Do Continuing Healthcare assessments in hospital still exist?

Published 22/01/2018

Please note: This article was published prior to July 2022, and some information may be outdated.

Should Continuing Healthcare still be assessed prior to discharge from hospital?

One of our readers recently asked this question when his relative was about to be discharged from hospital.

So what’s the situation with Continuing Healthcare assessments in hospital?

On raising the issue of an NHS Continuing Healthcare assessment with the hospital discharge team, our reader was told that the government has now instructed hospitals to discharge patients first – before any Continuing Healthcare assessments are done.

The hospital team said that NHS Continuing Healthcare assessments should now take place ‘in the community’.

Is this correct?

NHS Continuing Healthcare assessments in hospital

In August 2017 NHS England sent a letter to CCGs saying that “less than 15% of all full NHS Continuing Healthcare assessments [should now] take place in an acute hospital setting”.

However, this does not mean that no Continuing Healthcare assessments should take place in hospital!

In addition, there are some vital things to remember if you’re told by a hospital discharge team that they ‘don’t do’ NHS Continuing Healthcare assessments.

We’ve outlined those here:

Typically, and in the experience of hundreds of families sharing their experiences on our website, a hospital will try to discharge a patient before an NHS Continuing Healthcare assessment is carried out. CCGs often call this ‘discharge to assess’.

However, many families call it ‘discharge to forget’, because people often have to wait months to be assessed outside hospital and some are never assessed at all once the hospital no longer has any responsibility.

Once a person has been discharged, families also lose the leverage of their relative occupying a hospital bed. It can be much more difficult to get an assessment done quickly as a result.

CCGs are responsible for paying for care in the interim

The Care Act stresses that people should be considered (i.e. assessed) for NHS Continuing Healthcare before they are are discharged from hospital, because that’s the only way to know who should pick up the care bill once they have actually been discharged.

If a person is discharged before being assessed for NHS Continuing Healthcare, the NHS must by default pick up the bill for ongoing care until the full NHS Continuing Healthcare process has been carried out.

What also often happens in practice is that many people are discharged and told that they’ll just have to start paying for care until the Continuing Healthcare assessment can be done.

This is completely flawed.

Why? Because it puts the responsibility for ongoing care onto the local authority – and local authorities means test people for care.

If a local authority does take on this responsibility before the Continuing Healthcare assessment process is complete, the local authority is in a potentially illegal position. It should never take on responsibility for care that is actually the responsibility of the NHS – or before a person has been assessed for Continuing Healthcare At this point it has yet to be decided who should be paying.

Additional false information that people in hospital (and elsewhere) are also often given is that they must pay care fees anyway if they have savings or a house. As we know, that is completely flawed.

So let’s go back to the letter that NHS England sent to CCGs – the one that told CCGs to reduce the number of NHS Continuing Healthcare assessments in hospital:

A letter from NHS England does not change the law. Nor does it change the principles of the Care Act.

In addition, the letter talked about ‘full’ NHS Continuing Healthcare assessments. Stage one of the process is the Checklist assessment; stage two is the full multidisciplinary team assessment.

Some families do allow their relatives to be discharged before the NHS Continuing Healthcare assessment process is complete. This is sometimes because being in hospital is proving detrimental to their relative’s health and wellbeing.

Others accept that their relative will be discharged, but (correctly) refuse to pay any care fees until the Continuing Healthcare assessment process has been carried out in the community (e.g. at home or in a care home).

Feedback and comments from many families also indicate that hospital discharge teams sometimes know very little about the proper NHS Continuing Healthcare process – and even less about the law. They are focused instead on managing and freeing up beds.

Stand firm when it comes to NHS Continuing Healthcare assessments in hospital

So if you’re told that an NHS Continuing Healthcare assessment can no longer be done in hospital, question this using the points outlined above. The person you are speaking to may be referring to the pressure from NHS England to free up beds or, alternatively, they may have been given incorrect information and may lack training in NHS Continuing Healthcare.

Ask them whether they have read and understood the Care Act, and if they tell you to start paying care fees, remind them that the NHS has a duty to cover the cost of ongoing care until the NHS Continuing Healthcare assessment process is complete.

