A Beginner’s Look into…CHC (Continuing Health Care)

[Chemmy]

NB: I would like to point out that this thread is not intended to be a prescriptive guide on how to apply for or obtain CHC funding . It's an opportunity for members to share experiences, which will naturally be anecdotal, and as such, any information should always be verified by consulting official sources.

The Alzheimers Society has produced a booklet When does the NHS pay for care?

and the Department of Health publishes its NHS Continuing Healthcare Checklist

According to the NHS Choices website, CHC is a package of continuing care provided outside hospital, arranged and funded solely by the NHS, for people with ongoing healthcare needs.

The phrase that crops up time after time is ‘primary health need’. Google that as much as you like or ask about it on here, but I’ve yet to see an answer which spells out in simple terms what it actually means in practise. So the idea of this thread is to cut through the gobbledegook so that those of us who are not experts can try and establish if the person we’re caring for might be eligible.

So, starting with the basics:

the checklist appears to be the tool used by professionals to establish whether or not the patient should be referred for a full assessment

Looking at it, there appears to be 11 main sections

Behaviour*
Cognition
Psychological/Emotional
Communication
Mobility
Nutrition
Continence
Skin Integrity
Breathing*
Drug therapies and medication: symptom control*
Altered states of consciousness*

each of which is assessed in three categories: A, B & C, which, in simple terms, I would sum up as being
A: severe
B: difficult, but managable
C: not present

It appears that you qualify for a full assessment for NHS continuing healthcare if there are:
 two or more As
 five or more Bs
 one A and four Bs
 one A, if marked with an asterisk *

This asterisk bit is interesting as it would explain why people whose behaviour is highly unpredictable seem to qualify for CHC even though their communication and continence issues, for example, are less severe than others who are turned down.

I apologise in advance to anyone who finds this interpretation too simplistic and I’m quite happy to be corrected if I’ve got things wrong. However, as the title suggests, the purpose of this thread is to allow those of us who haven’t got to grips with the fine details of CHC the opportunity to ‘ask the b****** obvious’ and to have it explained, if possible, in laymen’s terms.

I would be very interested to hear from people who have been awarded CHC what it was that tipped the balance in their favour.

What medical conditions do you have to have to get an A?

Equally interesting, what medical conditions were classified as not severe enough to get an A?

 

[winda]

Hi Chemmy,

I think this thread is a good idea as CHC is so confusing and I think it is made deliberately so.

Could I just point out that there is also another category of Priority and CHC is usually only considered when things are placed in this area. It is very mysterious as to what qualifies a condition to be considered for this category. I feel that it is all kept deliberately mysterious. If anyone knows the answer it would be very useful.

 

[Chemmy]

Hi Winda

I believe the priority categories are the ones with the asterisks

Taken from the checklist (p4)

one domain selected in column A in one of the boxes marked with an asterisk
(i.e. those domains that carry a priority level in the Decision Support Tool)

ie you only need one of those *categories to score an A to be put forward to the full assessment.

Hopefully between us we can tease out the answers

 

[winda]

Hi Chemmy I have my husband's completed checklist in front of me and there is a Priority category for all these areas:-

Cognition
Psychological Needs
Communication
Mobility
Nutrition
Continence
Skin
Other significant needs (?)
Altered States of Consciousness, Continence,Communication and Psychological Needs, also count if they are in in the Severe category.

The others only count in the Priority category.

 

[Chemmy]

Interesting, Winda - good to hear from someone who has an actual list in front of them.

Now then, thinking this through, is your list the initial assessment list I was refering to, which is used to decide if the case should be put forward for the full assessment or

the DST (Decision Support Tool) which seems to have different levels - Severe, High, Moderate, Low or no needs, rather than A/B/C scores as mentioned before.

I must admit I've not come across the DST document before, so I need to go and have a read through that.

 

[winda]

I should have added that if a person is placed in the Priority category for at least one of the above then they may be considered for CHC.

