Following the COVID-19 restrictions imposed for NHS Continuing Healthcare Funding (CHC) since 19 March 2020, the Government has just announced some positive news.
From 1st September 2020, Clinical Commissioning Groups (CCGs) have been mandated to resume their NHS Continuing Healthcare assessments and appeals. New NHS Guidance has been published for the reintroduction of CHC assessments. But is it back to business, as usual?
At the outset of the COVID-19 pandemic, acute hospitals were instructed to discharge all patients who no longer needed to be in a hospital setting as soon as it was clinically safe to do so. To assist these patients, between 19th March 2020 to 31st August 2020, the Government introduced a COVID discharge support fund. This was an emergency interim financial measure to help speed up the discharge of patients from NHS hospitals whilst recognising that it would not be possible to undertake assessments for NHS Continuing Healthcare during the pandemic and lockdown period. Patients were therefore provided with automatic emergency funding for their care. This interim funding was designed to help support the cost of their recovery, rehabilitation and reablement care, with the intention that they would undergo an assessment for CHC in due course, when the situation returned to some kind of normality.
Many individuals will have been discharged from hospital and admitted to care or nursing homes during this period and will have been in receipt of emergency COVID funding. It is important to remember that this is not NHS Continuing Healthcare Funding, and subsequent assessment will inevitably find that some individuals do not meet the criteria for CHC Funding. This does not mean that they were previously eligible and funding has now been withdrawn – the previous funding was solely emergency COVID funding and does not in any way reflect an individual’s eligibility or otherwise.
Thankfully, it now seems that the time has come for CCGs to restart their assessments and appeals. As from 1st September 2020, the Government wants to resume ‘normality’ as best it can and address the issues of both CHC and Local Authority funded care.
Understanding the difference between these two funding routes is vital. CHC is free at the point of need and is not means-tested. Social care is provided by the Local Authority and is means-tested, and may result in you contributing to the cost of your care or paying for it in full.
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The NHS expects these following outcomes on discharge from hospital:
- 65% of people will require no further care
- 35% of people will require an ongoing package of care
Of those 35% of people who receive ongoing care, it is expected that 10% will require a package of lower intensity than at the start of recovery and will have either a CHC or Local Authority assessment.
Our blogs below have previously raised several concerns, in particular, how the CCGs will cope with the backlog of outstanding assessments and appeals that were deferred, postponed or put on hold due to COVID-19, and at the same time, also deal with the new assessments pending in the pipeline. Our main concerns focused on:
- Timing – when will normality resume, and what will it look like for those undergoing CHC assessments or appeals?
- Resources and delay – how will CCGs cope with the huge volume of past, current and future assessments and appeals?
- How good will the training and supervision be of any new resources and staff coming back from frontline redeployment?
- Cost implications – will the NHS budget be large enough to recruit resources and fund care?
The Department of Health and Social Care recently published new guidance on 21st August 2020, which also addresses our concerns. The new guidance deals with the reintroduction of CHC assessments and appeals, specifically:
- How NHS Clinical Commissioning Groups will restart NHS Continuing Healthcare assessment processes from 1st September 2020
- Routine NHS Continuing Healthcare referrals, starting from 1st September 2020
Here is a brief overview of some of the key points you need to know that are taking effect from 1st September 2020:
1. CCGs will need to reintroduce reviews:
CHC assessments, 3 month reviews, 12 month annual reviews and appeals (both at CCG local resolution level and NHS England), will resume.
2. CCGs and Local Authorities will have to:
- Clear backlogs including: CHC outstanding deferred work, referrals, reviews and assessments put on hold between 19 March and 31 August 2020 due to COVID-19
- Manage the reintroduction of routine new CHC referrals
- Ensure that CHC assessments are carried out and eligibility decisions are confirmed within the 6 weeks following a discharge from hospital
3. Comply with the National Framework:
To help get back on track without undue delay, CCGs and Local Authorities will have to liaise closely to establish efficient, robust and legally compliant processes to manage the reintroduction of CHC work whilst still having regard to the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
4. Manage staff resources issues and ability to cope:
This may require recruiting additional professionals to cope with the volume of work.
Additional temporary health and/or social care staff will undoubtedly be required and recruited in order to manage their existing workload as well as catch up with outstanding CHC and social care funding deferred assessments and appeals that have been held in abeyance since March 2020.
This process needs to be strategically planned and managed carefully, to ensure that staff who were redeployed to other frontline roles to help fight COVID since March 2020, are now integrated smoothly back into their CHC roles and are able to restart work from no later than 1 September 2020.
The guidance expects CCGs to also consider using well-trained non-clinical staff, wherever possible, to allow clinical or professional staff time to focus on robust eligibility recommendations for CHC.
Good training and supervision are critical to success and for restoring public confidence in their expectation that assessments and appeals will be conducted robustly in this new climate. Hopefully, this will be an improvement, but we shall have to wait and see!
5. Quality control and training:
The guidance recognises that there will need to be formal arrangements to confirm who is undertaking the Checklist screening assessments on behalf of the CCG and a ‘checklisting’ training programme.
