CHC Thresholds
September 2010
Introduction
This documentation has been drawn as a joint agreement between NHS Manchester and Manchester
City Council. It is intended to provide practical guidance for staff in respect of the agreed threshold of
funding for those patients that have been deemed eligible for fully funded Continuing Health Care and
the funding responsibilities between NHS Continuing Health Care and Adult Social Care
‘Continuing care’ means care provided over an extended period of time, to a person aged 18
or over, to meet physical or mental health needs that have arisen as a result of disability,
accident or illness. ‘NHS continuing healthcare’ means a package of continuing care that is
arranged and funded solely by the NHS. The actual services provided as part of that
package should be seen in the wider context of best practice and service development for
each client group. Eligibility for NHS continuing healthcare places no limits on the settings in
which the package of support can be offered or on the type of service delivery.” (CHC
framework July 2009 revised)
The National Framework for NHS Continuing Health Care states that:‘Where an individual has a primary health need and is therefore eligible for NHS continuing
healthcare, the NHS is responsible for providing all of that individual’s assessed needs –
including accommodation, if that is part of the overall need.’
Threshold Guidance
“PCT’s should be mindful that where a person is eligible for NHS continuing healthcare the
NHS is responsible for meeting their assessed health and social care needs.”
Responsibility of PCT:
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The PCT is responsible for facilitating the MDT and approving eligibility. in conjunction with the
local authority
Ensuring the support plan is completed
Approving the support plan
Commissioning services that meet the identified needs including health and identified social
care
Where applicable managing and commissioning services funded by local authority (acting on
behalf of LA )
Case manage the patient
Review patients annually
Ensure a person centred approach for each patient
PCT Funding responsibility:
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Where a patient has been deemed to have a Primary health care need the PCT is responsible
to fully fund a patient’s assessed need including any identified social needs and this may be
met within the community or to access the community.
“Where someone is assessed as eligible for NHS continuing healthcare but chooses to live in their
own home in order to enjoy a greater level of independence, the expectation in the Framework is
that the PCT would remain financially responsible for all health and personal care services and
associated social care services to support assessed health and social care needs and identified
outcomes for that person, e.g. equipment provision (see 11.3), routine and incontinence laundry,
daily domestic tasks such as food preparation, shopping, washing up, bed-making, support to
access community facilities, etc. (including additional support needs for the individual whilst the
carer has a break)[.CHC guidance March 2010]”
Responsibility of Local Authority:
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To assess and identify social care needs
To provide an annual social care review
To participate in a joint review process
To complete carers assessment
To review carers assessment annually
Fund assessed carers support (services supplied directly to carer or to enable a carer to
maintain support )
LA funding responsibilities:
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Assist with property adaptations (DFG’s)
Support with parenting activities
Process:
Each member of the MDT is required to provide a specialist assessment clearly identifying the
patients’ needs. The CHC MDT will identify the agreed outcomes .As part of the MDT meeting it is vital
that the social work clearly identifies all social care needs and is clear in respect of who is the
responsible funding body based on the guidance above.
The support Plan template has been developed to identify assessed needs and outcomes against the
CHC domains. By linking in the support plan directly to the CHC domains it will demonstrate how it is
supporting a primary health need and therefore determine the funding responsibility.
The PCT and Local authority have a duty to work together. Where it has been agreed to be the
responsibility of the Local Authority agreement needs to be reached as to who will commission/
arrange the service.The approach should be based on providing a person centred approach for the
patient.
Dispute
Where a dispute arises it is imperative that the patients service is not delayed and funding should be
based on the current guidance issued.
Funding approval is via PCT - CHC commissioners and LA District Manager.
Where a funding dispute occurs in respect of who is the responsible funder the following process will
be followed:
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Head of commissioning will discuss with LA Head of service.
The care plan will need to be made available to both parties identifying the assessed need.
Where it clearly supports a need within the CHC domain then funding would via PCT
Where it is not part of a primary health need it does not become the responsibility of the PCT –
and may be responsibility of LA (it is not by default an LA funding need as it may available
through another funding stream. – e.g. Department Work Pension – e.g. access to work )
Helen Hemming
Personal Health Budgets Project Manager
September 2010