciplinary team (which may include a community nurse, social worker, and other health professionals). The team, supported by a Continuing Healthcare nurse, will discuss with you how the personal health budget may work. An important part of setting a personal health budget is agreeing how the care you receive will benefit your health - your team will talk this through with you.

3. Working out the amount of money that may be available

As soon as Continuing Healthcare funding is confirmed at 3 months, your nurse can work out the amount of money that will be available to you in your personal health budget. The amount of money will be based on your health and wellbeing needs and what a conventional package of care would look like. Have a chat with your continuing healthcare nurse if you have any questions or concerns.

4. Making a personalised care and support plan

If you choose to have a personal health budget you will need to have a personalised care and support plan (sometime called a Health Support Plan). This is developed by you and your support planner - together you will design a plan that meets your needs and meets NHS funding rules. 

5. Organising care and support

As soon as your Health Support Plan has been approved, your personal health budget will need to be “activated” – this can be organised in a number of different ways:

  • Notional personal health budget – this means the Continuing Healthcare team will buy the services you need directly from the service provider (e.g. a care agency, or if you are in permanent residential accommodation.
  • 3rd party personal health budget – this means we pass on the money to someone you know, who then organises your care for you (as agreed and described in your Health Support Plan).
  • Direct payment – this means we pass on the money directly to you, and you can organise your own care (as agreed and described in your Health Support Plan).

You can also choose to receive your budget as a combination of the three options above.

6. Making sure the money is working for you

Your Continuing Healthcare nurse is responsible for making sure the help and support you are receiving is meeting your needs. As your needs change, so might your personal health budget, to make sure it is giving you the most appropriate support. Eligibility for CHC funding is also reviewed regularly.

In order to ensure that your care support plan provides you with increased flexibility and choice, is safe, and that public funds will be spent appropriately, all care support plans will be reviewed by the personal health budget lead and the senior management team. It is important to us that the use of personal health budgets is fair and equitable to all. 
If you want to know more or you have any questions about personal health budgets, you can call and speak to a member of the Continuing Healthcare team on 0330 057 1022.

 NHS Continuing Care is provided to a small group of children and young people with complex health needs up to the age of 18, who need a tailored package of community support.

You can contact the Children’s Complex Cases Team by calling them on 01733 847380 or emailing them capccg.childrenscomplexcases@nhs.net

We want you to be happy with the way we assess your needs. If for any reason you are not, we would like to address the issues with you, your relative, friend or representative. We are also able to put you in touch with agencies that can offer support and advice.

We will help and guide you through our established appeals process. It is not necessary to engage legal counsel to pursue an appeal.

If you would like to make an appeal, or speak to someone about an ongoing appeal please contact:

Complex Cases Team
Gemini House
Cambridgeshire Business Park
Angel Drove
CB7 4£A

Tel: 0330 057 1022
Email: capccg.complexcases-chc@nhs.net

Useful links and other websites

The following trusted organisations also provide a wealth of useful information on NHS Continuing Healthcare.

Age UK 

Alzheimer’s Society 

Beacon - If you would like more information on NHS Continuing Healthcare, you can contact Beacon who will provide 90 minutes of free impartial advice, (NB after the initial 90 minutes there is a financial charge which they will inform you of). Beacon can be contacted on 0345 548 0300 or via their website which has free resources and information. 

Healthwatch Cambridgeshire and Peterborough - They are the independent champion for people who use health and social care services in the Cambridgeshire and Peterborough area. Their job is to make sure that those who run local health and care services understand and act on what really matters to people. They listen to what people like about services and what could be improved. They  share what people tell them with those with the power to make change happen. They encourage services to involve people in decisions that affect them.  They also help people find the information they need about services in their area. For more information visit their website.

National framework for NHS funded healthcare 

National guidance on personal health budgets