NHS Continuing Healthcare (CHC): Writing Winning Complex-Care Bids

CHC contracts are among the toughest in health and social care tendering. Here’s how to evidence clinical governance, risk management, PBS, and measurable outcomes — so your complex-care bids score at the top of the table.

💡 Useful links for providers: Strengthen your CHC tender with expert support — Complex Care Bid Writer · Home Care Bid Writer · Domiciliary Care Bid Writer · Bid Review & Proofreading.

🏥 What Makes CHC Bids Different (and Harder)

NHS Continuing Healthcare (CHC) funds a person’s ongoing, complex health needs outside hospital — frequently in their own home. For providers, CHC tenders are challenging because they require clinical rigour and community flexibility in the same model. Evaluators look for three things above all:

  • Clinical safety — assured governance for high-risk tasks (tracheostomy, ventilation, enteral feeding, epilepsy rescue meds, wound care).
  • Continuity and resilience — rota stability for 24/7 packages, dependable escalation, and a known team.
  • Measurable outcomes — reduced hospital use, stable parameters, skill acquisition, and quality of life improvements.

Winning providers translate bedside excellence into clear, auditable evidence — and present it in a narrative that matches NHS scoring logic.

🧭 The CHC Scoring Blueprint: Five Pillars

1) Clinical Governance (Show Control, Not Just Care)

  • Named clinical lead: RGN/ACP oversight with defined hours and on-call availability. Include biography and registrations.
  • Policies & SOPs: medicines management, infection prevention, tracheostomy care, suctioning, oxygen/ventilation, enteral feeding, seizure management, wound care, MCA/DoLS/LPS readiness, incident/RCA, safeguarding.
  • Audit cycle: monthly clinical audits (device checks, line care, MAR accuracy), quarterly deep dive themes, and learning dissemination.
  • Escalation map: thresholds, who to call (community nurse/rapid response/OOH/999), response times, documentation requirements.
  • Interface with NHS teams: MDT reviews, joint competencies, shared care plans via NHSmail/digital platforms.

2) Workforce Competence (Observed, Re-observed, Recorded)

  • Role-mapped curriculum: care/support worker → senior → team lead; bespoke modules for trachy, ventilation, PEG/PEJ, catheter, bowel care, epilepsy rescue meds.
  • Competency sign-off: supervised practice, DOPS/OSCE-style observation, minimum supervised episodes per skill, assessor credentials.
  • Re-observation cadence: 3-month post-sign-off check, then 6–12-monthly (or sooner after any incident/near miss).
  • Simulation & drills: emergency trachy dislodgement, seizure protocol rehearsal, anaphylaxis, oxygen failure — recorded outcomes and actions.
  • Reflective supervision: clinical reflection and wellbeing check every 6–8 weeks; learning actions tracked to closure.

3) Continuity & Rota Resilience (24/7 Without Cracks)

  • Patch teams: 8–12 clinicians/carers dedicated to each package; relief “buddy” identified for sickness/leave.
  • Continuity KPI: ≥80% “known staff” rate per 4-week period; continuity protected during leave via pre-briefed buddies.
  • Lone-working safety: check-in/out protocols, GPS devices where appropriate, OOH escalation.
  • Weekend & bank holiday plan: rostered clinical supervision, equipment support, pharmacy pathways.

4) Outcomes & Value (Data That Speaks NHS)

  • Safety: incidents per 1,000 hours; medication error rate; device-related incident count.
  • Hospital utilisation: 30-/90-day avoidable admissions; A&E attendances; length of inpatient stay if admitted.
  • Clinical stability: patient-specific parameters (SpO₂ ranges, seizure frequency/duration, pressure-area status) with trend lines.
  • Quality of life: PROMs/PREMs, participation indicators, goal attainment scaling (GAS).
  • Efficiency: agency hours % and trend; care minutes right-sized without risk; cost avoidance narrative.

5) Digital Readiness & Information Security

  • DSPT compliance and annual refresh.
  • eMAR and digital care planning with real-time incident/observation logs.
  • NHSmail/secure messaging for MDT communication and shared documents.
  • Device & data governance: access controls, audit trails, data retention and IG incident handling.

📐 Structuring Your CHC Bid Answer (Copy/Paste Framework)

  1. Context: Briefly define the cohort and risks (e.g., ventilation/trachy/PEG, epilepsy, complex wound care).
  2. Clinical governance: Named clinical lead, policies, audits, escalation map.
  3. Workforce & competencies: training pathway, supervised practice, re-observation, supervision cadence.
  4. Continuity & resilience: patch team model, known-staff thresholds, lone-working safety, OOH plan.
  5. Outcomes & measurement: KPIs and baseline → improvement story.
  6. Partnership & integration: MDT cadence, shared plans, therapy and community team interfaces.
  7. Assurance: governance committee oversight, RCA/learning loops, improvement actions closed.

Keep paragraphs short, anchor each section with one metric, and finish with a concise “tender line” that makes the result quotable.

🧪 Example Packages & Tender Lines You Can Adapt

Example A — Tracheostomy & Ventilation at Home

Context: Adult with long-term ventilation, cuffed tracheostomy, and recurrent infections.

Approach: Nurse-led governance; twice-daily device checks; humidification protocol; eMAR and suction logs; weekly MDT.

Evidence: Zero unplanned decannulations in 12 months; respiratory infections reduced by 31%; no avoidable admissions.

Tender line: “Specialist governance with daily device safety checks achieved zero unplanned decannulations and cut respiratory infections by 31% year-on-year.”

Example B — PEG/Enteral Feeding With Seizure Risk

Context: Adult with PEG feeds, complex epilepsy, and hydration concerns.

