If you are registered with a GP in the Mid and South Essex Integrated Care System, please contact your social worker or healthcare professional to refer you to the All Age Continuing Care service. You are also able to self-refer or a member of your family / advocate or legal representative can also request an assessment with your consent, or in your best interests if you do not have mental capacity.
Frequently Asked Questions
How is eligibility for NHS Continuing Healthcare or Funded Nursing Care decided?
Usually the process starts with a ‘Checklist’ completed by a trained social worker or healthcare professional. The ‘Checklist’ is a screening assessment that gives an indication whether your needs require further assessment for Continuing Healthcare. A positive Checklist outcome does not in itself indicate that you have a primary health need.
If you have a positive Checklist, your needs are then assessed by a ‘multi-disciplinary team’ (MDT) of health and social care professionals using a ‘Decision Support Tool’ (DST). You (and where appropriate, a family member or representative) will be involved in the assessment process. The assessment may take place in your own home or usual place of residence. It may be undertaken face-to-face, or via video-conference.
The assessment team uses a framework for NHS Continuing Healthcare which is defined by NHS England. To be eligible for NHS Continuing Healthcare, you must be assessed as having a ‘primary health need’ in line with the domains included in the NHS Framework. A ‘primary health need’ does not relate to any particular diagnosis or condition. Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:
- Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs.
- Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care.
- Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/ongoing care.
- Unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.
What happens after my assessment?
Following your assessment, you will be notified in writing of the outcome. If you are not eligible for NHS Continuing Healthcare, the reasons will be explained in the letter. A copy of the assessment will be provided with that letter. The letter will also tell you how to appeal if you feel the decision is wrong. The professional who referred you for the assessment will also be informed of the outcome of the decision.
What is Joint Funding?
If you are not eligible for Continuing Healthcare, nor awarded Funded Nursing Care, you may still have some health needs that are not within the legal remit of the Local Authority to legally provide. If the MDT agree that this is the case, they will make a recommendation for a jointly funded package of care with the Local Authority. The NHS and Local Authority will agree the split of funding and you will not be subject to any financial assessment for the NHS element of your care package.
What is Fast-Track?
Fast-Track is a type of Continuing Healthcare funding that can be awarded without a full assessment for an individual who is rapidly deteriorating and may be in a terminal stage of their life. The funding is awarded where there are no suitable local NHS-commissioned services that can meet the individual’s needs. For example, this funding would not be awarded where a local provider (e.g. a hospice) is already commissioned by the NHS to meet the individual’s rapidly changing and deteriorating needs in their preferred place of care.
What is Care and support planning?
If you are eligible for fully funded NHS Continuing Healthcare, the next stage is to arrange a care and support package which meets your assessed needs. Depending on your situation, different options could be suitable. The All Age Continuing Care team will work with you to discuss your needs and consider your views about what support might best meet those needs. Other factors such as risks, cost and value for money of different options will also be taken into account.
Will I always be eligible for funding once I have been assessed?
If you are eligible for NHS Continuing Healthcare, NHS Funded Nursing Care, or your care package is jointly funded by the NHS and Local Authority, your needs and support package will be reviewed within three months and thereafter at least once a year. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, you may require a further full assessment to consider whether you are still eligible for NHS funding for your care and support needs.
How do I appeal against an eligibility decision that I do not agree with?
The letter you are sent to inform you of the outcome of your assessment will contain information about how to appeal the decision if you do not agree with it. You have 6 months from the date of that letter to advise the All Age Continuing Care service that you wish to appeal. There are several steps in the process designed to resolve concerns and disagreements, commencing with informal discussion, local resolution meeting, local appeal panel, the NHS England Independent Review Panel and final recourse to the Parliamentary and Health Services Ombudsman if required.
Can I make a claim for NHS funding for care already received?
The national deadline for submitting retrospective claims for care received prior to 1 April 2012 has now passed. It is still possible to make a retrospective application for any previously unassessed period of care since 1 April 2012. Retrospective assessments can be requested by an individual or their representative, where the individual has never been assessed, not been assessed in recent years, or has died before an assessment could be undertaken. This is generally a paper-based exercise, where an experienced clinical assessor gathers the available evidence and creates a portrayal of needs over a period which may cover a short timeframe to many years. The Integrated Care Board will make a decision based on the recommendation resulting from that retrospective assessment.