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Hospital Based Complex Clinical Care

Hospital Based Complex Clinical Care
Hospital Based Complex Clinical Care was previously known as NHS Continuing Healthcare.

The Independent Review of NHS Continuing Healthcare, published on 2 May 2014 recommended that NHS Continuing Healthcare be completely revised, as it was no longer fit for purpose. 

From 1 June 2015, NHS Continuing Healthcare was replaced by Hospital Based Complex Clinical Care.

Why change?

The way care is being provided is changing. People want to stay in their own home - or in a homely setting - for as long as possible. Receiving long-term care in a hospital should be the last resort.

Local councils and health boards have been working together over the last few years to develop services that support this, including Intermediate Care services, like reablement, 'hospital at home' (specialist care delivered at home as an alternative to being treated in an acute hospital environment, overseen by a consultant or other specialist, like your GP) and more intensive home care services. 

These services can support people with high-level needs at home or in a care home.

New eligibility question

Assessment for long-term complex clinical care will now be based around one eligibility question:

Can your care needs be properly met in any setting other than a hospital?

If, following a full assessment, the answer to this question is Yes, you will be discharged from NHS care to a suitable community setting like:

  • your own home with support
  • a care home
  • supported accommodation

At this point, your local council’s charging policies will apply, and you may have to contribute towards the cost of your care. The council will carry out a financial assessment to work out how you need to contribute towards care costs.

The NHS will remain responsible for meeting any medical needs after discharge from hospital. 

Assessment

The assessment will be carried out by a consultant or equivalent specialist, helped by the multi-disciplinary team. The assessment should be carried out in partnership with you, and your family and/or carer. Your views and wishes should be taken into account. 

The assessment will help establish the best place for you to have your clinical healthcare needs met. All options should be considered, and the outcome of the process will be explained to you, and your family and/or carer.

What happens after discharge?

Health and social care staff will start discharge planning on - or soon after - you're admitted. The planning process will help to make sure appropriate support is there in the community to help you when you leave hospital.

The Scottish Government have a leaflet called Ready for Discharge? What happens next? (PDF, 271 KB).

Moving to a care home

If the assessment identifies that the your long-term care needs can only be met in a care home, social care staff will support the you, your family, carers or advocate to choose an appropriate care home, able to meet your assessed needs. 

The Scottish Government have a leaflet on Moving from hospital to a care home (PDF, 269 KB).

What if I'm currently receiving NHS Continuing Healthcare?

People assessed as eligible for NHS Continuing Healthcare under the Scottish Government's old guidance (PDF) will continue to receive that level of care for as long as they remain eligible. People currently receiving this care in a care home will continue to do so, for as long as they remain eligible.

Why do I have to pay?

If you have a health need, the NHS will still be responsible for meeting that need - free of charge. However, if you're in a care home, you'll be asked to contribute - subject to your financial circumstances - towards social care and accommodation costs.

Only those who need to be in hospital will be exempt from charges relating to their accommodation. Everyone else - whatever their age or disability - should contribute to the funding of accommodation costs, following a financial assessment.

Why can't I stay in hospital?

Hospitals should be places that we turn to when we need specialised investigations and treatment that are best provided there, rather than in the community.

However, a prolonged stay in hospital can result in:

  • a sense of separation from family and friends, leading to boredom, loneliness, loss of confidence, and depression
  • increased likelihood of hospital infections
  • distress for family members who have to spend time and money on regular, frequent visits to a hospital that may be some distance from home

Who can support me?

Community health and care services - working in partnership with housing, third sector and independent providers, and with support from a range of specialists - are experts in supporting people to recover after an illness.

They provide care and support at home or in a homely setting for people who need chronic care and support, palliative or end-of-life care. 

The information was last updated on: 12th August 2015

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