Hospital Discharge and NHS Continuing Healthcare (CHC)
1st October 2025
1st October 2025
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Hospital Discharge and NHS Continuing Healthcare (CHC)
Hospital discharge can feel like the rug has been pulled from under you. One moment your loved one is in a ward with doctors and nurses on hand, and the next you’re faced with planning their future care — often with little notice, and even less clarity about who is responsible for what. Families are suddenly asked to make decisions about where someone will go, what support they will receive, and how it will all be paid for. The NHS discharge process has changed in recent years. The aim is to move people out of hospital as soon as they are medically fit, with assessments of longer-term needs happening later in the community. On paper this avoids unnecessary delays. In reality, it often leaves families confused about their rights, particularly when it comes to funding and whether NHS Continuing Healthcare (CHC) should apply. Too often, CHC is not even mentioned during discharge planning, so families must be prepared to raise the issue themselves. This newsletter explains how the system is meant to work, what often happens in practice, and the questions families can ask to ensure care and funding decisions are fair. What is CHC? NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded solely by the NHS for adults with a primary health need. The process starts with the Checklist (a simple screen) and, if indicated, a full Decision Support Tool (DST) assessment by a multi-disciplinary team. Except in limited circumstances such as the Fast Track pathway at end of life, Checklists and DSTs should usually take place after discharge, once the person’s longer-term needs are clearer in a community setting. Families should not assume the hospital will arrange this; in practice, you often have to ask. The principle is clear: “There must be no gap in the provision of appropriate support to meet the individual’s needs.” In other words, care should continue without interruption while CHC eligibility is being determined. Whether that happens smoothly depends on local practice — and on whether families know to press for it. What happens at discharge? Planning for discharge should start early, often even at admission. Staff should explain when discharge is likely, where the person will go, what support they will need, and who will provide it, involving family or carers if the patient wishes. The NHS now follows a model called Discharge to Assess (D2A), which sets out four recognised pathways (Pathways 0 to 3): Pathway 0: A simple discharge home, with no new needs or with existing services simply restarted. Pathway 1: A discharge home with new or additional short-term support, such as carers, therapy, or reablement services, with long-term needs assessed once the person has settled. Pathway 2: A discharge to a temporary community bed — in a care home or community hospital — for recovery, rehabilitation or reablement before longer-term plans are made. Pathway 3: A discharge directly into a new residential or nursing home placement. This should only happen in exceptional circumstances, when it is already clear that long-term care will be required immediately. Best practice is that permanent care home decisions should not be made from a hospital bed unless unavoidable. For those discharged on Pathway 1 or 2, short-term recovery support is often provided through intermediate care or reablement. National policy states this should be free for up to six weeks. Be aware though, the full six weeks is not guaranteed everywhere. Some areas provide less, and some services stop early if recovery goals are met quickly. Families should always check their local arrangements. If no free reablement is offered, or if it ends before recovery is complete, the responsibility usually shifts to the local authority to arrange support under the Care Act 2014. That means a care needs assessment and, if eligible, a financial assessment to decide contributions. Importantly, if the needs are primarily health rather than social care, then the NHS may still be responsible under CHC. Whatever the pathway, the guiding principle is that there should be no gap in care or funding. If CHC is later awarded, costs can sometimes be backdated to cover the period when those needs were already present. Who Funds What and When? One of the most common questions families face at the point of discharge is: who is actually responsible for paying for care while everything is being worked out? The National Framework makes it clear that there should be no gap in support, but in practice the picture is far less straightforward. Whether the NHS, the local authority, or the family carries the cost depends on how the person’s needs are viewed, and at what stage the assessment process has reached. If someone is leaving hospital for a care or nursing home for the first time, it is reasonable to assume there may be a need for CHC. In these circumstances, short-term Discharge to Assess (D2A) funding is sometimes agreed, with the NHS covering costs until the person can be properly assessed in the community. In practice, this funding may only last a few weeks — or longer if the system is slow to act — and whether it is offered often depends on local protocols and on how prepared the family are to press their case. For those discharged to a residential home with relatively straightforward support needs, the assumption is usually that the primary need is social care rather than health. In this situation, the local authority becomes involved, unless there are strong indicators that healthcare is the dominant need. The care home can then request a Checklist