What is the CHC National Framework?

The National Framework for NHS Continuing Healthcare

You have probably heard reference made to the CHC National Framework, even if you have not come into contact with the document yourself.

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care sets out the principles and processes for deciding eligibility for CHC. It is a detailed policy document published by the Department of Health and in short is a guideline for how the NHS Continuing Healthcare process should work.

Here we look at the background of the CHC National Framework, charting its introduction in October 2007 through to the version we use today.

History

In the early 1990s a growing number of people found themselves paying for long-term care which had previously been provided free by the NHS or their local authority. Means testing was introduced for Local Authority care through the Community Care Act and subsequently the line between social or personal needs and health needs became blurred. Increasingly, the care costs for people with complex needs were being funded privately by people whose care should have been funded and managed by the NHS.

In the following years, a number of changes were introduced to the health and social care system.

Timeline

1996: Department of Health provided guidance to England’s 95 Health Authorities to write the first sets of criteria on NHS Continuing Healthcare eligibility

1999: Pamela Coughlan won a landmark appeal case against a ruling that she was ineligible for continuing healthcare funding. Following the Court of Appeal decision, the Department of Health instructed all Health Authorities to review their criteria to ensure they were ‘Coughlan compliant’

2002: The NHS underwent reorganisation. 95 Health Authorities were abolished and replaced with 28 Strategic Health Authorities (SHAs). The Department of Health issued further instruction to all SHAs to agree upon a set criteria within each area

Following an investigation into NHS Continuing Healthcare by the Public Health Service Ombudsman, the Department of Health again instructed all 28 SHAs to review their criteria and bring them in line with the Coughlan judgement. They were also asked to retrospectively review everyone who had been in receipt of long-term nursing care since April 1996, providing compensation where the criteria had been applied restrictively

2004: Each SHA in England was working to its own set of criteria and toolkits which led to what became known as the ‘postcode lottery’, where eligibility partly dependent upon where you lived. This problem was recognised by the Department of Health and in 2004 they began developing a national set of tools and assessment processes to clarify key areas of contention

2006: A further NHS reorganisation saw the 28 Strategic Health Authorities merged into just 10 as well as a significant reduction in the number of Primary Care Trusts (PCTs)

2007: The National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care was launched. All NHS trusts were instructed to fully implement the Framework by October that year

2009: The Department of Health issued a revised National Framework in July, following wide consultation since initial launch

2012: The Department of Health issued a revised National Framework in November. The main purpose of the latest revision was to bring terminology in line with the pending restructure of the NHS and incorporate the Department of Health’s 2010 Practice Guidance into the Framework

2013: Primary Care Trusts were replaced with a greater number of Clinical Commissioning Groups (CCGs). CCGs become responsible for implementing the National Framework with the NHS Commissioning Board (NHS England) replacing the role of Strategic Health Authorities in commissioning responsibilities and reviewing eligibility decisions

2015: NHS England published the Operating Model for NHS Continuing Healthcare which brought together the NHS’ overall approach and aimed to help NHS trusts achieve the best possible assessment and care pathways for individuals. The Operating Model included an ‘Assurance Framework’ to help ensure assessments and care pathways be delivered locally in a fair, efficient and cost effective manner

Introduction of the Care Act 2014 which represented the first major change in adult social care legislation for 70 years, but did not change the legal limits of Local Authorities to provide health care. Therefore, the primary health need boundary (NHS continuing healthcare eligibility criteria) was maintained

2018: On 1 March 2018 an updated version of the National Framework came into use, primarily to reflect the implementation of the Care Act 2014; update the definition of a ‘social care need’; improve the nature of annual CHC reviews; clarify ‘top ups’; clarify the make-up of the multidisciplinary team; and strengthen the guidance around CCGs’ commissioning responsibilities

2022: On 1 July 2022 an updated version of the National Framework came into use, primarily to incorporate the legislative changes brought about by the Health and Care Act 2022 (which transferred statutory responsibility for CHC from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs)); to strengthen guidance around the relationship between CHC and the Discharge to Assess model, incorporating recent best practice and aligning with new policy; and to clarify when consent and participation should be sought throughout the CHC journey

Click here to read the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

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