How to apply
The CCG uses the National Framework for NHS-funded Continuing Healthcare with supporting guidance and tools to determine what on-going care services people aged 18 years or over should receive from the NHS. There are more details of the process in deciding the eligibility to Continuing Healthcare on the NHS website. If you do not pay for your own care, or think you will not be deemed as a ‘self-funder’ you request a Checklist from your GP practice or Social Services. If you are a ‘self-funder’, please see the section on ‘Self-funding your care in the community, residential care or nursing care’.
The Continuing Healthcare Application Process
Step 1 - Checklist
For most people the first step is to have an assessment with a health or social care professional using a screening tool called the Checklist. This may be:
- part of the discharge pathway from hospital;
- introduced by a GP or nurse may use it in an individual’s home OR
- social workers or care managers may use it when carrying out a community care assessment.
This list is not exhaustive, and in some cases it may be appropriate for more than one person to be involved.
If the Checklist concludes you may be eligible for NHS Continuing Healthcare, a full assessment of your needs will be arranged using a tool called the Decision Support Tool.
If it concludes you are not suitable for the NHS Continuing Healthcare process, you will not proceed to the next stage. However if your circumstances change you may request another Checklist to be undertaken.
If you are unhappy with the outcome of the Checklist, please see the Reviews, Complaints and Appeals page.
You will be fully involved in the assessment and decision-making process, and your views about your needs for care and support will be taken into account.
If you fund your own care and you wish to be assessed for eligibility then you can contact us directly.
If the Checklist indicates that you need a full assessment, then a Decision Support Tool needs to be completed and submitted to us with supporting evidence demonstrating the intensity, complexity, unpredictability and nature of needs and care provision.
A lead professional will be appointed and will coordinate the assessment collation to complete the Decision Support Tool. This is done in a meeting with at least two health and/or social care professionals and the person or their representative. The professionals (or Multi-disciplinary team) will then make a recommendation on eligibility and send the application to the Continuing Healthcare team for ratification. This person will also keep the applicant and their family or representative informed of the process.
A retrospective claim for Continuing Healthcare can be made. This means that if you or your family feel that you may have been eligible for Continuing Healthcare in the past, then you can make a retrospective claim. We will go through your health and social care records looking for evidence of eligibility, in the same way we would consider evidence of a prospective claim.
Following the change of Primary Care Trust to Clinical Commissioning Groups, a large number of retrospective claims were made for the seven years prior. Now we are part of the CCG, it is possible to claim for the previous financial year only.