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Changes to NHS Continuing Healthcare enacted by the Coronavirus Act 2020
Here we set out in detail the temporary changes to NHS Continuing Healthcare (CHC) implemented by the COVID-19 (coronavirus) emergency legislation.
For simplicity, we refer to ‘you/your care’ throughout. We acknowledge that in many or most cases the reader will be a loved one or representative of the individual in need of care, and that care planning and decision-making may be the responsibility of the loved one/representative.
For the duration of the emergency period, significant changes will be implemented to CHC in the following areas:
- Discharge from hospital
- Who pays for care
- Assessments for eligibility
- Appeals
- Complaints
- Reviews
- Fast Track (End of Life)
- Assurance Standards
We also outline how the changes are likely to affect the CHC system in the months after the emergency period.
After you have read about the changes below, take a look at our advice to help you secure a suitable care package post-hospital discharge, and prepare in case you need to enter the CHC system – or pick up unfinished assessment or appeal – afterwards.
Discharge from hospital
During the emergency period, if you are in hospital for any reason and your health team decides that you no longer need hospital care, you will be discharged. This will happen quickly, normally within three hours of the decision being taken that you are clinically safe to be discharged.
Discharge arrangements will be discussed with you and your family/representatives before you leave hospital. You should be given leaflets explaining how your discharge will work when you arrive at hospital, and when you are ready to leave hospital.
You will not have a choice over your discharge and you will not be able to stay in hospital while you arrange your post-hospital care, for example researching care homes or discussing changes to your care plan. Hospital staff should discharge you to a safe and appropriate place, in most cases this will be to your own home with support where required, such as a care package.
People who have needs that are too great to return to their own home will be discharged to a suitable bed in the community, for example a rehabilitation bed or a residential nursing home. The hospital Discharge Service will choose your placement from a national community bed tracker, with which all care homes have been instructed to register.
There will not be time to discuss your preferences for long-term care before discharge from hospital. Once you are in your immediate placement after discharge, you should be given the opportunity to have these conversations with your care coordinator.
If you are being discharged to your home, any immediate practical needs – such as transport home, shopping or turning the heating on – will be arranged before you are discharged if you have nobody else to do this. If you need care on the day of your discharge, this will also be arranged by a care coordinator before you leave hospital.
The assessment of your ongoing care needs will take place after you have left hospital. If you have been discharged to your home (or that of a loved one), a lead professional or multidisciplinary team, as is suitable for the level of care needs, will visit you on the day of discharge or the day after to arrange what support is needed in the home environment and rapidly arrange for that to be put in place.
Patients who are discharged to a rehabilitation bed or care home will be followed-up by a care coordinator, to ensure you are able to move to your long term care home as soon as possible.
Read our advice on how to prepare for discharge and assessment under the new rules.
Despite the emergency period, it is still important to ensure that care packages meet the needs of the vulnerable individuals with significant and often complex care needs, who would normally proceed through the CHC system.
Who pays for care
All of this care and support will be paid for by the NHS for the duration of the emergency period. This is to ensure you can move out of hospital quickly as soon as you are clinically safe to do so, to reduce pressure on acute services.
The government has agreed that the NHS will fully fund the cost of new or extended out-of-hospital health and social care support packages during the emergency COVID-19 period. This applies to new care packages and to enhancements to existing care packages agreed on or after 19 March 2020.
Anyone already receiving out-of-hospital care and support that started before 19 March will be expected to be funded as they were previously. For example, through NHS CHC funded packages, Local Authority means-tested care packages or self-funded arrangements.
In all circumstances, health and social care staff involved in delivering these emergency procedures should have conversations with patients and their families about the possibility that they will need to pay for their care after the emergency period, as appropriate.
Assessments for eligibility
NHS CHC assessments will not be required and are therefore expected to stop for the duration of the emergency period, in all care settings. This is to enable Clinical Commissioning Groups to release staff to support the new discharge arrangements.
Local systems need to ensure that they have some method of monitoring actions taken during the COVID-19 emergency measures, for example using the CHC Checklist, so that individuals are assessed correctly once business as usual resumes.
Appeals (Individual requests for a review of an eligibility decision)
Individuals are still able to access the ‘appeal’ process by requesting a review of that decision (both Local Resolution and Independent Review). Individuals should adhere to the normal deadlines to register their wish to appeal, however, the timeframe for CCGs to deal with that request will be relaxed.
There is currently no further guidance on appeals that are already in the system. However, as some CHC staff may be redeployed to support the discharge and care planning of COVID-19 patients, we anticipate that appeal meetings and panels will become ‘virtual’ (carried out via online video calling), or postponed.
There will probably also be delays in processing other elements of appeal work, such as obtaining care records, producing Needs Portrayals and processing Questionnaires.
If you’re not sure whether to appeal a decision, our blog is a good place to start.
Complaints
The Ombudsman has decided to pause their work involving health complaints until further notice. This means that they will not accept new health complaints, nor progress existing ones where this requires contact with the health service or clinical advisers – due to the unprecedented pressure on the NHS at this time. The Ombudsman has said that the situation will be kept under close review.
Review of people already receiving NHS Continuing Healthcare
There is an expectation that CCGs will take a proportionate view to carrying out the normal reviews of individuals who are currently eligible for CHC, at three months and annually. Also that, within the Covid-19 Discharge Guidance, CCGs will take a proportionate view to undertaking three and twelve-month reviews to ensure that an individual’s emergency-funded care package is meeting their needs and to ensure that any concerns raised are addressed as appropriate.
Fast Track (End of Life)
The Covid-19 Discharge Guidance also sets out that end of life services remain important. However, to remove decision making delays, the responsibility to co-ordinate the arrangements for care at home or a hospice bed should be passed to local community palliative care teams during this period. The Fast Track process pathway tool can still be used for clinical assessments or other local tools as appropriate.
Assurance Standards
During the COVID-19 emergency period, CCGs will not be held to account on the NHS CHC Assurance Standards nor for adhering to timeframes for dealing with appeals.
Impact and implications of the emergency measures on CHC
A backlog of approximately 5,000 assessments per month will be created, which will have future workload implications for CCGs, NHS and Local Authority staff. The same will apply to individual requests for a review of an eligibility decisions (i.e. Local Resolution and Independent Review).
NHS England has recognised that a handling plan will be needed to enable the CHC system to ‘normalise’ following the COVID-19 emergency period. We anticipate that these emergency measures are likely to have a significant impact on the CHC assessment and appeal system.
The Government has agreed to fully fund the cost of new or enhanced out-of-hospital health and social care support packages, referred to in the Covid-19 Discharge Guidance, for people being discharged from hospital or who would otherwise be admitted into hospital for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services.
After the emergency period, some people will have to begin contributing to, or fully funding their own care, according to the outcome of their CHC assessment or Local Authority means-testing.