I would be very interested to know the criteria the assessor uses in order to put something in the Priority areas. It is all down to his interpretation.

 

[winda]

Hi Chemmy,

We must have posted at the same time.

The list I am referring to is the final result of my husband's assessment when it was decided that he did not qualify. (it was the list used to decide whether to send it to the panel, which it was). I think that the DST can have different formats, the one used for us was the one that uses Severe, High, Moderate, Low, No needs.

There are some boxes which are shaded on the final part of the Decision Support Tool and my husband was not placed in any of them. It is only when a person is in the shaded areas that they would possibly qualify but I don't know if it's guaranteed.

I have just realised that I have forgotten to add some extra info in my previous post. Will put that right.

 

[Pheath]

Really helpful Chemmy, thanks for putting this together as people often post questions about CHC.

Makes me think my dad would qualify just on grounds of behaviour (v unpredictable) and cognition plus would score quite high on a couple of other criteria too. It’s good you put it in simplistic terms as it’s a complicated subject area and there’s a lot of confusion about it. At least if we understand the basics that’s something to start from! As winda says I think a lot of it depends on the subjective interpretation of the assessors as there’s no guarantee that even when you think you’ll qualify that you actually will.

 

[Chemmy]

OK, so we've now established that the Department of Health has two different documents on it's website,

NHS Continuing Healthcare Checklist

DST (Decision Support Tool)

using different scoring systems, which seemingly can be used to establish whether or not to refer the person for full assessment.

I wonder if the DST is the full version that some authorities use at the outset instead of the simpler one? Perhaps someone who knows could clarify?

 

[Saffie]

I wonder if the DST is the full version that some authorities use at the outset instead of the simpler one? Perhaps someone who knows could clarify?

Our authority used this for the initial pre-full assessement and I have it here. His application never even went to full assessment even though he had/has multiple health problems as well as dementia. I have only just realised that the reason for this was because the nurse didn't furnish enough evidence to support the level of severity she placed him in. The CHC team then offered the help of an assessor to complete the form but the nurse and the SW then decided that my husband didn't qualify for the CHC. This fact was hidden from me by both the SW and the hospital. I have now applied for retrospective and forward CHC funding.

 

[Chemmy]

Thanks, Saffie. So that's 2/2 so far using the DST form at the pre-assessment stage.

Hypothetical scenario:

Patient is in hospital. You decide to apply for CHC funding for them.

1. who do you approach in the first instance?

2. who is responsible/carries out the initial assessment?

 

[ggma]

Thanks for starting this Chemmy, very interesting and hopefully will help us all when we reach a certain point.

will continue to follow with interest

 

[winda]

Hi Chemmy,

My husband was in an assessment ward. I didn't have to ask anyone for the CHC it was done automatically before he was discharged. This is what should happen, if not you should tell the senior nursing staff that you want one done.

The person who does it is a Nursing Assessor from the PCT. Others are invited to give their views ie Nurse from the ward, SW, the person who is being assessed if they have capacity and/or a family member. It is also possible to have a solicitor present if you so wish.

It is the Nursing Assessor who decides whether it will be referred to the Panel.

 

[hopeful56]

Checklist and DST

I think we are in danger of confusing the checklist, the full DST, and the categories Priority and Severe.

The Checklist is merely a gatekeeping process. The practitioner completing it will score each of the domains already mentioned as either A, B or C.
A full assessment for NHS continuing healthcare is required if there are:
• two or more domains selected in column A;
• five or more domains selected in column B, or one selected in A and four in B; or
• one domain selected in column A in one of the boxes marked with an asterisk
(i.e. those domains that carry a priority level in the Decision Support Tool), with any number of selections in the other two columns.

Once the decision is made that the person meets the criteria above a full assessment must be carried out by a multidisciplinary team. This will score the 12 domains as:

Priority (only possible in those domains that carry that as a possible score - behaviour,breathing, altered state of consciousness)
Severe
High (but this is the highest possible score for communication, psychological and emotional, and continence)
Moderate
Low
No Needs

CHC SHOULD be awarded for anybody who score one priority OR two severes - without further discussion! The panel is under instruction to agree!!
If the person scores one severe and several other highs or moderates then they may well be eligible for CHC - and this is where the fight comes in I feel!

