Continuing NHS Healthcare information booklet for individuals, families and carers - What CHC is

Continuing NHS Healthcare, also known as CHC, is a package of on-going care that is arranged and paid for by the NHS.

You will be eligible for CHC if your Local Health Board assesses you as having a primary health need. This is explained in the eligibility section. This is the only eligibility criteria for CHC. If you are assessed as having a primary health need, it is your right to have CHC.

For example, this could include people who have longer term physical and/or mental health support needs because they are disabled or have an illness or had an accident. It can be provided in any setting, including your own home, within a care home, hospice, or in a prison and be delivered by a range of health and care workers.

If you have long term care needs the type of care you need may be the responsibility of either the NHS or your local authority social services or both. Sometimes it will be obvious who will be responsible for your care but if you have complex care needs you may receive a mixture of services from each of these organisations. This booklet is about services funded by the NHS.

NHS

All NHS services are free, so if you are eligible for CHC, the NHS will cover the cost of all of your health care and most of your social care, including residential accommodation (in a care home). Your Local Health Board (LHB) is responsible for organising the assessment process to see if you are eligible and if so it will also plan and deliver the CHC package of care. If you are found to be eligible for CHC, the NHS will pay for:

• If you live at home the NHS pays for healthcare such as services from a community nurse or specialist therapist and associated social care needs, help with washing and dressing for example. This does not include the cost of accommodation, food or general household support. 
• If you live in a care home, the NHS will contract with the home to pay fees covering your accommodation and assessed health and personal care needs.

Local Authority

Local Authorities (LAs) are responsible for providing Information, Advice and Assistance about care and support. If you do not have a primary health need, your care and support could be provided by your LA, through Social Services. Eligibility for social care is defined in the Social Services and Well-being (Wales) Act 2014. These services are means-tested, meaning that depending on your financial circumstances, you may have to pay towards your care and accommodation.

Do I need to pay towards my care home costs if I am eligible for CHC?

The NHS will pay for your accommodation and assessed health and personal care needs. There may be circumstances where you choose to pay fees to your care home for additional services such as to receive extra sessions of physiotherapy (in addition to those agreed in your care plan). Other examples include a more expensive accommodation type (larger room) or ‘extras’ such as daily newspapers. These are sometimes referred to as ‘top-up’ fees and are a separate, private payment arrangement you have with the care home provider. More information on different accommodation types and whether you will need to pay towards them is in the section 'How is CHC organised'

Any decision you make to purchase additional services must be through a personal choice of yours and not through a lack of appropriate NHS funding to meet your needs as identified in your CHC care plan.   

If you receive a request from your care home provider to fund additional services that you have not agreed to then contact your LHB immediately to resolve this.

The CHC assessment process can be complex. Think about who you would like to support you throughout the process. Many people find there are some things that they don’t fully understand; the assessment is about your needs and what is best for you, so please ask questions at any time.  It is likely that you will need to talk about things that are sensitive. It is important to have clear and open conversation. A team of health and social care professionals, known as the Multi-Disciplinary Team (MDT) will work with you to assess your needs (see 'How is CHC eligibility assessed').

Advocacy

An advocate is someone who can help you make your views known during the assessment process. The use of an advocate may help you to better and more confidently navigate the CHC process.  As well as supporting you to better understand your own role in the CHC process, an advocate can also help you understand the consequences of the choices and decisions you make.  You can nominate a person to represent your views or speak on your behalf and this could be a family member, friend, a local advocacy service or someone independent who is willing to undertake an advocacy role for you. The LHB should make you aware of local advocacy services.

It’s important to understand the difference between the roles of an advocate and the Care Co-ordinator. The Care Co-ordinator will likely work for the health board or the LA and will not be independent.  The LHB and LA should make you aware of local advocacy services that could offer you advice and support.  

Information on how to contact your LHB, how to complain and other useful contact details, including advocacy support. 

Consent

You will be asked to give your informed consent to the CHC assessment process. In order to give informed consent, your Care Co-ordinator will meet with you to explain the whole process, and make sure you have enough information to make your decision.

