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Applying for CHC

Where can CHC be delivered?

Anywhere other than in hospital - such as in the patient’s own home; a care home; or the home of a family member.

Are children eligible for CHC?

CHC is for patients over 18 only. Continuing care for children is available but is based on different criteria than CHC for adults and arranged in a different way. For example, the way in which the child receives their education has to be included.

How is a patient assessed for CHC eligibility?

The process usually begins with an assessment by a health or social care professional, helped by the use of a screening method called a Checklist Tool. This might be done, for example, by a nurse or social worker before a patient leaves hospital, or by a district nurse or social worker while carrying out a community care assessment. (Occasionally, an application will be passed to the next stage - full assessment - without the checklist stage being done. There is also a Fast Track route, used when appropriate).

The assessment is done with the patient (and/or their representative where appropriate). Patients seen as possibly eligible for CHC then have a named co-ordinator appointed by Bedfordshire CCG. The Co-ordinator arranges for a full assessment. This will be carried out by a  multidisciplinary team of health and social care professionals, using a Decision Support Tool. (The tools are used to help streamline the process and aid consistency of approach).

What happens if a patient is told they are eligible for CHC funding?

We will discuss with the patient how their needs will be met and their care managed, and by which organisation.

What happens if a patient is found not to be eligible for CHC funding?

Other forms of care planning and provision might be appropriate.  The patient’s local authority will have been made aware of the decision (in which, if the application had reached the full assessment phase, they usually will also have been involved) and will discuss with the patient whether or not they may be eligible for support from the local authority. Sometimes the NHS may still be involved in paying for part of the support a patient needs. Care involving both the local authority and NHS is sometimes known as a joint package of care.

Patients not eligible for CHC remain entitled to use all the usual healthcare services available to everyone entitled to use the NHS, such as services provided by (for example) GP practices, hospital outpatient departments, clinics, etc.

If you do not qualify for NHS continuing health care, you may have to pay for some or all of your care, although the NHS will still provide for your medical needs. You may have to take a local authority means test to decide how much you should pay towards your personal care and accommodation if you are in a care home.

What if the patient does not agree with the decision?

If the decision was made at the initial, checklist, stage not to proceed to a full assessment, the patient (or their representative) can contact Bedfordshire CCG to ask for the decision to be reconsidered.

If the decision was made as a result of the full assessment, the patient (or their representative) can contact Bedfordshire CCG to lodge an appeal against the decision: an appeal must be lodged within six months of the decision date. (These details are also included in the decision letter). The CCG then has three months to review the decision and/or satisfy the requestor (known as ‘local resolution’): but if this is not successful, the applicant can lodge an appeal with NHS England, which has three months to address this appeal.

What is NHS-funded nursing care?

NHS-funded nursing care is only provided to patients in care homes registered to provide nursing care, and to patients who do not qualify for CHC but do need care from a registered nurse.

What about patient confidentiality?

The various authorities concerned will not talk to each other about patients and their needs without the patients concerned - or someone with the correct authority to act on their behalf (usually Lasting Power of Attorney) - consenting to this.

Retrospective applications (Previously Unassessed Periods of Care – PUPoC)

Applications can be made for any period starting after 1 April 2012 to the present time. Patients and/or their representatives can write to BCCG's CHC team, advising the possible period of eligibility. The CHC team will send a questionnaire in response which will start the screening process.

Many retrospective applications are made on behalf of someone else. Please note that anyone applying on behalf of someone else will need to have ‘Lasting Power of Attorney’ registered with the Court of Protection and provide the CHC team with the original document: this will be photocopied and returned to you. If the person has died the person applying must have evidence that they have the authority to act (i.e. executor of the will).

Is there a backlog of retrospective applications?

Bedfordshire CCG 'inherited' a substantial backlog of unprocessed retrospective applications for CHC funding for the period 1 April 2004 to 31 March 2012 from the former local Primary Care Trust (PCT).

As at January 2016, there were still some outstanding applications. These are being dealt with by a separate team with NHS England monitoring the monthly completion of cases. It is anticipated that the backlog will be cleared by 31 March 2017.


 

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