The Checklist is the beginning of the assessment process, and if positive, will enable individuals to progress to a Full Assessment where their eligibility for CHC Funding is considered. Training in the assessment process and the National Framework is essential – both to ensure that everyone who requests a Checklist assessment has that opportunity – and when it does takes place, it is done correctly. It is important to ensure that individuals aren’t screened out of the process prematurely or incorrectly, only causing delays and setbacks to their entitlement to CHC Funding.
From 19 March to 31 August 2020 additional Government funding through a COVID-19 budget has been available to enable the NHS to pay for new, or extensions of, existing packages of care and support for patients discharged from hospital, or who would otherwise have been admitted to hospital.
From 1st September 2020, CCGs and Local Authorities will need to work in close partnership to ensure that an initial Checklist assessment is carried out promptly and in accordance with the National Framework, save, of course, where it is not necessary, such as:
- Where it is clear to practitioners that there is no need for CHC at this point in time;
- 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 CHC Funding;
- The individual has a rapidly deteriorating condition and may be entering a terminal phase and the Fast-Track Pathway Tool should be used instead;
- An individual is receiving services under section 117 of the Mental Health Act that are meeting all their assessed needs; or
- It has previously been decided that the individual is not eligible for CHC Funding and it is clear that there has been no change in their needs.
7. Beware the 2nd Checklist!
Despite depleted resources during the COVID period, there is a suggestion that in some rare circumstances CCGs may have used the Checklist to monitor those individuals who may need longer-term care. However, pursuant to paragraph 115 of the National Framework, it is possible for CCGs to instigate a second Checklist if the individual’s needs reduce in the time frame between a positive CHC Checklist and a Full Assessment. Healthcare needs can, of course, fluctuate over time. But this specific mention will be of real concern to many families whose valid application for CHC Funding may be derailed even before it gets to a Full Assessment.
The guidance expects that individuals should be fully informed of this intervention as it could directly impact on their finances if a second Checklist is imposed on them.
8. Audits and checking:
Comprehensive processes will need to be implemented to monitor the speed and quality of deferred assessments and appropriate decision-making regarding eligibility for CHC Funding. Data will be collected regularly to monitor the completion of CHC assessments that were deferred between 19 March and 31 August 2020, and this will continue until the backlog of postponed assessments is completed.
9. Six-weeks to assess post-discharge from hospital:
From 1 September 2020, CCGs and Local Authorities should liaise closely to ensure that those individuals being discharged from hospital have funding and support in place to help them recover and rehabilitate.
An assessment for ongoing health and care needs should take place within 6 weeks of discharge from hospital and a decision about how this care will be funded should also reached within this timescale.
After this 6-week period, CCGs will not be able to draw down from the Government’s discharge support fund and will have to pay out of their own budgets. So, at least there is some pressure on CCGs to perform and carry out an assessment and reach a quick decision.
If, however, a decision is not reached within this 6-week time frame, the CCG or Local Authority paying for the existing care package should continue to do so until the relevant ongoing care assessments have been completed.
In the absence of agreement, it is suggested that the following default position is adopted at the end of the initial 6 week’s funded care:
- Where the CHC or NHS Funded Nursing Care (FNC) assessments are delayed, the CCG remains responsible for paying until CHC/FNC assessment is done.
- Subsequently, where the individual is assessed as not eligible for CHC, responsibility for funding will pass to the Local Authority (and subject to means-testing) in line with existing procedures until their means-tested assessment is completed, after which normal funding routes will apply.
In any event, from week 7 onwards, CCGs and Local Authorities will have to agree on a funding strategy but using their own funds, and not Government discharge support funds, to pay for the individual’s ongoing care.
10. End of the line
Important: The guidance states that the COVID-19 discharge recovery fund budget will not be available from 1 September 2020 onwards to fund any new packages of support for individuals discharged from, or who would have been admitted to, hospital between 19 March and 31 August 2020.
11. Transitional funding
In the meantime, individuals who received a COVID-19 discharge recovery funded package of care between 19 March and 31 August 2020, will continue to be funded under those existing arrangements after this date.
So, at the end of the assessment process:
If an individual is found eligible for CHC Funding, the payment of their care costs will now transfer from the COVID-19 budget over to the CCG’s budget. Any care fees paid by their Local Authority or from private means (self-funders) whilst waiting an assessment, should be refunded to the individual or the Local Authority, in accordance with the National Framework.
Conversely, if an individual is not eligible for CHC Funding, the payment of their care costs will transfer from the COVID-19 budget to their Local Authority and be subject to means-testing with the possibility that they may have to pay for their own care.
The NHS should be congratulated on the tremendous service they have undertaken in risking their lives to fight the coronavirus pandemic. They have been supported by Government funding during this crisis which has undoubtedly helped many thousands of people with care and support packages following discharge from hospital. The guidance on the Reintroduction of NHS Continuing Healthcare should assist all those waiting for an assessment or appeal. But, it will inevitably take time, patience and need enhanced resources, whilst CCGs get to grips with clearing their backlogs of assessments and appeals.
Early planning and thorough preparation are essential ingredients for a successful application for CHC Funding. However, families often tell us that they find CHC assessments and appeals overwhelming, daunting, stressful and emotionally draining. If you need professional help or advocacy support with your assessment or appeal, visit our one-to-one page.
For further information, here are some useful links: