Anywhere other than in hospital – such as in the patient’s own home; a care home; or the home of a family member.

NHS CHC is for patients over 18 only. Children’s and young people’s continuing care is available but is based on different criteria than NHS CHC for adults and arranged in a different way. For example, the way in which the child receives their education has to be included.

The process usually begins with an assessment by a health or social care professional, helped by the use of a screening method called a Checklist Tool. This might be done, for example, by a nurse or social worker before a patient leaves hospital, or by a district nurse or social worker while carrying out a community care assessment. (Occasionally, an application will be passed to the next stage – full assessment – without the checklist stage being done. There is also a Fast Track route for rapid deterioration and end of life care).

The assessment is done with the patient (and/or their representative where appropriate). Patients seen as possibly eligible for NHS CHC then have a named co-ordinator appointed by the ICB. The Co-ordinator arranges for a full assessment. This will be carried out by a multidisciplinary team of health and social care professionals, using a Decision Support Tool. (The tools are used to help streamline the process and aid consistency of approach).

The ICB will discuss with the patient how their needs will be met and their care managed, and by which organisation.

Other forms of care planning and provision might be appropriate. The patient’s local authority will have been made aware of the decision and will discuss with the patient whether or not they may be eligible for support from the local authority. Sometimes the NHS may still be involved in paying for part of the support a patient needs. Care involving both the local authority and NHS is sometimes known as a joint package of care.

Patients not eligible for NHS CHC remain entitled to use all the usual healthcare services available to everyone entitled to use the NHS, such as services provided by (for example) GP practices, hospital outpatient departments, clinics, etc.

If you do not qualify for NHS CHC, you may have to pay for some or all of your care. You may have to take a local authority means test to decide how much you should pay towards your personal care and accommodation if you are in a care home.

If the decision was made at the initial checklist stage not to proceed to a full assessment, the patient (or their representative) can contact the ICB to ask for the decision to be reconsidered.

If the decision was made as a result of the full assessment, the patient (or their representative) can contact the ICB to lodge an appeal against the decision: an appeal must be lodged within six months of the decision date. (These details are also included in the decision letter). The ICB then has three months to review the decision and/or satisfy the requestor (known as ‘local resolution’): but if this is not successful, the applicant can lodge an appeal with NHS England, which has three months to address this appeal.

NHS-funded nursing care is only provided to patients in care homes registered to provide nursing care, and to patients who do not qualify for NHS CHC but do need care from a registered nurse.

If you’re concerned about changes to your care package because of a move to NHS CHC, your ICB should talk to you about ways that it can give you as much choice and control as possible. This is known as a personal health budget, with one option being a “direct payment for healthcare”.

An assessment for NHS CHC cannot be carried out without your consent, so it is possible to refuse. However, if you refuse, although you’ll still be entitled to an assessment by the local authority there is no guarantee that you will be provided with services. There is a legal limit on the type of services that a local authority can provide.

If you refuse to be assessed for NHS CHC, the ICB should explore your reasons for refusing, and try to address your concerns. If someone lacks the mental capacity to consent to or refuse an assessment, the principles of the Mental Capacity Act will apply and in most circumstances an assessment will be provided in the person’s best interest.

If there is evidence that a move is likely to have a detrimental effect on your relative’s health or wellbeing, discuss this with the ICB. It will take your concerns into account when considering the most appropriate arrangements.

If the ICB decides to arrange an alternative placement, they should provide a reasonable choice of homes.

No, it is not possible to top up NHS CHC packages, like you can with local authority care packages.

The only way that NHS CHC packages can be topped up privately is if you pay for additional private services on top of the services you get from the NHS. These private services should be provided by different staff and preferably in a different setting.