NHS Continuing Healthcare and the Discharge to Assess process

Experts at Beacon CHC advise on the NHS Continuing Healthcare and Discharge to Assess process

The Discharge to Assess (D2A) process supports the discharge from hospital of individuals who are clinically stable and no longer require acute hospital care, but who may require further assessment to establish their ongoing health and social care needs.

D2A usually involves short-term funding for support services to facilitate the assessment process, such as home care or a short stay in a care home.

Where there may be a need for NHS Continuing Healthcare (such as where a long-term care placement with nursing is required, or if the individual has significant support needs), the individual should be assessed for eligibility via the usual CHC checklist / assessment method.

This need should be identified before discharge. However, no assessment or checklist should usually take place in hospital, unless in exceptional circumstances.

Is an assessment for NHS Continuing Healthcare required?

The CHC checklist is designed to screen in, rather than out. Therefore, the threshold is set intentionally low.

In the following circumstances an assessment for NHS Continuing Healthcare will not be required:

• If it has been previously decided that the individual is not eligible for CHC and there has been no clear change in needs
• If it is clear that there is no need for CHC at this time
• If the individual has short-term health care needs or a temporary condition and their long-term care needs are unclear
• If the ICB agrees to go straight to a full assessment
• If the individual has a rapidly-deteriorating condition which may be entering a terminal phase (in this case the individual should be referred for Fast Track)
• If all needs are being met under S117 of MHA

It is not appropriate for a practitioner to refuse to carry out a checklist because they don not think the individual will be eligible for CHC.

NHS Continuing Healthcare and D2A scenarios

An individual may be discharged via one of five scenarios relating to NHS Continuing Healthcare and D2A.

• Scenario 1: It has been agreed that the existing package/placement still meets the needs of the individual without any changes. The individual should be discharged under existing funding arrangements, a checklist should take place within six weeks, and if eligible reimbursement should be backdated to the date of discharge. This includes individuals self-funding their own care packages along with any other scenario, including LA packages
• Scenario 2: It has been agreed to provide interim NHS-funded services to support the individual after discharge. This may allow individuals to reach a better point of recovery and rehabilitation in the community before their longer-term needs are assessed. In such a case, before the interim NHS-funded services come to an end, screening, if required, for NHS Continuing Healthcare should take place through use of the Checklist and, where appropriate, the full MDT process using the DST (i.e. an assessment of eligibility)
• Scenario 3: A ‘negative’ Checklist is completed in an acute hospital (i.e. the person does not have a need for NHS Continuing Healthcare)
• Scenario 4: A ‘positive’ Checklist is completed in an acute hospital and interim NHS- funded services are put in place to support the individual after discharge until it is either determined that they no longer require a full assessment (because a further Checklist has been completed which is now negative) or a full assessment of eligibility for NHS Continuing Healthcare is completed
• Scenario 5: A ‘positive’ Checklist is completed in acute hospital and a full assessment of eligibility for NHS Continuing Healthcare takes place before discharge. In a small number of circumstances, it may be decided to go directly to a full assessment within the acute hospital, without the need for a Checklist

If an individual in hospital has been identified as requiring a checklist, or has already received a positive one (in exceptional circumstances), and is being discharged into a new or changed care placement, interim NHS funding is not guaranteed, and this will depend on the local criteria for D2A funding and relevant clinical decision-making.

NHS Continuing Healthcare and D2A principles

• Eligibility for NHS Continuing Healthcare should be considered after discharge, when the needs of the individual are clearer
• Until an eligibility decision is made the existing care arrangements (including any funding arrangements) should continue
• A full assessment should take place in a community setting as longer term (or end of life) care needs should be assessed once the individual has reached a ‘point of recovery’… However, where the individual’s needs continue to fluctuate after discharge, assessments should not be unreasonably delayed
• Risk management at the point of discharge is important as oversubscribing assessments for CHC wastes resources, and undersubscribing risks the individual not receiving the care and support required for recovery. Discharge teams should work with the individual, the onward care provider and the unpaid carer/advocate/representative in order to effectively manage risk and plan the care
• Each locality (ICB/LA/NHS bodies/partners) develops its own protocols regarding the roles and responsibilities for discharge procedures, the intermediate/rehab care arrangements, and the arrangements for care assessments including CHC. This must include the identification of individuals who require a CHC screening/assessment at the appropriate time and place
• The screening should take place when an accurate assessment of needs can be made, but should not be delayed indefinitely just because some needs continue to fluctuate
• Any interim NHS funded services should continue until it is decided whether or not the individual is eligible for CHC
• Local protocols establish where responsibility for meeting needs lies and who is responsible for funding

How Beacon CHC can help

Through our Free Information & Advice Service you can access preliminary advice about the D2A process, and receive up to 90 minutes of free personalised advice from a specialist Tier 2 adviser.

Beacon is able to answer queries relating to points above, navigating the system and raising complaints where you feel that the process has not been correctly followed. However, this service is not able to advise on medical, financial or legal matters, including:

• The suitability of an individual for discharge.
• The appropriateness of a proposed care package, placement, or provider
• The discharge process in your area, including eligibility for or appropriateness of interim NHS-funded care services
• Queries or concerns relating to clinical/medical safety

Click here to download the Free Navigational Toolkit which includes expert guidance and advice on all aspects of CHC including referrals, assessments and reviews.

For further advice, you can explore the webpage and factsheet from Age UK.