Approach: Competency-based PEG training; hydration prompts; seizure protocol; MAR+hydration overlap in digital plan; quarterly dietitian review.

Evidence: Medication errors down 58%; seizure-related A&E attendances dropped from 6 to 1 over 10 months; BMI stabilised within target.

Tender line: “Structured PEG & epilepsy competencies reduced med errors by 58% and nearly eliminated seizure-related A&E attendances in 10 months.”

Example C — Spinal Injury, Complex Wound Care

Context: Person with SCI requiring pressure-area management and complex wound care.

Approach: Repositioning schedule; equipment optimisation; weekly nurse review; wound photography with secure storage; joint tissue-viability input.

Evidence: New category 2+ pressure damage reduced to zero in 9 months; wound area reduced by 46%; satisfaction improved to 95%.

Tender line: “Device and positioning audits eliminated new pressure damage for 9 months while accelerating wound healing by 46%.”

🧱 Competency Architecture (What Panels Reward)

  • Care Certificate + Clinical Skills: map general standards to complex-care tasks.
  • Micro-credentials: trachy care, ventilation alarms, enteral feed hygiene, seizure emergency meds, catheter care, sepsis recognition, escalation drills.
  • DOPS/OSCE: minimum supervised episodes per skill (e.g., 10 trachy suction episodes) before solo practice.
  • Observation logs: time-stamped sign-offs stored in LMS with expiry dates and alerts.
  • Annual refresh + ad-hoc re-obs: triggered by incident/near miss or after therapy/MDT changes.

In bids, present this as a one-page matrix and cite completion & competence rates (e.g., “96% clinically competent; 4% in supervised up-skilling”).

🧩 Positive Behaviour Support (PBS) in Complex Care

For CHC packages where behaviour is a factor, PBS must be integrated — not separate:

  • Functional assessment to understand triggers and functions of behaviour.
  • Proactive supports (sensory strategies, communication aids, visual structure, preferred routines).
  • Reactive plans that emphasise de-escalation and least-restrictive responses.
  • Practice leadership — observations, coaching, reflective supervision, MDT review.
  • Outcome linkage — reduced restrictive incidents, improved participation, fewer hospital contacts.

Tender line: “PBS embedded in clinical governance reduced restrictive incidents by 43% and improved community participation for two individuals.”

📊 The CHC KPI Set (Keep It Small, Make It Strong)

  • Safety: incidents per 1,000 care hours; MAR accuracy; device check compliance.
  • Stability: seizure frequency/duration; SpO₂ within range; infection rate; wound area change.
  • Utilisation: 30-/90-day readmissions; A&E attendances; avoided admissions via early escalation.
  • Continuity: % “known staff”; rota fill %; missed/late visit rate.
  • Experience: PREMs (satisfaction, confidence) and qualitative feedback.

Present three quarters of trend data if possible, and pair each line with a one-sentence explanation of what changed in practice.

🛠️ Templates You Can Deploy This Week

  • Clinical Governance Strategy — escalation flow, policy index, audit calendar, RCA template, learning dissemination plan. (See Editable Strategies.)
  • Competency Matrix & DOPS Pack — procedure lists, supervised episode counts, assessor sign-off forms. (See Editable Method Statements.)
  • Emergency Drill Checklist — trachy dislodgement, seizure escalation, anaphylaxis, oxygen failure, lone-worker incident.
  • Outcome Dashboard — safety, stability, utilisation, continuity, experience — monthly, with Qtr summary.
  • Family & MDT Communication SOP — secure messaging, joint visit scheduling, documentation standards.

🧮 Value Messaging That Resonates With ICBs

  • Efficiency: competent, stable teams → fewer incidents → fewer unplanned admissions → lower system cost.
  • Flow: reliable home-based capacity supports discharge, prevents re-admission, and keeps beds moving.
  • Assurance: strong governance and digital reporting reduce commissioner oversight burden.

Make your bid read like a solution to system pressure — not just a staffing plan.

🧠 Common Pitfalls (and How to Fix Them)

  • ❌ Policy lists with no practice. ✔ Add a short example of how each policy changed care or reduced risk this quarter.
  • ❌ Training without observation. ✔ Provide observed competence rates and re-observation cycles.
  • ❌ Relying on agency to plug gaps. ✔ Show a relief-buddy model and continuity thresholds with performance data.
  • ❌ Outcome claims with no numbers. ✔ Include three concise KPIs and a one-line narrative per KPI.
  • ❌ Weak escalation detail. ✔ Add thresholds, response times, and named contacts; include a sample escalation log (redacted).

🧭 Key Takeaways

  • 🏥 CHC bids reward clinical control as much as compassionate care.
  • 🧱 Build around five pillars: governance, competence, continuity, outcomes, and digital readiness.
  • 📊 Prove change with 3–5 KPIs and a credible before/after story.
  • 🤝 Integrate with NHS teams — joint visits, shared plans, secure comms, MDT cadence.
  • 🚀 Turn your evidence into scoring lines — short, specific, and verifiable.

Need your CHC submission tightened fast? We can help you structure, evidence and polish through Bid Writer – Complex Care, Bid Review & Proofreading, and capability-building via Bid Strategy Training. For wider capacity or discharge work, see Home Care Bid Writer and Domiciliary Care Bid Writer.

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🚀 Ready to Win Your Next Bid?

Chat on WhatsApp or email Mike.Harrison@impact-guru.co.uk

Updated for Procurement Act 2023 • CQC-aligned • BASE-aligned (where relevant)

Written by Impact Guru, editorial oversight by Mike Harrison, Founder of Impact Guru Ltd — bringing extensive experience in health and social care tenders, commissioning and strategy.

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