NHS Continuing Healthcare (CHC)

In this section, the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (July 2022, revised) is referred to as the National Framework. The National Framework sets out the principles and processes that should be followed to determine a person’s eligibility for NHS Continuing Healthcare (CHC) and NHS-Funded Nursing Care (FNC). This guidance and the associated tools: NHS Continuing Healthcare Checklist, Decision Support Tool (DST), and Fast Track tool were revised and implemented on 1st July 2022.

Joint working between organisations is essential to the successful delivery of NHS Continuing Healthcare and in ensuring a person-centred approach.

NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS for persons aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness.

To be eligible for NHS Continuing Healthcare, a person must be assessed as having a Primary Health need.

NHS Continuing Healthcare can be delivered in any setting, including care homes and a person’s own home. It is not means tested and it is free to the person.

NHS-Funded Nursing Care is the funding provided by the NHS to support the provision of nursing care by a registered nurse, where the person is resident in a nursing placement. This includes direct care provision, care planning, and the delegation and supervision of care delivery.

A person should have their eligibility for NHS Continuing Healthcare considered before a decision is made to award NHS-Funded Nursing Care.

In day-to-day practice, NHS-Funded Nursing Care is often referred to as ‘FNC’.

The NHS Continuing Healthcare process in Lincolnshire is led by the Lincolnshire Integrated Care Board (ICB).

Where Adult Care Practitioners are unable to resolve issues with their manager, they can contact the LCC Adult Care Continuing Healthcare Coordinator for advice and support on NHS CHC via email: AdultCareCHC@lincolnshire.gov.uk.

Practices regarding our Continuing Healthcare processes are also highlighted within Adult Care’s Quality Practice Assurance Standards which can be found in the Quality Practice Standards section in the Local Resource Library.

• National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (July 2022 revised);
• NHS-Funded Nursing Care Practice Guide (July 2022, revised);
• National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations (2012). Part 6 of the Standing Rules is specific to NHS Continuing Healthcare and includes local authority responsibilities;
• Care Act 2014;
• Mental Capacity Act 2005;
• Mental Health Act 1983.

Below are the key issues that Adult Care practitioners should know and be aware of:

1. the practitioner must be familiar with the principles of the National Framework and supporting documents (see NHS Continuing Healthcare (CHC): Introduction);
2. the practitioner should have an understanding of what constitutes a primary health need;
3. the practitioner must undertake the Checklist Training and pass the set test before completing and submitting NHS Continuing Healthcare Checklists. The training is provided jointly by Lincolnshire ICB and LCC Adult Care and can be accessed via Lincs2Learn;
4. in cases where practitioners need to complete a Checklist and have not completed their training and passed the test, they should email their completed Checklist to AdultCareCHC@lincolnshire.gov.uk for the CHC Co-ordinator to countersign. Please approach a member of your team or team manager who has completed the training to countersign the Checklist in the CHC Coordinator’s absence;
5. the practitioner must be familiar with the Decision Support Tool (DST). An example DST is available in the Continuing Healthcare section in the Local Resource Library. This provides advice and suggestions as to what information should be considered when completing the DST;
6. the practitioner should be able to apply the Four Key Characteristics of Nature, Intensity, Complexity and Unpredictability and the primary health need test to the person’s assessed needs, to determine their eligibility for NHS Continuing Healthcare;
7. best practice is for the same practitioner to be involved throughout the whole of the NHS Continuing Healthcare assessment process for each person;
8. the practitioner should shadow and be shadowed by an experienced colleague before participating in a multi-disciplinary team (MDT) meeting to complete a DST;
9. practitioners would benefit from observing the NHS Continuing Healthcare Panel which sits every Wednesday. Contact the LCC Adult Care Continuing Healthcare Coordinator to arrange an appointment. Alternatively, the practitioner or their manager can contact the CHC team directly using this email address: chcquality@nhs.net.

The CHC Monitoring (Workflow) in the person’s Mosaic record is a central point for Practitioners to record CHC activity. It is mandatory to fill in the Workflow when you have completed a positive or negative Checklist, as well as participating in a DST. Practitioners should be aware of the following when completing the Workflow:

1. ensure that all relevant sections are filled out. Some sections have now been made mandatory;
2. do not complete a form for people who are funded under Section 117 of the Mental Health Act unless they require consideration for CHC funding for needs that are not related to or arise from their mental disorder;
3. where a positive Checklist has been completed, the practitioner must keep this form open until the DST has been completed and a decision on eligibility has been made by the ICB. Once you have a decision, record this information on the Workflow and complete the workflow as a next action;
4. the National Framework states that decisions on eligibility should not take more than 28 days from the date the Checklist is received by the ICB. In some cases, however, decision making may be delayed for a variety of reasons. A common reason is lack of evidence to support the DST.