Tagged Categories: Care homes and hospitals, CHC essentials, CHC funding, Checklists and assessments, Getting assessed, Hospitals and discharge, NHS Continuing Healthcare

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13 Comments

Katherine January 25, 2019 at 3:54 pm

I have just returned from a nasty discharge meeting at Newton Abbot hospital, where the social worker said my mum (who had a stroke at the end of November and needs complex care in a nursing home) will be discharged as soon as Thursday next week, and we should find a care home for her asap, which my elderly dad will have to pay for out of his savings until they have decided if she qualifies for the NHS Contnuing Helathcare or not - so far I understand just the initial checklist has been completed, along with a general report on her healthcare needs from the hospital that apparently will now be sent to the CCG for their final decision on funding - we only got a copy of these two documents today! My dad is really stressed about the whole thing, and I am feeling as if there is no point in carrying on. Not only have I effectively ' lost' my mum (she's not even recognising me when I visit any more, and cannot speak anyway) - she was the only person I could really talk to after my best friend died of cancer and another friend stepped under a train last year, and now I fear I am losing my dad too. Before mum's stroke he was in relatively good health for his age (80s) but now is struggling on his own. The social worker insisted that it is common practice to discharge a patient before the CHC assessment has been completed, but it just seems plain wrong Dad will have to pay for mum's care out of his own savings while they decide. They claim it makes no difference when mum is discharged because the care home fees will be fully refunded if she qualifies for CHC, but of course this is not certain, and meanwhile my Dad is panicking about all his hard-earned money being swallowed up by expensive care homes for mum. He talks about having her back at home until they decide, but that is really not an option since she needs a hoist and 2 people just to move her, is doubly incontinent, has skin sores in danger of infection, and requires five different meds administered via a PEG tube which also feeds her. Dad has gone away for a few days after an argument we had at the hospital following the meeting, and I do not know how to contact him. I am really feeling alone. Please help.

Care to be Different January 25, 2019 at 4:04 pm

Hi Katherine - so sorry to hear this. It is stressful enough as you say without having the added anxiety that goes with sorting out the funding for your Mum's care. if you want to get in touch to talk to us and see if we can help please contact via enquiries@caretobedifferent.co.uk Kind regards and you are not alone!

Meggie January 23, 2018 at 5:31 pm

Thanks for the article. I am struggling to put together a complaint about everything that happened over a period of 18 months. I am concentrating on a gap in care provision that arose when he was discharged from hospital without assessment and despite evidence of extensive and growing care needs over the months that followed not assessed in the community either. Family members provided all the care needed. It was an enormous strain physically mentally and financially (two daughters gave up work and we also paid a carer privately to support us and paid for some daycare). We were misinformed about NHS Continuing Healthcare by the professionals we spoke to, deterred from pushing for assessment by being misinformed that he would fail an assessment as he didn't qualify and so on. When after six months a Checklist was completed the nurse who completed and the CCG refused to move to a full assessment saying they had to wait until he was at his optimum. There were further delays when a GP sent a second Checklist and he was waiting for a date for full assessment/Multidisciplinary Team when he deteriorated rapidly and was Fast Tracked for end of life care by his GP.
Can you confirm that throughout the period when we were forced to fund all care my father was the responsibility of the NHS? You state the Care Act is clear that the NHS "must by default pick up the bill for ongoing care until the full NHS Continuing Healthcare process has been carried out." Is this really the case?

Holly January 22, 2018 at 9:00 pm

Thank you so much for this article. We nearly fell foul to agreeing to pay care fees whilst awaiting results of an NHS Continuing Healthcare (CHC) assessment which was done at our insistence, before discharge from hospital. At the end of the assessment the lady leading the Decision Support Tool said she recommended Funded Nursing Care (FNC) not CHC funding. We were then told that Mum was to be discharged to a nursing home. They said the council require a flat fee of £135.05 per week plus any top up fees whilst Mum awaited full financial assessment, at which point she would be liable for full fees less the £155 Funded Nursing contribution from the LA as she owns her own home. We agreed to this as it sounded better than paying full fees immediately (and we didn’t know any better). However, in the days running upto discharge Mum had another stroke. Despite this accelerating the Alzheimer’s further, and reducing her mobility, they refused to do another assessment, stating that there had to be a 12 week break between CHC assessments. Instead they have been pressuring us into a discharge date. We had an impromptu meeting yesterday, after passing me from pillar to post. Social workers keep talking as if Mum has been awarded FNC, despite there being no result of the first assessment yet. I informed them that the recommendation shouldn’t have even been given before the results of the CHC were back, and that the assessment was now void as it’s contents is no longer accurate. I stated that because of the previous errors, we would like the assessment done in the hospital, rather than the community as they keep offering. They have agreed to ask for another assessment, and we are awaiting news. Thanks for all your help Care to be Different. Advice to others... read read read!!

