Getting to grips with NHS CHC

by David Chandler

17 May 2019

Finance staff have major role to play in NHS continuing healthcare, but need better understanding of how it works

NHS continuing healthcare, or NHS CHC as it is more commonly referred to, is a source of constant consternation for clinical commissioning groups. NHS CHC supports some of the most vulnerable people in our society and it is essential to get it right and apply the rules consistently. But for finance staff, NHS CHC can sometimes just represent an ever growing overspend or pressure in the accounts. Not only is the number large and growing, but some can feel it is shrouded in mysterious conditions and process.

It can be said NHS CHC blurs the boundaries between health and social care, integrating care at an individual level for those with the most significant health needs. In this way, it is an exemplar of what can be achieved through integrated, system working with duties on both the CCG and local authority to involve each other where appropriate.

However, the way that NHS CHC is delivered varies across the country. Costs can be vastly different and patient experience can vary and is not always positive. A 2017 report by the National Audit Office into NHS CHC highlighted significant variations in the number and proportion of people assessed as being eligible from place to place. They noted that costs were increasing and while no quota or cap would be applied, NHS England asked CCGs to make efficiency savings of £855m by 2020/21 (compared with predicted growth in spending).

NHS England and NHS Improvement has recognised that significant variation exists across the country for those receiving care through NHS CHC. A strategic improvement programme has sought to address this, considering areas as wide ranging as workforce and the use of digital technology, as well as cost variations. The March 2019 board report from NHS England showed improvements in assessment, no change in eligibility rates and a cost saving to date of £757m. A positive outlook for the service.

Eligibility for NHS CHC does not take account of the setting of care, so it can be provided in residential care or in a person’s own home. Since April of this year, CCGs have been required to offer personal health budgets as the default option for people who receive NHS CHC in the community. In some areas this personalisation of care represents business as usual. But for others, this may well be a significant step up on the current provision of personal health budgets.

The HFMA is supporting finance staff to understand more about NHS CHC in two ways. First, a new easy to read ‘how it works’ guide has been published to explain the basics of NHS CHC. The guide enables finance staff to gain an overview of the eligibility criteria and the responsibilities of the CCG and the local authority. A number of other terms that staff may come across are also covered, for example explaining the difference between NHS CHC and funded nursing care.

For those who have greater involvement in the process and who support their CCG to manage it well, the HFMA’s Commissioning Finance Faculty is holding a technical forum this month. While the premise of NHS CHC is relatively simple, doing it well is not. The forum will give delegates a chance to hear how other areas are meeting the challenge and take some learning back to their own organisations.

NHS CHC can feel like a dark art practised by people who have much more knowledge than the rest of us, shut away in a distant part of the CCG. However, it is an essential part of meeting the NHS commitment to support those who need it the most in an out of hospital setting. Ensuring it is carried out in the best possible way – for both those who receive it and the wider population – is essential. Finance staff can play a key role in the effectiveness of NHS CHC especially if they have a good understanding of how it works.


The HFMA Commissioning Finance Faculty Steering Group has a few vacancies. HFMA members interested in joining can contact