Following the implementation of the revised National Framework in July 2022, significant changes were made to the requirement for consent. The National Framework continues to emphasise the importance of the person, and/or their family/representative being fully informed and empowered to participate actively in the assessment process and any subsequent reviews. Their views should be recorded on the DST and considered as part of the eligibility decision making process. There are a number of legal requirements when it comes to a person’s consent for parts of the NHS Continuing Healthcare process.

As stated within the National Framework, it is not necessary to seek consent from a person in order to share their personal data where this is necessary for the purposes of their NHS Continuing Healthcare assessment (and subsequent reviews) or the provision or management of their health or social care needs between health and social care professionals.

However, to comply with the UK General Data Protection Regulation (GDPR), it is necessary to inform the person how and with whom their personal data will be shared as part 7 of the assessment process or to arrange appropriate care and support.

A person with the relevant capacity, who is to be assessed for NHS Continuing Healthcare, should be provided with relevant information about the process. This will enable them to make an informed decision regarding their participation in the process, including about the potential consequences of refusing to participate. The consequences of undertaking the NHS Continuing Healthcare assessment or review as a paper-based exercise should be carefully explained to the person, including that this may affect the quality of the assessment, for example, if the health and care records to be considered by the MDT are not up-to-date or accurate.

A person with the relevant capacity, who is to be assessed for NHS Continuing Healthcare, should be provided with relevant information about the process. This will enable them to make an informed decision regarding their consent to the sharing of their personal data with a third party such as a family member, friend, advocate, and/or other representative as part of the assessment for NHS Continuing Healthcare.

In all cases, ICBs are expected to make all reasonable effort to seek participation of the person (or their representative) during each stage of assessment, review and care planning, utilising a person-centred approach.

If the person concerned lacks capacity to consent to care and/or the sharing of their personal data with third parties as part of a CHC assessment process, a best interest decision should be taken and recorded. This may be done by a third party (such as a relative) with valid and applicable Lasting Power of Attorney (LPA) for health and welfare or a Deputy (health/welfare) appointed by the Court of Protection.

If no valid LPA or Deputyship order is in place, the professional (including unqualified social care practitioners) completing the Checklist, DST or Fast Track Tool should make the best interest decision, taking into account the views of those with interest in the person’s welfare.

LCC Adult Care Practitioners can only complete the Checklist. All LCC Learning Disability Practitioners can complete Checklists and the nurses in the teams can also complete DSTs.

If there is a concern that the person may not have capacity to participate with the CHC process and/or consent to share information with third parties, this should be determined in accordance with the Mental Capacity Act (MCA) 2005 and the associated Code of Practice. This decision and rationale should be recorded in the Consent section of the Checklist document on Mosaic, along with the best interest decision where appropriate. This should include a description of the evidence regarding how capacity was determined.

If the process appears to be complex or contentious, for example, where there is a disagreement on what is in the person’s best interests, practitioners may wish to use the Mental Capacity Assessment and/or the Best Interest Checklist which can be found in the Mental Capacity section in the Local Resource Library.

Carrying out an assessment for consideration of NHS Continuing Healthcare eligibility is a ‘welfare decision’ in the context of the Mental Capacity Act (2005). A third party cannot give or refuse consent for the sharing of information with another third party, for the purposes of an assessment of eligibility for NHS Continuing Healthcare on behalf of a person who lacks capacity, unless they can demonstrate they have a registered Lasting Power of Attorney for Health and Welfare or that they have been appointed as a Deputy (Health and Welfare) by the Court of Protection. This means the person holding the authority must provide evidence that the Lasting Power of Attorney is registered with the Office of the Public Guardian or, as a Court Appointed Deputy, provide evidence of the Court Order.

A third party holding Enduring Power of Attorney or Lasting Power of Attorney for Property and Finance cannot give consent to sharing of information with a third party for NHS Continuing Healthcare.

In cases where the practitioner is completing the Checklist and there is no third party with the appropriate authority to consent to sharing of information with a third party on behalf of a person who has been deemed to lack capacity, the practitioner is responsible for making the best interest decision. The best interest decision maker must consult with any relevant third party who has a genuine interest in the person’s welfare. They should take into account any advance decisions, and should bear in mind the expectation that everyone who is potentially eligible for NHS Continuing Healthcare should have the opportunity to be considered for eligibility.

