Who is responsible for starting a continuing healthcare assessment for adults?

Continuing Healthcare Funding (CHC) is funding provided by the NHS, where somebody has a Primary Healthcare need. Therefore, anyone that is entitled to CHC funding will have a very high level of needs. 

However, accessing CHC funding can be difficult. It is very often the case that somebody who may meet the CHC criteria will already be receiving support from the Local Authority, and in those circumstances, the Local Authority or social worker, can make your referral for CHC for you. 

They can even complete the CHC checklist, which is the initial screening document as the starting point of the CHC process. It is the threshold test to ascertain if a full CHC assessment will be done in due course, via a Decision Support Tool.  

It is in the Local Authority’s interests for someone to meet the CHC criteria, because it means the responsibility for funding that person’s care then moves across to the NHS.  

Therefore, it will often be the Local Authority that makes the initial referral, but it doesn’t have to be. It can be a GP, family member, or a deputy that can simply contact the NHS and start the process, and that should be sufficient for the NHS to complete that initial checklist stage. 

The purpose of the checklist stage is to identify cases which are not likely to be eligible for CHC funding, and so usually there is no real issue in getting to that initial checklist stage.  

The location in which a person is currently receiving their care shouldn’t be a barrier to the initial checklist being undertaken, unless their needs are rapidly changing, for example when they are receiving active treatment in hospital, when there may be an argument that it makes practical sense for their needs to have stabilised before carrying out the assessment, so that it is clear what their needs will be when they are ready to be discharged. 

The full DST assessment should be done within 28 days of a successful checklist being completed, but it is often the case that it takes longer than this. It can be the case that there are legitimate reasons why a full assessment needs to take longer, for example obtaining a medical or therapy report. 

However, if the reason for the delay is simply a lack of resourcing, then funding can, and often is, backdated to a date 28 days from the date of the initial checklist being completed, providing that the CHC eligibility threshold is met.  

Whilst this can be helpful, care will need to be privately funded, or funded by the Local Authority in the meantime, and this can cause significant hardships and complexities.  

Where an adult is eligible for CHC, then all of their care needs are met entirely by the NHS and the local authority is not legally responsible for funding any of the provision. Some health bodies and local authorities do now have joint funding protocols that are in place to help coordinate care provision, which means that they sometimes operate a joint funding model – however this does not impact the legal position, which is that where somebody is eligible for CHC then the NHS retains all responsibility for arranging and providing the care – and so this should not impact the individual. This blog was written in conjunction with Rook Irwin Sweeney LLP. If you want to discuss any of the above issues, please get in touch with our specialist team. 

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This blog was written in conjunction with Rook Irwin Sweeney LLP. If you want to discuss any of the above issues, please get in touch with our specialist team.