Key Information

NHS Continuing Healthcare provides fully-funded care for people with complex, intense, or unpredictable health needs. This guide covers eligibility, the assessment process, and how to access this vital funding in the West Midlands.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a package of care arranged and funded by the NHS for individuals who have been assessed as having a 'primary health need'. This means their care needs are primarily for healthcare rather than social care.

If you qualify for NHS CHC, the NHS will fund the full cost of your care, whether provided:

In your own home
In a care home
In a nursing home
In a hospice

Who is Eligible for NHS Continuing Healthcare?

Primary Health Need

To qualify, you must have a 'primary health need' which means:

Nature: The type of health needs you have
Intensity: How complex or severe your needs are
Complexity: How difficult your needs are to manage
Unpredictability: How changeable your condition is

Common Conditions That May Qualify

Conditions Often Eligible for CHC

Advanced dementia with complex behavioral needs
Terminal illnesses requiring palliative care
Severe brain injuries with ongoing complications
Multiple sclerosis in advanced stages
Motor neurone disease
Huntington's disease
Complex mental health conditions
Severe learning disabilities with health complications

The Assessment Process

Step 1: Referral

Anyone can request an assessment for NHS CHC, including:

The person needing care
Family members or carers
Healthcare professionals (GP, hospital staff, nurses)
Social care professionals
Care home staff

Step 2: Checklist

A healthcare or social care professional will complete an initial CHC Checklist to determine if a full assessment is needed. This quick screening tool looks at:

Behavior and psychological needs
Cognition (thinking and memory)
Communication needs
Mobility requirements
Nutrition needs
Continence management
Skin integrity and tissue viability
Breathing requirements
Drug therapies and medication
Altered states of consciousness
Other significant health needs

Step 3: Decision Support Tool (DST)

If the checklist indicates potential eligibility, a full assessment using the Decision Support Tool will be conducted by a multidisciplinary team including:

NHS nurse assessor
Social worker
Other relevant healthcare professionals

Assessment Timeline

Checklist: Should be completed within 2 weeks of referral
Full assessment: Within 28 days of positive checklist
Decision: Within 28 days of assessment completion
Fast track: For people with rapidly deteriorating conditions

Care Domains and Priority Levels

The DST assessment examines 12 care domains, each rated at different priority levels:

The 12 Care Domains

Behaviour: Challenging or disturbed behavior
Cognition: Memory, understanding, planning
Psychological/Emotional: Mental health needs
Communication: Ability to communicate needs
Mobility: Movement and positioning
Nutrition: Eating, drinking, weight management
Continence: Bladder and bowel control
Skin: Pressure sores, wounds, skin conditions
Breathing: Respiratory problems
Drug therapies: Complex medication needs
Altered consciousness: Seizures, coma, confusion
Other needs: Any other significant health needs

Priority Levels

Priority (P): Severe/critical needs
High (H): Significant needs requiring professional input
Moderate (M): Needs that can be met by trained care staff
Low (L): Needs that can be met with minimal support
No needs (N): No identifiable needs in this domain

Decision Making

How Decisions Are Made

A multidisciplinary team will determine eligibility based on:

Overall picture: Not just adding up scores
Primary health need: Whether healthcare is the main requirement
Nature, complexity, intensity, unpredictability: The four key characteristics
Professional judgment: Clinical expertise and experience

Possible Outcomes

Eligible: NHS funds all care costs
Not eligible: Social care assessment may be offered
NHS-funded nursing care: Partial funding for nursing home fees

Fast Track Process

For people with a rapidly deteriorating condition nearing end of life, the Fast Track pathway can approve CHC funding immediately without a full assessment, typically within 48 hours.

What CHC Funding Covers

Home Care Package

If you're eligible for CHC and choose to receive care at home, the NHS will fund:

Care services: Personal care, nursing care, therapy services
Equipment: Hospital beds, hoists, mobility aids
Adaptations: Home modifications for accessibility
Respite care: Short breaks for family carers
Day services: Community-based support
Transportation: Medical appointments and treatments

Residential Care

For care home placements, CHC covers:

Full care home fees
All personal care costs
Nursing care if required
Accommodation costs
Meals and utilities

Appeals Process

Local Resolution

If you disagree with a CHC decision, you can:

Request a review: Ask for the decision to be reconsidered
Provide additional evidence: New medical information
Local resolution meeting: Discuss concerns with the CHC team

Independent Review Panel

If local resolution doesn't resolve the issue:

Request an Independent Review Panel within 6 months
Panel includes independent clinical experts
Panel can overturn original decisions
Process is free of charge

Parliamentary and Health Service Ombudsman

As a final resort, you can complain to the Ombudsman if:

You're unhappy with the Independent Review Panel outcome
There have been serious failures in the assessment process
You believe there has been maladministration

Important Timescales

Request local resolution within 6 months of decision
Apply for Independent Review Panel within 6 months
Contact Ombudsman within 12 months of IRP outcome
Keep all documentation and correspondence

Retrospective Claims

When You Can Claim Back Payments

You may be able to claim retrospective CHC funding if:

You paid for care that should have been NHS-funded
You weren't assessed for CHC when you should have been
Your assessment was flawed or unfair
Your condition met CHC criteria during the period in question

Time Limits

No time limit: For ongoing cases where someone is still alive
12 months: After death for new claims
April 2013: Earliest date for retrospective claims

West Midlands CHC Contacts

Sandwell and West Birmingham CCG

CHC Team: 0121 612 3500
Email: chc.swbccg@nhs.net

Dudley CCG

CHC Team: 01384 321159
Email: dudley.chc@nhs.net

Independent Support

CHC Alliance: www.chcalliance.org.uk
NHS Complaints Advocacy: 0300 330 5454
Citizens Advice: 0800 144 8848
Age UK: 0800 678 1602

Tips for a Successful Application

Before the Assessment

Gather evidence: Medical records, consultant letters, care plans
Document needs: Keep detailed records of daily care requirements
List professionals: All healthcare and social care staff involved
Prepare questions: What you want to ask the assessment team

During the Assessment

Be honest: Describe your worst days, not your best
Include family: Have carers present to provide their perspective
Take notes: Record what's discussed and decided
Ask for copies: Request copies of all assessment documents

After the Assessment

Read the decision letter carefully: Understand the reasoning
Check the DST: Ensure it accurately reflects the assessment
Seek advice: Contact advocacy services if you need support
Consider appeal: If you disagree with the decision

Need Support with CHC Applications?

Everyday Care Plus has extensive experience supporting families through the NHS Continuing Healthcare process. We can provide expert care while you navigate the assessment system.

Conclusion

NHS Continuing Healthcare can provide vital funding for people with complex health needs, but the assessment process can be challenging to navigate. Understanding your rights, preparing thoroughly for assessments, and seeking appropriate support can significantly improve your chances of success.

If you believe you or a family member may be eligible for CHC, don't hesitate to request an assessment. With the right preparation and support, you can access this important funding to ensure the best possible care and quality of life.

NHS Continuing Healthcare Funding in West Midlands: Complete Guide