Please note: People who are subject to some sections under the Mental Health Act (MHA) or MCA, including Powers of Attorney, Court Appointed Deputy and Deprivation of Liberty Safeguards, must have those orders or statuses recorded in their social care record.

The NHS Continuing Health Care Checklist is a screening tool to help practitioners identify if a person requires a full consideration of their eligibility for NHS Continuing Healthcare (CHC). The Checklist is the only tool that can be used for this purpose.

The Checklist can be completed by one discipline, which can be an Adult Care practitioner; it does not have to be a qualified social worker. Although it may be appropriate in some cases, it is not essential for a health professional to be involved in completing the Checklist.

As of November 1st 2021, the CHC team will no longer accept Checklists from practitioners who have not completed the NHS Continuing Healthcare Checklist Training and passed the set test.

In cases where practitioners haven’t completed the Checklist Training and passed the test, they should email their completed Checklists to AdultCareCHC@lincolnshire.go.uk for the CHC Coordinator to countersign. In the CHC Coordinator’s absence, practitioners should approach a member of their team or team manager who has completed the training to countersign the Checklist.

When completing an adult care needs assessment or review, practitioners must give consideration to completing a Checklist. Using their professional judgement and experience, they should make a decision as to whether or not it is appropriate to complete a Checklist.

Where a decision is made not to complete a Checklist, the practitioner must record their rationale in the person’s case notes. They should also discuss their decision with the person and/or their representative.

4.2.1 When to complete the Checklist

Screening for NHS Continuing Healthcare should be at the right time and location for the person when their ongoing needs are known.

A practitioner would be expected to complete a Checklist in the below examples:

1. where, on a first assessment, a person has significant support needs;
2. wherever a person requires a long-term care home placement with nursing. NHS-funded Nursing Care cannot be awarded (except in urgent placements) without consideration of eligibility for CHC;
3. where a review indicates a significant change in needs that does not meet the criteria for health funding through the Fast Track process and may impact on the person’s eligibility for CHC;
4. a Checklist should be completed if a request to do so is made by the person or, where they lack capacity, their formally appointed representative. The practitioner should record on the Checklist that it was completed at the request of the person/their representative.

4.2.2 When a Checklist will not be required

Situations when a Checklist will not be required include when:

1. it is clear to practitioners working in the health and care system that there is no need for NHS Continuing Healthcare at this point in time. If there is doubt between practitioners, a Checklist should be undertaken;
2. the person has short-term health care needs or is recovering from a temporary condition and has not yet reached their optimum potential (if there is doubt between practitioners about the short-term nature of the needs, it may be necessary to complete a Checklist);
3. it has been agreed by the ICB that the person should be referred directly for full assessment of eligibility for NHS Continuing Healthcare;
4. the person has a rapidly deteriorating condition and may be entering a terminal phase – in these situations, the Fast Track Pathway Tool should be used instead of the Checklist;
5. a person is receiving services under Section 117 of the Mental Health Act that are meeting all of their assessed needs. A Checklist should only be completed when needs arise that are not related to Section 117, for example, from a physical injury;
6. where, in the practitioner’s judgement based on their knowledge and experience of CHC, having completed an assessment or review, the outcome for CHC eligibility would be negative;
7. irrespective of any previous Checklist or DST outcomes, a Checklist is not required where, at review, there is no significant change in needs that would impact on the person’s eligibility for CHC or requirement to vary the support plan;
8. where an occupational therapist is contributing an additional specialist assessment and CHC has already been considered as part of the current Adult Care episode. Practitioners should record the detail of previous considerations.

Before completing the Checklist, the practitioner should:

1. inform the person that the Checklist needs to be completed;
2. explain the process to the person and provide a brief explanation of what NHS Continuing Healthcare is;
3. give the person / their representative a copy of the Department of Health Public Information Booklet for NHS Continuing Healthcare and NHS-Funded Nursing Care and a leaflet about Beacon, an organisation that provides initial free expert advice on NHS Continuing Healthcare;
4. inform the person that they have a right to a personal health budget (PHB) if they are found eligible for NHS continuing healthcare. Inform them that they can find information on PHBs on the NHS England website and Lincolnshire ICB website; they can also have a PHB for the healthcare element of a joint funded care package. A copy of the Lincolnshire Personal Health Budget Policy is available in the Continuing Healthcare section in the Local Resource Library. Please note this shouldn’t be shared with the person;
5. inform the person that the Checklist does not determine if they are eligible for NHS Continuing Healthcare, only whether they are entitled to full consideration of their eligibility, that is, a positive Checklist does not mean the person has a primary health need and is eligible for CHC funding;
6. ask the person if they wish a family member or another representative to be present while the Checklist is completed. If they do and the identified person isn’t present, the practitioner will have to make a return visit;
7. inform the person that the ICB will notify them in writing of the outcome of their Checklist;
8. inform the person of their right to ask the ICB for a reconsideration of any decision not to proceed to a full assessment for NHS Continuing Healthcare. How to do this will be in the letter from the ICB;
9. record that they have completed all of the above within the person’s case notes.

