NHS CHC restarts to support joint health and social care system recovery

The NHS has published new guidance on how CCGs will restart NHS Continuing Healthcare (NHS CHC) assessment processes from 1 September 2020.

NHS CHC is a package of care for adults that is arranged and funded solely by the NHS. In order to receive NHS CHC funding, individuals have to be assessed by Clinical Commissioning Groups (CCGs) according to a legally prescribed decision-making process to determine whether the individual has a ‘primary health need’.

This package of care is designed to support patients who have a lot of difficulties with certain activities, such as eating and drinking, memory and thinking, breathing, getting around and taking medicines.

However, due to the coronavirus pandemic, NHS CHC was temporarily suspended between 19 March and 31 August 2020, with the health service instead focusing on treating patients with COVID-19, preventing the spread of the virus and meeting the unprecedented demand.

To help overcome these obstacles, new hospital discharge service requirements were introduced in March 2020, with a focus on discharging patients who no longer needed a hospital bed to their home as quickly as possible in order to meet the demand for hospital beds.

Now, NHS CHC will restart in September, as the NHS enters phase three of its COVID-19 response as levels of the virus have fallen across England.

This means that CCGs will undertake referrals, reviews and assessments that have been received between 19 March and 31 August 2020, and any that have been deferred as a result of the COVID-19 hospital discharge service requirements (March 2020).

The guidance states: “Local health and social care systems should, where appropriate, consider aligning Care Act and NHS CHC assessments, so that there is a single ‘collation’ of relevant information to support a joint approach to a (health and social care) recommendation for long-term funding, by either the local authority or the NHS.

“This approach should not, however, cause any further delays. It should be legally compliant and have regard to the national framework for NHS continuing healthcare and NHS-funded nursing care.”

Workforce

The guide says that CCGs and local authorities should secure sufficient staff to deal with the NHS CHC and Care Act deferred work (from 19 March and 31 August 2020) and business as usual activity. This may require securing additional temporary health and/or social care professionals, the NHS notes.

Furthermore, the guide underlines that NHS CHC staff that were redeployed to other roles in March 2020 need to be brought back to their roles in CCG teams to start from no later than 1 September 2020. The NHS says that this process needs to be managed carefully so that the teams and services where NHS CHC staff are currently working in are not negatively affected.

Discharge to assess operating model

The decision to reintroduce NHS CHC across England coincides with the new ‘discharge to assess’ operating model that will be carried out in hospitals up and down the country.

This new model focuses on discharging patients from hospitals into the appropriate setting, considering what ongoing care they might need after being discharged from hospital, whether that is care at home or going into a care home, for instance. It means patients can be quickly discharged from hospital, with full understanding about what their care plans are once they are home or in a care setting.

The new model is based on four clear pathways:

• Pathway 0: 50 percent of people – simple discharge, no formal input from health or social care needed once home.
• Pathway 1: 45 percent of people – support to recover at home; able to return home with support from health and/or social care.
• Pathway 2: four percent of people – rehabilitation or short-term care in a 24-hour bed-based setting.
• Pathway 3: one percent of people – require ongoing 24-hour nursing care, often in a bedded setting. Long-term care is likely to be required for these individuals.

£588 million fund

To support the new hospital discharge operating model, the Department of Health and Social Care (DHSC) announced a new £588 million fund to facilitate rapid hospital discharges by giving people timely access to care and recovery services beyond acute settings.

This funding gives people six weeks of funded health and care recovery and support services after they are discharged from hospital, such as access to physiotherapy services. The funding can be used to cover adult social care or the immediate costs of care in their own home.

With this new funding, following NHS CHC and Care Act assessments that have been carried out, eligibility decisions should be confirmed within the six weeks following a discharge from hospital.

Funding arrangements

Government funding between 19 March and 31 August 2020 paid for new or extensions of existing packages of care and support for patients discharged from hospital or who would otherwise have been admitted to hospital. This approach was funded through a COVID-19 budget which supplemented CCG and local authority usual expenditure on discharge and rehabilitation and reablement services.

“CCGs should assume that anyone discharged from hospital on discharge to assess pathways 1, 2 and 3, who needed a new (or enhanced) package of support upon discharge or admission avoidance, will have received care funded from the CCG, local authority and/or COVID-19 discharge funding for as long as they required care (and may still be receiving this),” the NHS states in the guidance.

Importantly, the guide emphasises that where care has been NHS-funded during the COVID-19 period, local health and care systems need to explain to patients how the local authority Care Act Assessment and subsequent means testing could lead to some individuals having to contribute to, or fully, fund their future care, should they be identified as not eligible for NHS CHC funding.

Individuals discharged from, or who would have been admitted to, hospital between 19 March and 31 August 2020

From 1 September 2020 onwards, the COVID-19 discharge and recovery service budget will not be used to fund any new packages of support on discharge from hospital.

“People funded though the COVID-19 Discharge funding arrangements which commenced on 19 March 2020, who entered a care package between 19 March and 31 August 2020, will continue to be funded through those arrangements,” the NHS explains. “Relevant assessments should be completed for these individuals as soon as is practical to ensure transition to normal funding arrangements. CCGs are expected to carry out assessments in a timely manner.”

If an individual was funded during this period using the COVID-19 budget and is assessed as eligible for NHS CHC funding, the payment of their care costs will transfer from the COVID-19 budget to core CCG CHC budgets at the end of the NHS CHC assessment process.

However, if an individual was funded during this period using the COVID-19 budget and is not eligible for NHS CHC funding, the payment of their care costs will transfer from the COVID-19 budget to local authority responsibility, following the end date of the NHS CHC assessment process.

The guidance emphasises that in this situation, local authorities will need to determine if individuals continue to be eligible for support under the Care Act or are responsible for the costs of their own care.

Where individuals are assessed and found eligible for NHS CHC and they, or the local authority, funded any part of their care while awaiting an NHS CHC assessment, then CCGs should arrange for refunds to take place directly to the individual or the local authority, as long as that funding arrangement is consistent with the national framework, the NHS says.