Reintroduction of NHS CHC to address backlog of referrals and assessments
The NHS has published new guidance on how CCGs will restart NHS Continuing Healthcare (NHS CHC) assessment processes from 1 September 2020.
NHS CHC is a package of care for adults that is arranged and funded solely by the NHS. In order to receive NHS CHC funding, individuals have to be assessed by Clinical Commissioning Groups (CCGs) according to a legally prescribed decision-making process to determine whether the individual has a ‘primary health need’.
NHS CHC can help people who have a lot of difficulty with things like moving around, eating and drinking, breathing, taking medicines, and moving and thinking.
However, due to the coronavirus crisis, NHS CHC was temporarily suspended between 19 March and 31 August 2020, with the health service instead focusing on treating patients with COVID-19, preventing the spread of the virus and meeting the unprecedented demand.
During the peak of the pandemic, new hospital discharge service requirements were introduced (March 2020), with a focus on discharging patients who no longer needed a hospital bed to their home as quickly as possible in order to meet the demand for hospital beds.
Now, NHS CHC will restart in September, as the NHS enters phase three of its COVID-19 response as levels of the virus have fallen across England.
This means that CCGs will undertake referrals, reviews and assessments that have been received between 19 March and 31 August 2020, and any that have been deferred as a result of the COVID-19 hospital discharge service requirements (March 2020).
The guidance states: “Local health and social care systems should, where appropriate, consider aligning Care Act and NHS CHC assessments, so that there is a single ‘collation’ of relevant information to support a joint approach to a (health and social care) recommendation for long-term funding, by either the local authority or the NHS.
“This approach should not, however, cause any further delays. It should be legally compliant and have regard to the national framework for NHS continuing healthcare and NHS-funded nursing care.”
Discharge to assess operating model
The decision to reintroduce NHS CHC across England coincides with the new ‘discharge to assess’ operating model that will be carried out in hospitals up and down the country.
This new model focuses on discharging patients from hospitals into the appropriate setting, considering what ongoing care they might need after being discharged from hospital, whether that is care at home or going into a care home, for instance. It means patients can be quickly discharged from hospital, with full understanding about what their care plans are once they are home or in a care setting.
To support this new ‘discharge to assess model’, the Department of Health and Social Care (DHSC) announced a new £588 million fund to facilitate speedy hospital discharges by giving people timely access to care beyond acute settings.
This funding gives people six weeks of funded health and care recovery and support services after they are discharged from hospital, such as access to physiotherapy services. The funding can be used to cover adult social care or the immediate costs of care in their own home.
The funding helps ensure that NHS CHC and Care Act assessments have been carried out and eligibility decisions have been confirmed within the six weeks following a discharge from hospital.
Furthermore, the new guidelines underline that NHS CHC teams should work closely with community health and social care staff when discharging patients to ensure appropriate planning concerning a person’s long-term care options happen as early as possible during the six-week discharge pathway.
This close working and communication will also ensure time is allowed for the CCG to undertake the full NHS CHC assessment and for local authority staff to undertake Care Act assessments where it is needed.
Care funding
Importantly, the guide outlines that where care has been NHS-funded during the COVID-19 period (since 19 March 2020), local health and care systems need to explain to patients how the local authority Care Act Assessment and subsequent means testing could lead to some individuals having to contribute to, or fully, fund their future care, should they be identified as not eligible for NHS CHC funding.
Workforce
The guide says that CCGs and local authorities should secure sufficient staff to deal with the NHS CHC and Care Act deferred work (from 19 March and 31 August 2020) and business as usual activity. This may require securing additional temporary health and/or social care professionals, the NHS notes.
Individuals discharged from, or who would have been admitted to, hospital between 19 March and 31 August 2020
Furthermore, the guide adds that the COVID-19 discharge and recovery service budget will not be used to fund any new packages of support on discharge from hospital from 1 September 2020 onwards.
“People funded though the COVID-19 Discharge funding arrangements which commenced on 19 March 2020, who entered a care package between 19 March and 31 August 2020, will continue to be funded through those arrangements,” the NHS explains. “Relevant assessments should be completed for these individuals as soon as is practical to ensure transition to normal funding arrangements. CCGs are expected to carry out assessments in a timely manner.”
If an individual 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.
However, 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.
The guidance emphasises that in this situation, 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.
Where individuals are assessed and found eligible for NHS CHC and they, or the local authority, funded any part of their care while awaiting an NHS CHC assessment, then CCGs should arrange for refunds to take place directly to the individual or the local authority, as long as that funding arrangement is consistent with the national framework, the NHS says.