It is good practice to provide a blank copy of the Checklist to the person and their representative, so they can look at it while the practitioner goes through the domains with them.

Using the Adult Care assessment, any other available care records (for example, care and support plans and daily records) and any verbal information relevant to the person’s care needs, compare the descriptions of need to the needs of the person and select level A, B or C, as appropriate, for each domain. If the needs of the person are the same or greater than anything in the A column, then ‘A’ should be selected.

For each domain, give a brief description of the need and state where the evidence that supports the indicated level can be accessed. This helps with accessing the appropriate information to complete the Decision Support Tool if the person proceeds to a full NHS Continuing Healthcare assessment.

Where it can reasonably be anticipated that the person’s needs are likely to increase in the next three months, for example, because of an expected deterioration in their condition, this should be reflected in the levels selected. Where the extent of a need may appear to be less because good care and treatment is reducing the effect of a condition, the need should be recorded in the Checklist as if that care and treatment was not being provided.

A full assessment for NHS Continuing Healthcare is required if there are:

1. two or more domains selected in column A;
2. five or more domains selected in column B, or one selected in A and four in B; or
3. one domain selected in column A which is marked with an asterisk in one of the four domains that carry a priority level in the Decision Support Tool which are:
   • breathing;
   • behaviour;
   • medications and symptom control;
   • altered states of consciousness.

There may also be circumstances where, from the practitioner’s experience of NHS Continuing Healthcare and their knowledge of the person, they decide that a full assessment for NHS Continuing Healthcare is necessary, even though the person does not apparently meet the indicated threshold above, for example, one domain selected in column A and three domains selected in column B.

The practitioner must inform the person and their representative of the outcome as to whether or not the Checklist has screened the person in for a full consideration of their eligibility for NHS Continuing Healthcare.

The practitioner must clearly indicate the outcome of the Checklist and provide a rationale for the decision in the ‘Rationale for Decision’ box, which should give enough detail for the person and their representative to be able to understand why the decision was made.

Where the decision to proceed or not to proceed to a full consideration of eligibility is based on the number of As, Bs, and Cs scored, a statement to this effect will often be sufficient.

In cases where the person does not meet the threshold, but the practitioner makes a decision that they should be referred for a full consideration of their eligibility, the practitioner will need to provide a more detailed rationale to support their decision.

The practitioner should record in the ‘Rationale for Decision’ box that they have discussed the outcome of the Checklist with the person and their representative.

The practitioner must sign and date the Checklist and provide their contact details including their email address.

They must also ensure that they have recorded the name, address and phone number of the person’s next of kin/representative on the Checklist. Failure to provide these can result in the representative not being invited to attend the multidisciplinary team (MDT) meeting to complete the DST.

The person or their representative should be given/sent a copy of the completed Checklist, including the Checklist user notes. This may be achieved by completing two Checklists, ensuring that the recording on each of them is identical, and allowing the person or their representative to choose which one they wish to keep. Alternatively, the practitioner may agree with the person and their representative that the practitioner will post them a copy of the completed Checklist. Where the person is a resident in a care home, the care home manager may allow a photocopy to be made.

Before photocopying the Checklist, the practitioner should record on it that a copy has been provided to the person or their representative.

The practitioner must send the completed Checklist and evidence of consent to the ICB via secure email: licb.chcops@nhs.net. This applies regardless of whether or not the Checklist has screened the person in for a full assessment.

If the Checklist is positive, the practitioner will record dates and times within the 28 day Key Performance Indicator (KPI) when they are available to attend a Multi-Disciplinary Team (MDT) meeting in Section 4 ‘Rationale for decision’ box on the Checklist.

Within Mosaic, the practitioner will select section 6 ‘Action Tasks’, then select ‘Adult Care CHC Workflow’. This will trigger a CHC monitoring workflow.

