NHS continuing healthcare (CHC) review

When you first get CHC, you have an initial review after 3 months. After that, you normally have a review every year.

Your local integrated care board (ICB) will have a policy on how often you will have a review. When you get a CHC award, the letter should say when your next review is.

You should have a key contact. This is the person who is in charge of your CHC funding. Contact them if you want to know when your next review is.

Your ICB can tell you who your key contact is.

Find your local integrated care board (NHS)

The review’s main purpose is to assess whether your care plan is working and meeting your needs.

For example, it should check if your condition has got worse and if you now have extra care needs.

The review will check your eligibility but cannot reduce or stop your CHC funding. If the person carrying out the review thinks your care needs have reduced, another CHC eligibility assessment would decide this.

It is rare for your funding to be reduced or stopped if you have evidence that your needs are unchanged.

The review should take a person-centred approach. This means you are involved throughout. Your views and preferences are important and should be listened to.

A nurse normally does a continuing healthcare review. When you are awarded CHC, the letter should say when your review is.

The 3-month review and the annual review will follow the same process.

They will come to your home and ask questions about your CHC funding and if it is working. You can choose to have the assessment over the phone. Let your local ICB know if you would like to have the assessment in a different format.

It normally takes an hour to complete.

The review will:

• confirm that you are still eligible for continuing healthcare
• look at your care plan
• make sure everything in your plan is happening
• check the plan is still meeting your primary health needs
• ask if your needs have changed

A review is a good time to talk about any problems with your care package. This includes how you manage your CHC budget.

Managing your continuing healthcare

Everyone should prepare for the review. If your needs have changed or you think your needs are not being met, there are extra things you can do to prepare.

Preparing for your review 

After a review, you will receive a letter which will explain what happens next and if you need to do anything. If you do not receive a letter, ask your key contact to send a letter that explains the outcome of your CHC review.

Outcomes of a CHC review

Before a review, think about:

• Are your health needs being met?
• Is the support you receive the same as the support in the care plan?
• Do you need more support?
• Have your health needs changed?
• Is your care managed the way you would like (personal health budget or NHS organised)?
• If you have personal assistants, is their training up to date?

Use a copy of your care plan to see what support you should be receiving. If your personal assistants have done training, have evidence of this to show the assessor.

If you are happy with how your continuing healthcare funding is working, have some examples of how it has benefited your health. This might include fewer or no hospital admissions.

If you are unhappy with your continuing healthcare funding, get evidence to show how it is not meeting your needs.

Not meeting your needs

Your CHC funding might not be meeting your primary health needs if:

• the care plan is not being followed
• your needs have increased

Tell the assessor if your plan is not being followed. Share any examples if you can. You can say what changes you would like to happen. Or ask the assessor what changes they can make to follow your care plan.

If your needs have changed and you want to ask for more funding, you will need to prove this.

You can write down why you need more support. Be as specific as you can, using examples where you have gone without support. Think about these questions:

• What is the impact of not having that care?
• Is it making your health worse?
• Has there been an increase in hospital admissions or appointments?
• Could those admissions or appointments have been prevented if you had more funding for support?

You can use evidence to support your request for more support. Evidence can include:

• care plans
• treatment plans
• letters from specialists
• hospital admissions
• discharge reports

The CHC checklist will tell you what counts as a health need.

CHC checklist

When you have continuing healthcare, you decide who will manage the money.

You can ask the NHS to:

• decide and organise your care and support
• put the money in a personal health budget

If the NHS organises your care, they will let you know what support you receive.

You can have a combination of NHS organised care and a personal health budget.

During the review the assessor will ask you about how you manage your care and if that is still working. You can:

• ask to move to a personal health budget
• stop using a personal health budget and have the NHS manage your care
• change which parts of your care are in a personal health budget

Personal health budget

Everyone with a continuing healthcare plan should have the option of a personal health budget. You might have to ask your ICB if this was not offered after your assessment or you’d like to try it.

If they think you can manage your own care, you can have a personal health budget. It does involve paperwork, but you can get support to do this.

A personal health budget gives you more control over your care. This can mean your care is more personalised and helps you achieve your goals. When you have a personal health budget, the CHC still funds your care.

A personal health budget can pay for:

• a personal assistant (PA) to help with everyday care
• equipment not provided as standard by the NHS
• leisure or educational activities and transport costs to meet a medical need
• respite care to spend time away from your carer or do an activity with them
• anything that has been agreed and will help you manage your condition

Personal health budget

After a review you will receive a letter with the outcome.

If you do not receive a letter, ask your key contact to send a letter that explains the outcome of your CHC review.

Your continuing healthcare funding will:

• increase
• or stay the same
• or be reassessed

You will have a CHC assessment for eligibility if the assessor thinks you have fewer needs or you’re no longer eligible for CHC. It’s rare for your funding to be reduced or stopped if your needs have not changed.

If you’re happy with the outcome, you can follow the instructions on the letter. You normally have to do something if your package is changing.

If you’re not happy with the outcome, you can challenge your CHC review.

Appeal a continuing healthcare (CHC) decision