Angela Sherman January 23, 2018 at 11:53 am

Thank you, Holly, for your kind feedback.

Helen January 22, 2018 at 7:09 pm

My local NHS Continuing Healthcare (CHC) department said they don't normally do even a Checklist in hospital, that they like to wait until people have had a chance to "settle" out of hospital and are at their "optimum". When I pointed out they were essentially ignoring possible health needs in the hope patients would either eventually improve in some way so as to be too well for CHC or die, the person I spoke to had no answer.

Meggie January 23, 2018 at 5:17 pm

Hi Helen, I am hoping that some of the very well-informed individuals who post on the site can answer this question about someone being at their "optimum". Where does it come from? And how does someone get NHS Continuing Healthcare if an assessment depends on a subjective decision at some point in the future by someone in the CCG who has never met the patient concerned? I felt it was just another way to deny assessment.

Jenny January 23, 2018 at 1:22 pm

A further objective may be to get as many as possible redefined as "Social Care" need, and thereafter self funding, and "Off the books" altogether. The lines are already blurred in the mind's of patients, NHS staff and Social Services. This is now further aided by linking the two departments under Jeremy Hunt, and the ever more frequent mention in the media of Social Care. It's all working out well for the NHS - if their aim is to offload health need responsibilities.

John Fahy January 22, 2018 at 5:31 pm

My mother was discharged from hospital direct into a care home after a perfunctory "assessment" four weeks earlier - hardly "part of the process of discharge". Four months later she was properly assessed and immediately granted full funding which lasted, despite attempt to remove it, until her death. I applied unsuccessfully for re-imbursement of her four months' care home fees relying on paragraph 54 of the National Framework. The Independent Review Panel disagreed with me and now the Ombudsman has the case in hand.

Brian January 22, 2018 at 4:53 pm

Great info - getting this knowledge to families before discharge will be invaluable....wish I'd known this 18 months when my Mum was in NHS hospital.....caretobedifferent so valuable.....

Of course the downside is that the hospital bed backlog will increase as a result.....

Angela Sherman January 22, 2018 at 5:22 pm

Thanks for your kind feedback on the website, Brian - appreciated.

Richard J. Terrell January 22, 2018 at 2:59 pm

Thank you for this page.
I am caring for a friend at home, whom had been originally discharged from hospital in March 2015 then re-admitted again I recall about December 2016, then admitted briefly again, then again November 2017, but then put into a Care Home against human rights (he was subjected to agreeing, by being told he would be cut off from his family, signed 2 LPA's covering his finance and health without explanation, denied right to change his mind being told it was just for two weeks respite and given no documentation whatsoever.) He was locked behind closed door, could not go out without a nurse, not allowed home. He was even incorrectly told he was now under a different council. I had to get a solicitor to fish him out.
So, what's this all about.....Care Fees; incomplete and incorrectly done NHS Continuing Healthcare (CHC) Assessments. Without explaining further, I vermently agree he should pay nothing. To date he is alleged to owe now over £40,000 for what is illegal and inhumane treatment.
Additionally, the ongoing invoices we receive each month, with treats to deduct from bank, time to time court proceeding, do not even represent the care he receives. Come on someone, is taking the Micky!
Thus , I am livid - he will not pay a penny.
Correction, the those dates likely should read March 2015, then November 2015, then November 2016. It is part of an ongoing saga I written elsewhere on your site.
Autumn of 2016, it was established in a NHS CHC Checklist, he is now entitled to the Full NHS CHC Assessment, but still not done, as he was stripped on a Social Worker due to the agreement.