Within two working days of receipt of the invitation to attend the MDT DST meeting, the practitioner will confirm to CHC, via the generic email inbox, whether or not they can attend on the date/time given.

Where the practitioner is unable to attend on the date/time given, the practitioner should also email the generic email box or telephone the CHC department within the next two working days and endeavour to agree an alternative date/time, as detailed within the CHC Collaborative Working Agreement which can be found in the Continuing Healthcare section of the Local Resource Library.  

Where a third party holds Lasting Power of Attorney or is a Court Appointed Deputy for Health and Welfare for the person, a copy of their authorisation should be securely emailed with the Checklist. Alternatively, the practitioner can record on the Checklist that evidence of a valid LPA or Court Appointed Deputy has been viewed and provide the date it was registered.

The practitioner must ensure that there is a copy of the completed Checklist on Mosaic. The Department of Health and Social Care has set a 28 day target for the NHS Continuing Healthcare process. This means from the date the ICB receive a Checklist screening the person in for a full consideration of their eligibility for NHS Continuing Healthcare, it should take no longer than 28 days for the assessment process to be completed and a decision on the person’s eligibility to be made.

In order to assist in the prevention of delays and promote a quality experience for the person in their journey through the CHC process, it is essential the Checklist is fully and accurately completed.

If any of the following are not completed or provided, the Checklist will be returned to the practitioner:

1. person’s name;
2. date of birth;
3. person’s GP and practice address;
4. practitioner’s signature, job title, contact telephone number and secure email address;
5. date the Checklist was completed;
6. person’s current location (for example, hospital and ward, own home);
7. person’s usual / home address;
8. evidence, where appropriate, of capacity and best interests decision (i.e. for third party information sharing);
9. ABC levels for all domains;
10. references to where supporting evidence can be found for each domain (this should include a brief description of the need);
11. clear rationale as to the outcome of the Checklist.

In cases where the Checklist is returned, the practitioner will be required to complete the missing information and re-submit it within two working days. You can access the latest ‘Standard Operating Procedure for completing Checklists in Lincolnshire’ in the Continuing Healthcare section in the Local Resource Library.

In cases where the Checklist screens the person in for a full consideration of their eligibility for NHS Continuing Healthcare, a health professional will act as the Case Manager. The Case Manager for all cases, except Learning Disabilities (LD), that are the responsibility of Lincolnshire ICB will be a Case Manager from the Lincolnshire ICB CHC Team (CHC Team). There is a Section 75 agreement in place between Lincolnshire ICB and LCC Learning Disability Services which includes Registered Nurses in the LD Team being able to undertake the Case Manager role.

All positive Checklists received by the CHC Team will be sent to one of two Locality Managers depending on the area where the person lives i.e. South / South West, West, East. They will then allocate the case to a Nurse Assessor to act as the Case Manager.

They will be responsible for but not limited to:

1. arranging and leading the Multi-Disciplinary Team (MDT) meeting;
2. ensuring that the person/their representative are informed of the date/time of the meeting;
3. ensuring everyone relevant to the meeting is invited;
4. ensuring all relevant evidence is collated;
5. completing the Decision Support Tool (DST) and submitting it with supporting evidence to the Integrated Care Board (ICB).

When obtaining a price for a care home with nursing, please remember that any agreed fee must be excluding any NHS Funded Nursing Care determination and that the relevant NHS authority (within the area you are placing in) is responsible for payment of that determination. For further information, see chapter 5.0.5 Processes for Arranging All Support and Services.

Statutory responsibility for the commissioning of NHS Continuing Healthcare currently sits with the Integrated Care Board (ICB). This includes the commissioning and provision of care to meet the assessed health and social care needs of a person who is eligible for fully funded NHS Continuing Healthcare, and the health needs of a person who is eligible for a jointly funded package of care.

A person only becomes eligible for NHS CHC once the ICB has made a decision that they are eligible, as informed by the completion of a Decision Support Tool (DST) or Fast Track Pathway Tool (FTPT). Lincolnshire ICB backdate the CHC funding to the date the DST was completed.

However, local authorities must consider their wider responsibility in meeting community care needs for people in receipt of fully funded NHS Continuing Healthcare; for example, safeguarding, assistance with parenting responsibilities, carer’s assessments, support with housing and adaptations.

A person is not awarded NHS Continuing Healthcare on a permanent basis; their needs should be reviewed at least annually. As a result, organisational responsibility for meeting and funding their assessed needs may change.

