CH175-Assessing People for NHS Funding Policy

Registration Number: {{org_field_registration_no}}

Assessing People for NHS Funding Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} supports eligible individuals to access appropriate NHS funding for their health and care needs, including NHS Continuing Healthcare (CHC) and NHS Funded Nursing Care (FNC). This policy outlines how we identify individuals who may qualify, provide accurate information and advocacy, and work collaboratively with health professionals to ensure fair and lawful assessment. It aligns with CQC Regulation 9 (Person-Centred Care), Regulation 17 (Good Governance), and the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised 2022), and helps ensure people receive care that is fully funded where appropriate.

2. Scope

This policy applies to all individuals receiving care and support from {{org_field_name}} who may have complex primary health needs. It also applies to all care staff, managers, nurses, advocates, and administrative staff involved in care planning, referral, liaison with health and social care professionals, or coordination of funding. The policy covers adults eligible for NHS Continuing Healthcare (full package of care funded by the NHS) and those eligible for NHS Funded Nursing Care (contribution to nursing care within a residential setting). It applies whether care is provided in the person’s own home or a supported accommodation setting.

3. Related Policies

CH07 – Person-Centred Care Policy
CH04 – Good Governance Policy
CH18 – Risk Management and Assessment Policy
CH26 – Recruitment, Selection, and Retention Policy
CH36 – Initial Assessment and Care Planning Policy
CH42 – Communication and Engagement with Service Users and Families Policy

4. Understanding NHS Continuing Healthcare and FNC

NHS Continuing Healthcare is a package of care arranged and fully funded by the NHS for individuals assessed as having a “primary health need.” This can include complex physical or mental health needs requiring ongoing care. NHS Funded Nursing Care is for individuals in a care home with nursing needs, where the NHS contributes towards the nursing element of care. Eligibility is not based on diagnosis but on the nature, intensity, complexity, and unpredictability of the person’s health needs, as outlined in the National Framework. It is assessed by the local Integrated Care Board (ICB).

5. Identifying Potential Eligibility

All individuals undergoing assessment or review of care at {{org_field_name}} are screened for potential NHS funding eligibility. This includes:

Reviewing the individual’s physical, psychological, and nursing needs
Evaluating current levels of support, interventions, and clinical oversight
Identifying any escalation in health needs, hospital discharges, or end-of-life care situations
Where indicators of eligibility exist, the person’s case is referred for further consideration and a checklist is completed. Consent must be obtained and recorded, or a best interests decision made if the person lacks capacity.

6. Completing the NHS CHC Checklist

The NHS CHC Checklist is used as a preliminary screening tool to determine if a full assessment for CHC is needed. At {{org_field_name}}, only trained and competent staff may support or complete the checklist in conjunction with health professionals. The process includes:

Gathering detailed clinical and care information from care records, assessments, and multidisciplinary professionals
Involving the individual and their family or advocate in the process
Ensuring accurate documentation, including examples of how needs are being managed
Submitting the checklist to the ICB for triage and confirmation of next steps
The outcome is shared transparently with the individual, and any appeals or disputes are supported.

7. Coordination of Full CHC Assessments

Where a full CHC assessment is triggered, {{org_field_name}} works closely with the NHS CHC Team and other agencies to:

Provide access to all relevant care plans, daily notes, incident logs, and risk assessments
Attend multidisciplinary team (MDT) meetings where needed
Ensure the Decision Support Tool (DST) is informed by accurate evidence
Provide input on the domains such as cognition, behaviour, mobility, nutrition, skin integrity, medication, and continence
Support the individual in understanding the process, rights to appeal, and what the outcome may mean for their care funding
All communication with ICBs is documented, and decisions are reviewed regularly in line with the NHS Framework.

8. Advocacy and Supporting Decision-Making

People we support are given clear, accessible information about NHS funding processes and their right to advocacy. Where an individual lacks capacity, we ensure a family member, legal representative, or independent advocate is involved. This ensures the individual’s wishes, preferences, and best interests are fully considered. We encourage supported decision-making and promote empowerment through every stage of the assessment.

9. Appeals and Disputes

If a person is found not eligible for CHC or FNC and wishes to appeal, {{org_field_name}} supports the individual to understand the decision and access the appropriate appeals process. This includes:

Explaining reasons for ineligibility in plain language
Reviewing the assessment to identify any areas of challenge
Supporting the preparation of written submissions or representation at panel hearings
Working with independent advocates, solicitors, or clinical professionals as needed
All appeal activity is recorded and monitored through our governance systems.

10. Staff Training and Competency

All staff involved in identifying potential NHS funding, completing checklists, or contributing to assessments receive training in:

NHS CHC and FNC eligibility criteria
How to complete the Checklist and DST accurately
Communicating sensitively with individuals and families
Working within the National Framework and legal duties under the Care Act 2014
Training is refreshed annually and reviewed as part of the staff supervision and appraisal process. Only designated trained staff may lead on referrals and coordination.

11. Record-Keeping and Information Sharing

All documentation relating to CHC and FNC assessments, correspondence, and decisions is stored securely and in line with CH34 – Confidentiality and Data Protection Policy. Records include:

Completed checklists and DSTs
Consent or capacity assessments
MDT notes and communications
ICB decisions and outcomes
Appeals and reviews
Information is shared only with authorised professionals and advocates with the individual’s consent or best interests decision, in accordance with GDPR and Caldicott principles.

12. Efficient Funding Management at {{org_field_name}}

We manage NHS funding processes efficiently through:

Early screening at the point of assessment and care planning
Dedicated trained staff coordinating referrals and evidence gathering
A tracker system for monitoring pending assessments and outcomes
Good relationships with ICBs, district nurses, and NHS CHC coordinators
Ensuring that any changes in funding status are reflected in the person’s care plan and financial records
This ensures people receive the funding they are entitled to and care is aligned with assessed needs and entitlements.

13. Policy Review

This policy will be reviewed annually or sooner in response to updates to the NHS National Framework, changes in CQC guidance, or legislative amendments. The Registered Manager {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}} is responsible for ensuring all staff are aware of the policy and that practice remains compliant and person-centred.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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