How to access free NHS funded care upon discharge from hospital?
Dear Care To Be Different,
My mum has dementia and is about to be discharged from hospital. Should the NHS fund her care at least until the Checklist for NHS Continuing Healthcare is completed?
We are often asked questions about a patient’s entitlement to CHC care funding upon discharge from hospital.
As with all things CHC, there is no quick or easy answer to this; it depends on the circumstances! Here are three common scenarios to assist you:
What is CHC?
Firstly, if you are new to CHC, here’s a quick overview:
NHS Continuing Healthcare (commonly abbreviated to ‘CHC’) is defined in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022) as “a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a ‘primary health need’ as set out in this National Framework. Such care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen as a result of disability, accident or illness…”
The Checklist is the preliminary NHS screening tool to determine whether a patient will go on to a full assessment for CHC Funding carried out by a Multi-Disciplinary Team Meeting using the Decision Support Tool. If successful, the NHS will fund all that patient’s assessed healthcare and social care needs, including the cost of their accommodation. So, an award of CHC can make a huge difference as to who funds care.
The starting principle to bear in mind is that the NHS National Framework states that, “There must be no gap in the provision of appropriate support to meet the individual’s needs.”
Taken at face value, this suggests that the NHS should continue funding a patient’s care upon discharge from hospital until the NHS CHC assessment process is complete – starting with the Checklist assessment.
Understanding The Checklist Assessment
Getting started with CHC? How does the CHECKLIST work
Can the NHS refuse to carry out an initial Checklist?
1. Discharge to Assess from hospital
Looking at the NHS National Framework (the rule book and guidance for CHC), the general rule is this:
“112. The Standing Rules require an NHS Integrated Care Board (ICB) to take reasonable steps to ensure that individuals are assessed for NHS Continuing Healthcare in all cases where it appears that there may be a need for such care. These regulations also state that if an initial screening process is used to identify where there may be a need for such care, then the Checklist is the only screening tool that can be used for this purpose. The purpose of the Checklist is to encourage proportionate assessments of eligibility so that resources are directed towards those people who are most likely to be eligible for NHS Continuing Healthcare, and to ensure that a rationale is provided for all decisions regarding eligibility.”
And:
“117. Where there may be a need for NHS Continuing Healthcare, a Checklist should normally be completed.”
So, if the patient is going from hospital into a care home or nursing home (or perhaps EMI residential) for the first time, it would be reasonable to assume that there may be a need for CHC (i.e., healthcare). In which case, Discharge to Assess (D2A) funding may be appropriate, pending completion of the Checklist, once ongoing needs are clear. Essentially, the NHS will take responsibility to continue funding a patient’s care needs upon discharge until they have been assessed in their community setting for CHC. This D2A funding could be a matter of weeks or longer if the NHS are slow to get the Checklist actioned.
Remember: The NHS National Framework guidance is that Checklists should no longer be completed in hospital settings, in all but exceptional circumstances. Therefore, the NHS might be expected to fund ongoing care until the patient’s requirements are clear, and a Checklist can be completed. Whether this happens in practice can depend on each ICB’s local arrangements and how ready the family are to argue their corner for D2A to continue.
2. Is there a Primary Health Need?
“120. Local health and social care joint processes should be in place to identify individuals for whom it may be appropriate to complete a Checklist, including for individuals in community settings. Wherever an individual requires a long-term care home placement with nursing or has significant support needs, a Checklist would be expected to be completed (unless the decision is made to go straight to the completion of a Decision Support Tool).”
However, if they are being discharged to a residential home and their care requirements are straightforward, it may be reasonable to assume that the ‘primary need’ is for social care, unless there are indicators this is not the case. In this situation, we don’t think there would be an expectation for the NHS to fund on discharge from hospital (D2A). The onus would be on the care home to submit a Checklist once the person has settled in – IF their needs may be indicative of a primary need for healthcare. If they are subsequently found eligible at the full Multi-Disciplinary Team assessment, an argument could be made that CHC Funding should be backdated to the date of admission into care.
Establishing A Primary Health Care Need
3. Has the patient been Optimised?
Now let’s consider an alternative scenario:
“118. Screening for NHS Continuing Healthcare should be at the right time and location for the individual and when the individual’s ongoing needs are clearer. This will help practitioners to correctly identify individuals who require a full assessment of eligibility for NHS Continuing Healthcare.
119. In the vast majority of cases, individuals should be screened for NHS Continuing Healthcare in a community setting. Paragraphs 101-108 set out how NHS Continuing Healthcare interacts with the hospital discharge process.”
The other possibility is that the patient needs a period of ‘reablement’ at the point of discharge – i.e., having possible therapy or treatment that might help aid their recovery first, before a decision is made as to their potential long-term funding needs. This is known as ‘optimisation’ and options could include things like physiotherapy, mental health team involvement, rationalisation of medications etc. In which case, the NHS might be expected to fund care until such a time as optimisation is achieved, and there is a clearer picture of ongoing long-term care needs. At which point, a Checklist should be completed. Again, it depends how much the family wants to/is capable of arguing with the Hospital Discharge Team and what local arrangements the ICB have in place.
Get in touch if you need help arguing for CHC Funding upon discharge from hospital.
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I am just wondering how the article and particularly those parts of it which mention the Framework square with the legal position in that it is unlawful for the local authority to fund care if it is the responsibility of the NHS. That cannot of course be properly determined until a CHC assessment – either checklist or DST or both- has been carried out or it has been determined that an assessment is not necessary..
The reason I ask is that my father in law who is in a care home after direct transfer from hospital and for whom I have a POA, had to wait for 12 months from the end of his D2A until his CHC assessment. The D2A ended in October 2022. This was a rather shocking failure by the ICB, since, realising that the ICB had no intention of conducting an assessment, or indeed of informing me as they should have done about CHC,I had to write to them requesting one. This was on 1st february last year. It then took them until October to arrange one. In the meantime, I have been told by his social worker that social services have been paying all his care fees, despite the fact that they would have power to charge him under the Care Act. So far, since October 2022, they have not asked me for any money. I am expecting the ICB/NHS to foot the bill for their failure up to the date the DST was completed, i.e. 12 months. From thereon I expect to be charged, but not before that. I am not concerned of course about who has been paying the fees as long as it is not me but I have written to social services to tell them, for what it’s worth, that the NHS should be picking up the bill for those 12 months and not them. I should say that my father in law has an incurable mental health condition which can can never get better except for periods of remission. He has been in remission of one sort or another since October 2022 but a severe relapse could occur at any time with or without warning.
Nothing in this world is FREE.
6 weeks of free NHS care is all you get if you qualify the assessment.
That assessment leads to taking your money, going into your finances & your bank account savings etc & anything you own. Including your state pensions or any other income it being Attendance allowance or pip. They take it all.
Their answer to this astronomical amounts they want for your care being in your home or a care home is “It’s 24 hrs Care”
Wow at least £1,600.00 a WEEK . That is more than someone’s wage in a calendar month. How can they even be able to do this at least explain it.
It’s daylight robbery because the nursing staff don’t get paid that well. So to me it’s a money making business for the Rich YET AGAIN.
The patients that live in most care homes are not cared for in the way they should be for those prices. They are not treated any different from some of these hospitals that make you wait for a nurse to come when you have pressed the buzzer to go to the loo. We are the forgotten all but the money.
The more you have the more they take until they have bleed you dry. It then will be your relatives they ask for money when there are no more supplies coming from the persons care.
I would rather be left to rot starve to death than pay them for little more than that, because let’s face it it wouldn’t take long.
This world & it’s ways are debilitating in it self for what it’s becoming & it’s only going to get worse.