Partnership working is essential to the successful delivery of NHS Continuing Healthcare. This includes commissioning. By working together, ICBs and local authorities should be able to prevent unnecessary changes to a person’s service provider or their care package purely because the responsible commissioner has changed from the ICB to the local authority, or vice versa.  This is especially important for people who are in receipt of local authority direct payments and become eligible for NHS Continuing Healthcare, otherwise they may experience a loss of the control they have previously been able to exercise over their care.

Whilst the National Framework indicates when an ICB’s responsibility for a CHC care package should start, it is less clear as to when it ends. To address this, NHS England produced a document titled ‘When does an ICB’s funding responsibility cease for a Continuing Healthcare (CHC) Care Package?’ As a result of the content of this document, Lincolnshire ICB has opted to reduce the period of notice for withdrawing CHC funding from 28 to 14 days. The CHC Periods of Notice document setting out the periods of notice they now give in relation to CHC, Fast Track, Jointly funded packages of care and FNC can be accessed via the Local Resource Library.

In order to minimise any potential disruption to the person and their care provision when the responsible commissioning organisation changes, Lincolnshire ICB and LCC will continue to fund and provide care on the other organisation’s behalf to allow adequate time for the transfer, where appropriate, of existing care provision and for any new care services to be sourced and commissioned. This also takes into account the notice period required where a person has chosen to purchase some or all of their care through a personal health budget.

Currently this is done on a case by case basis. It is important to note that where a person is reassessed and they are no longer eligible for NHS CHC, LCC Adult Care should not ask the ICB to continue providing and funding the full care package whilst they complete relevant assessments and provide an appropriate package of care that is within their responsibility to do so.  Asking the ICB to continue the full care package in the interim would mean that LCC were paying for and providing care that the person has been assessed as no longer needing and was outside a local authority’s responsibility to commission.

Where a jointly funded care package is agreed, and regardless of whether or not the person is in receipt of local authority direct payments, LCC will only commission services to meet the person’s social care needs. The ICB will be responsible for commissioning services to meet the person’s health needs. This applies even where the same provider is providing a service to meet both the health and social care needs. In such cases, the provider will need to invoice the ICB directly in relation to the cost of the healthcare provision.

Where on review of a jointly funded care package, the ICB decides to withdraw or reduce the number of hours it will fund for the healthcare element of the package, LCC Adult Care will not accept responsibility for the commissioning or provision of such care.

Please note that within LCC’s Adult Care Learning Disabilities Service, there is a Section 75 agreement which allows LCC to commission healthcare provision.

See: Lincolnshire Personal Health Budgets Policy in the Continuing Healthcare section in the Local Resource Library, and Direct Payments if the person already has a Personal Health Budget.

As part of joint working, Adult Care occupational therapists should accept and action referrals made by health professionals to assess a person who is in receipt of fully funded NHS Continuing Healthcare or is jointly funded.

A person who is eligible for fully funded NHS Continuing Healthcare should have access to joint equipment services; however, any equipment provided will be funded by the NHS.

Provision of standard catalogue items will be funded by Lincolnshire Community Health Services (LCHS).

Bespoke/specialist items will be funded by NHS Continuing Healthcare.

Occupational therapists should send all requests for bespoke/non-contract equipment via secure email to licb.chc@nhs.net. Requests will be disseminated to the CHC Locality Lead for the relevant area.

There are two kinds of disputes that may arise in relation to NHS Continuing Healthcare (CHC).

These challenges are often referred to as ‘appeals’ or ‘Individual Challenges’.

Adult Care practitioners may be required to participate in the local Integrated Care Board (ICB) appeal process. This may include undertaking an assessment or review of the person’s needs and attending a Multi-Disciplinary Team (MDT)/Decision Support Tool (DST) meeting. In cases where the Individual Challenge progresses to presentation to an MDT Panel, this will be attended by an LCC CHC Coordinator.

If an Adult Care practitioner is asked by a person or their family or representative how to request an eligibility review, the practitioner should advise them to contact the ICB CHC Team and provide their phone number and/or address.

The National Framework requires all ICBs and local authorities to agree a local disputes resolution process.

In cases where practitioners would like to dispute the decision made by Lincolnshire ICB on a person’s eligibility for NHS Continuing Healthcare, they should refer to the Lincolnshire Interagency Dispute Policy which can be found in the Continuing Healthcare section in the Local Resource Library.

The National Framework advises that if a case involves a dispute between an ICB and a local authority in different areas, that the relevant ICB process should be followed. This will be different to the Lincolnshire Interagency Dispute Policy. In such cases, the practitioner should access the relevant ICB Inter-agency Disputes policy/process.