You have the right to refuse a CHC assessment, or later turn down an offer of CHC following an assessment. The LHB and LA will work with you to ensure that the risks are fully understood and mitigated as far as possible. They must inform you of the potential effect this will have on the ability of the LHB or LA to provide appropriate services. The NHS will continue to provide health services for free, for example GP and district nurse services. However, the LHB cannot become responsible for arranging and funding social care services to you that are free, as would be the case under CHC. You are free to change your mind at a later stage.  

You may be able to receive a shared/ joint care package from both the LHB, for any health elements, and the LA for any social care elements. The LHB and LA will work with you to co-produce your joint care plan to address any assessed needs you have. More about joint packages of care is included in the section 'What happens if I am not eligible for CHC'

If you lack capacity to give consent, staff will check to see if you have an appointed Lasting Power of Attorney (Health and Welfare) to act on your behalf, or if the Court of Protection has appointed someone as a personal welfare deputy. If not, the person leading the assessment at that point will be responsible for making a ‘best interests’ decision. In these circumstances a decision needs to be made as to whether it would be in the person’s best interests to proceed with the assessment and sharing of information or to delay seeking consent until capacity is regained. They will usually consult with family and friends. Where there are no family or friends available an Independent Mental Capacity Advocate will be provided.

Language

Throughout the CHC process, you have the right to use the language/format or method of your choice to communicate and participate fully, as an equal partner, in assessing your needs and arranging your health and social care.

Welsh language requirements are set out in the Welsh Government’s strategic Welsh language framework, ‘More Than Just Words’. Your request to communicate in Welsh should not delay your CHC eligibility assessment as there are specific Welsh Language Standards in place which require both LAs and LHBs to provide this to you.

The same considerations apply to British Sign Language (BSL) and other languages and formats, e.g. Braille.  

Carers

A carer is someone of any age who provides unpaid support to family or friends who could not manage without this help. This could be caring for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.

If you have a carer and it appears to your LA that they may have needs for support, your carer has the right to have their needs assessed by the LA. LHBs and LAs must tell you about this right. Carers could be eligible to receive support to help them with their caring role. It should never be assumed that your carer is able or willing to continue to provide support.

• You are identified as possibly being eligible for NHS CHC. You will be given a Care-Coordinator. They will oversee the whole process, answer your questions, keep you informed, seek your consent, tell you about advocacy and ensure your language or communication method of choice is used throughout the CHC process.
• Your Care-Coordinator will organise a Multi Disciplinary Team (MDT). The MDT will collect the evidence needed for your CHC assessment. They may contact you to get the information they need.
• An MDT meeting will take place to assess your needs. You and your carer, family or advocate can attend this meeting and be fully involved. The Decision Support Tool (DST) will be will be completed to support the process. The MDT will then make a recommendation to your LHB on your eligibility to receive CHC funding.  If eligible, your care package should be in place within 2 weeks from the date of this meeting
• If you are eligible for CHC, your LHB should arrange your package of care within 8 weeks from any initial indication or assessment for example the checklist, that indicated you may have a primary health need. This  includes any time you require for rehabilitation or reablement. This timescale may be extended if you require a longer period of rehabilitation or reablement.

If your need for care is more urgent, for example end of life care, the LHB should consider applying a fast track assessment.

Everyone involved in your assessment must work to these principles:

1. People first. Your best interests must be put first. You should be treated with dignity and respect.
2. Integrity of decision making. The Multi-Disciplinary Team must work with integrity. Their expert advice and decisions should be based on clear rationale.
3. No decisions about me without me. You are the expert in your own life. You and your carers should be fully involved in the assessment and care planning process.
4. No delays in meeting your needs due to funding discussions. You should not experience any delay in having your needs met because health and social services, and any other care provider, are not working well together. They have the responsibility to resolve any disputes or concerns as soon as possible.
5. Understand diagnosis. Focus on need. You are not defined by your diagnosis. Your care and support should be tailored to you. It should maximise your independence and focus on what is most important to you and your carers.
6. Coordinated care and continuity. Every effort must be made to avoid disruption to existing care arrangements, or to provide a smooth and safe transition where change is required for your best interests.
7. Communicate. Professionals must take extra care to communicate with you in your preferred way, and they should try to find out what that is before the assessment begins. This includes: Welsh, British Sign Language, written information in alternative formats such as easy read, or alternative methods of communication for people with severe speech and communication difficulties.