1. Introduction

On 19 March 2020 NHS CHC assessments were suspended under the Coronavirus Act 2020. From 1 September 2020, the Government has reintroduced NHS CHC assessments.

The reintroduction of NHS Continuing Health Care (CHC) assessments include:

  • three and twelve months reviews, and individual requests to review eligibility decisions deferred between 19 March and 31 August 2020 (see Section 2, Restart of the NHS CHC Process);
  • new NHS CHC referrals from 1 September 2020;
  • the introduction of six week Funded Recovery – Hospital Discharge Operating Model (see Section 5, Funding Arrangements).

2. Restart of NHS CHC Processes

See also Continuing Health Care (NHS) chapter

Three and twelve month reviews, and individual requests to review eligibility decisions deferred between 19 March and 31 August 2020 restart from 1 September 2020. Local health and social care systems may wish to extend the use of the Trusted Assessor Model and digital assessments in order to manage the reintroduction of NHS CHC assessments.

Where possible Care Act and NHS CHC assessments should be carried out jointly, so that there is a single ‘collation’ of relevant information and a joint approach to a (health and social care) recommendations for long-term funding. This approach should not, however, cause any further delays and should be legally compliant and have regard to the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care.

3. Principles

These principles should be adopted to support joint health and social care system recovery.

3.1 Workforce

Clinical Commissioning Groups (CCG) and local authorities should secure sufficient staff to manage the reintroduction of NHS CHC assessments. This may require securing additional temporary health and/or social care professionals (funding from the Hospital Discharge Programme will be made available to CCGs / local authorities to recruit extra health or social care staff to support the deferred assessment work).

Local health and social care systems should ensure that they use their workforce efficiently and effectively by:

  • using well-trained non-clinical staff, wherever possible, to release clinical or professional staff time to focus on robust eligibility recommendations; and
  • ensuring good training programmes and supervision.

3.2 Communication

Good local communication with individuals and families is important so that they understand future funding arrangements for long-term care. The Accessible Information Standard should be applied to the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss.

It will be important to explain to patients whose care has been NHS-funded during the COVID-19 period (since 19 March 2020) that the local authority Care Act Assessment might result in them having to contribute to, or fully fund their future care, if they are identified as not eligible for NHS CHC funding.

3.3 Efficient and effective referrals

To ensure that the right people are referred, there needs to be an agreement between CCGs and local authorities on the appropriate use of the NHS CHC checklist, consistent with the National Framework.

See Section 6: When it is not Necessary to Complete an NHS CHC Checklist.

The following should be in place:

  • formal arrangements to confirm who is ‘checklisting’ on behalf of the CCG;
  • a ‘checklisting’ training programme.

3.4 Assurance and governance

NHS CHC staff who were re-deployed to other roles in March 2020 should be brought back to their roles in CCG teams to start from no later than 1 September 2020.

There will be a regular NHS CHC situation report (SITREP) data collection to monitor the completion of NHS CHC assessments that were deferred between 19 March and 31 August 2020. This regular data collection will begin in August 2020 and last until decisions have been made on all deferred assessments.

4. Change of Process under the Discharge to Assess Arrangements

The Hospital Discharge Service Policy and Operating Model introduces a change of process for the discharge to assess approach (see Hospital Discharge Service chapter).

NHS CHC teams must work closely with community health and social care staff in supporting people on discharge pathways 1, 2 and 3, to ensure appropriate discussions and planning concerning a person’s long term care, including making sure NHS CHC assessments happen as early as possible during the six week discharge pathway.

If NHS CHC decisions are not reached within the six week time frame, care should continue to be provided until the ongoing care assessments are complete. Whatever arrangements are agreed, costs from week seven cannot be charged to the discharge support fund and must be met from existing budgets. CCGs and local authorities should agree an approach to funding of care from the seventh week.

Where an existing local arrangement is in place to agree who funds care while assessments are taking place, this may remain in place if it is affordable.

In the absence of any local arrangement for funding from week seven onwards, the following approach may be adopted:

  • costs to be allocated depending on the point the assessment process has reached at six weeks;
  • if NHS CHC or NHS funded-nursing care (FNC) assessments are delayed; the CCG remains responsible for paying until the assessment is completed;
  • if the person is assessed as not eligible for NHS CHC, the local authority will be responsible for funding in line with existing procedures until the Care Act assessment is completed.

5. Funding Arrangements

From 19 March to 31 August 2020 the NHS paid for new or increased packages of care for patients discharged from hospital or who would otherwise have been admitted to hospital. This was funded through a COVID-19 discharge and recovery budget.

From 1 September this budget will not be used to fund new or increased packages of support on discharge from hospital or to avoid admission to hospital.

From 1 September 2020 this will be replaced by the six week funded recovery. It will apply to all patients discharged from hospital, short term or rehabilitation beds and rapid response / admission avoidance. This funding ensures that NHS CHC and Care Act assessments can be carried out and eligibility decisions confirmed within the six weeks following discharge from hospital.

5.1 Individuals discharged from, or who would have been admitted to, hospital between 19 March and 31 August 2020

People funded though the COVID-19 discharge funding arrangements which commenced on 19 March 2020 and who entered a care package between 19 March and 31 August 2020, will continue to be funded through those arrangements.

Relevant assessments should be completed for these people as soon as is practical to ensure transition to normal funding arrangements.

If a person was funded during this period using the COVID-19 budget and is assessed as eligible for NHS CHC funding, the payment of their care costs will transfer from the COVID-19 budget to core CCG CHC budgets at the end of the NHS CHC assessment process.

If an individual was funded during this period using the COVID-19 budget, and is not eligible for NHS CHC funding, the payment of their care costs will transfer from the COVID-19 budget to local authority responsibility, following the end date of the NHS CHC assessment process.

Local authorities will need to determine if individuals continue to be eligible for support under the Care Act or are responsible for the costs of their own care.

It is essential that, under the new arrangements, there is clarity about which CCG is responsible for assessing each person’s needs and paying the relevant organisation for any healthcare services provided to the individual. See NHS England Who Pays? Rules for clarification.

6. When it is not Necessary to Complete an NHS CHC Checklist

The circumstances when it is not necessary to complete an NHS CHC checklist are set out in paragraph 91 of the National Framework. There will be many situations where it is not necessary. These include where:

  • it is clear to practitioners working in the health and care system that there is no need for NHS CHC at this point in time. Where appropriate/relevant, this decision and its reasons should be recorded;
  • the individual has short-term health care needs or is recovering from a temporary condition, and has not yet reached their optimum potential;
  • it has been agreed by the CCG that the individual should be referred directly for full assessment of eligibility for NHS CHC;
  • the individual has a rapidly deteriorating condition and may be entering a terminal phase. In these situations the fast-track pathway tool should be used instead of the checklist;
  • an individual is receiving services under section 117 of the Mental Health Act that are meeting all their assessed needs;
  • it has previously been decided that the individual is not eligible for NHS CHC and it is clear that there has been no change in their needs.