Transition from Children’s to Adult Continuing Healthcare (CHC)

ICBs face challenges to ensuring a smooth transition from children’s to adult Continuing Healthcare. Children’s and adult CHC operate under different legal frameworks, eligibility criteria, and service models. While children’s services focus on developmental needs and family‑centred support, adult CHC is grounded in the National Framework for NHS Continuing Healthcare and NHS‑funded Nursing Care.

Challenges to a smooth transition between the two are often out with the ICB control, but others occur as a result of systemic or operational barriers, lack of clear accountability, inconsistent process and pressure on ICB workforce capacity.

Practical steps for ICBs to support effective transition

Hempsons is familiar with disputes and complaints arising from the often difficult transition from children’s to adult CHC. What can ICBs do to ensure a smooth transition, ensure legal obligations are met and assist families with the process?

• Ensure staff are aware of the different legal frameworks, eligibility criteria and assessment tools.
• Ensure accountability and ownership of the transition – to ensure timely assessments and coordinated handovers and to avoid confusion for families as to the relevant contact.
• Ensure the young person is central to the process, identify preferences and aspirations, any need for advocacy or support in making decisions.
• Clear communication with families and young people and management of expectations where eligibility may change at 18. Providing explanations of the differences between children’s and adult CHC, realistic timelines, written information in accessible formats and opportunities for questions are all important in ensuring clarity.
• Clear communication between child and adult services in order to avoid duplication, inconsistency and frustration.
• Ensure expectations of families are managed including sharing of information and data with parents where young person with capacity turns 18.
• Ensure collaboration between agencies and health services. Regular multi‑agency meetings ensure everyone shares the same information and expectations.
• Ensure timely planning and start planning early to avoid gaps in care. Transition planning should begin no later than Year 9 (age 13–14), in line with SEND Code of Practice expectations. This allows time for obtaining accurate assessments, opportunities for young people to participate and full exploration of options. The CHC Checklist should be completed at around 16-17 and ICBs should ensure the Decision Support Tool is completed for a decision before the 18^th
• Ensure there is a continuity of care by not stopping services until new arrangements are confirmed, involving care providers early to plan staffing and training, ensuring contingency plans are in place.
• Ensure appropriate reviews are undertaken to confirm adult CHC is working effectively.
• Ensure staff are appropriately training on transition best practice.
• Consider whether existing or new care arrangements will amount to a Deprivation of Liberty and whether a court application is required to authorise arrangements. An application can be made to authorise a DoL for a 16/17 year old. This should be done in good time to enable appropriate authorisation to be in place prior to any move.

Legal risks and the importance of early, coordinated planning

A smooth transition between children’s and adult CHC is achievable when planning starts early, communication is clear, and the young person remains at the heart of the process. At the centre of ensuring transition is the need to ensuring ICB staff are equipped with the skills and knowledge required, have the capacity to assess early and communicate with young people, families and colleagues.

ICBs can face legal challenges including judicial review, in circumstances where transition planning starts too late, adult CHC decisions are not made before the age of 18, where packages change or stop abruptly and where families argue that statutory duties are not being met.

How Hempsons can help

Hempsons can provide training to assist at all stages of the transition process and can offer advice and support in respect of dispute resolution and complaint responses. If you have any questions, or we can be of any assistance, please contact us below.