All this is well detailed in the documents available from the DoH.

Hope this clarifies things a bit.

It is good to see some postings about CHC encouraging people to apply for it. It has been denied to dementia-sufferers for far too long. Let's fight this thing!

JJ

 

[winda]

Hi JJ,

From my earlier post you will see the areas which can be put in the Priority category.
I have taken this from the DST used for my husband earlier in the year.
It involves more areas than just the ones which are starred.

Unless I have got this completely wrong.

 

[hopeful56]

Hi Winda

I have taken the info from the DoH's website, so I am pretty sure it is right. Priority is only for those that are pretty life-threatening (either for the person themselves - breathing, drug therapies, altered state of consciousness - or for others ie behaviour). Several other domains also have a severe score available, while for others (eg communication and continence) High is the highest available.

JJ

 

[JPG1]

Excellent post, hopeful56. Thank you.

If I may add : the initial Checklist (used to decide whether a full assessment for CHC is to be carried out) can be completed by almost 'anyone' as long as they have received appropriate trianing, and is the very first stage.

"It is for each organisation to decide for itself which are the most appropriate staff to participate in the completion of a Checklist. However, it must be borne in mind that the intention is for the Checklist to be completed as part of the wider process of assessing or reviewing an individual’s needs. Therefore, it is expected that all staff in roles where they are likely to be involved in assessing or reviewing needs should have completion of Checklists identified as part of their role and receive appropriate training." (Page 1 of the Checklist)


The full assessment, as you so rightly say, is via Multi-Disciplinary Team input.

The National Framework for NHS CHC is the 'umbrella' document.

There are also other 'Guidance' documents available, each of which gives additional information.

There may also be confusion emerging here as to the definition of 'panel' and the stage at which the DST is compiled. Over to you, hopeful56!

Thanks again for your extremely helpful post, JJ.

 

[winda]

Hi JJ,

I didn't find the DoH website very helpful at the time of my husband's assessment as it did not include a full version of the DST.
Once all the areas have been looked at and put into categories they are all entered onto one chart showing all areas and categories. It is only at this stage that it is clear which areas are priorities. These boxes are shaded. Only if someone is placed in the shaded area is the person deemed to be priority. (I was told this by the nursing assessor as I was present).

You will see in my earlier post which areas may come into the priority category ie the shaded areas,

 

[Chemmy]

This will score the 12 domains as:

Priority (only possible in those domains that carry that as a possible score - behaviour,breathing, altered state of consciousness)
Severe
High (but this is the highest possible score for communication, psychological and emotional, and continence)
Moderate
Low
No Needs

For those of us who are playing catch-up, let's just run though that again :

There's an excellent chart on p6 of the DST document which makes this scoring system much easier to understand. I suggest everyone takes a look.

It shows all the categories and the possible scores for each.

If you then look at p9, it says

A clear recommendation of eligibility to NHS continuing healthcare would be expected in each of the following cases:
•a level of priority needs in any one of the four domains that carry this level.
•a total of two or more incidences of identified severe needs across all care domains.

So 1 x Priority level and/or 2 x Severe scores should secure you CHC funding

We seem to be getting somewhere now

It goes on to say

If there is:
• one domain recorded as severe, together with needs in a number of other domains, or
• a number of domains with high and/or moderate needs,
this may well also indicate a primary health need.

So this is where the ambiguity is coming in - anything less than the clear cut 1 x Priority/2 x Severe score is open to interpretation by the panel as to whether or not it is a primary health need. I think this is where I would like to see some real examples.

What is interesting is that continence and communication can only score a maximum of High.

 

[winda]

Looking at my husband's DST both Continence and communication can score Severe and Priority. This is where the government website is misleading.