once the person has settled. If CHC is eventually awarded, there may be grounds to argue that funding should be backdated to the date of admission. A third possibility arises where the person has not yet been medically “optimised”. This means their longer-term needs cannot be assessed accurately because they require further therapy, medication changes, or a period of reablement first. During this time, the NHS is generally expected to fund care. Once the individual’s condition has stabilised, a community Checklist should then be arranged. Again, the reality of how smoothly this happens depends both on local ICB practices and on how persistent the family is in making sure the process is followed. Preparing for the discharge meeting When it comes to hospital discharge, families are usually told that a “multidisciplinary team” (MDT) will be involved. In practice, this means a group of professionals — such as ward staff, doctors, therapists, hospital social workers, and sometimes a care transfer hub — working together to plan the right support for your relative once they leave hospital. Alongside the MDT, there should also be a named discharge coordinator or case manager. This is a single professional who acts as your central point of contact, making sure information is shared, plans are joined up, and you know who is responsible for each part of the process. The coordinator liaises with the MDT and with community services to arrange follow-up care, agree timelines, and keep the discharge on track. Different professionals within the MDT play specific roles. Ward staff are responsible for identifying discharge needs early, often from the point of admission. Therapists help to assess whether rehabilitation or reablement will be needed. Hospital social workers become involved where there are complex social circumstances, questions about mental capacity, or safeguarding concerns. In some areas, care transfer hubs link hospital teams with local authorities and community services to coordinate particularly complex discharges. The discharge meeting is the point at which the plan is brought together. It is where staff should explain the available options and guide you through them. It is not your responsibility to know every question in advance, but being prepared can help. Ask about reablement at home and what goals will be set, whether an occupational therapist will visit the home and arrange any equipment or adaptations, what short-term alternatives exist if home is not yet safe, who will be funding those options, and, if CHC eligibility is being flagged, where and when the CHC Checklist assessment will take place. Most importantly, ask for the discharge plan, the funding arrangements, and the timetable for follow-up assessments to be confirmed in writing. Warning: In many cases, CHC will not be mentioned at all during the discharge process unless families specifically raise it. Do not assume it will be considered automatically — you may need to ask firmly, and more than once. How ARROW can help Once your loved one has been discharged and had a chance to settle in their community setting — usually for around six weeks — we can help you consider whether they may meet the threshold for NHS Continuing Healthcare (CHC). Based on the information you provide, we offer a free consultation of around two hours, by phone or MS Teams. During this session we will explore your relative’s health and care needs in detail, explain how the Checklist works, map their needs across the eleven domains of care, and outline the next steps. If you hold the appropriate legal authority, such as a certified Health and Welfare Lasting Power of Attorney or a court-appointed deputyship order, we can also initiate the assessment on your relative’s behalf. This can be particularly important if the possibility of CHC has not been raised during the discharge or reablement process. To proceed, we would simply need to know which hospital your loved one is in and where you are based, so that we can identify the correct Integrated Care Board (ICB) and local authority. You do not have to navigate this complex system alone — and your relative should not miss out on funding to which they may be legally entitled. ARROW Continuing Healthcare Consultants offer independent, expert support to ensure families receive the funding they are legally entitled to. Contact us today for a confidential, no-pressure chat. |
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If you’re navigating a complex care situation and feel unsure about your eligibility for NHS Continuing Healthcare, we’re here to help.
Contact ARROW today for a confidential conversation about how we can support your application, appeal, or care review. learn more about how arrow can support you with your claim
At ARROW, we provide expert guidance and hands-on support throughout the NHS Continuing Healthcare (CHC) process. We can: ✔️ Arrange an initial Checklist assessment for you or your loved one. ✔️ Fully prepare you for the Checklist and Decision Support Tool (DST) assessments. ✔️ Gain access to healthcare records (for relatives, a certified Power of Attorney or Court Deputyship Order is required). ✔️ Build strong evidence using medical and care records to support your case. ✔️ Draft evidence-based supporting statements for assessment and appeal panels. ✔️ Represent and advocate for you or your loved one at any stage of the process. ✔️ Manage appeals if you’ve been wrongly assessed as ineligible for CHC funding. 💡 If you believe you or your loved one may qualify for NHS Continuing Healthcare, don’t go through it alone--let ARROW guide you every step of the way! 📞 Contact us today for a FREE consultation! |
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