Title: Managing CHC and Joint Funding Pathways in Older People’s Services Without Delay or Dispute
CHC and joint funding processes shape the stability of many older people’s placements, particularly for those with dementia, frailty and complex physical health needs. Delays and disputes rarely arise from a single decision; they usually reflect unclear evidence, inconsistent communication, and weak ownership of next steps. Two useful internal reference points are the Working With Commissioners, ICBs & System Partners tag and the Social Care Mini-Series — Tendering, Safeguarding & Person-Centred Practice. This article sets out a provider-led approach that reduces drift and maintains placement stability.
Why CHC pathways break down in practice
Problems typically arise when needs are described narratively rather than operationally, or when reviews are treated as isolated events. ICB teams need to understand daily risk, intervention intensity and escalation patterns—not just diagnoses.
A provider-led operating model
Maintain MDT-ready evidence
Providers should maintain rolling evidence packs for individuals likely to trigger CHC or joint funding review. These include incident summaries, care record extracts, professional input and family communication logs. Consistency builds trust.
Describe need through daily reality
Effective evidence explains what happens at specific times of day, what staff do, and what risks arise if support is delayed or absent. This clarity supports defensible decision-making.
Operational examples
Example 1: Night-time respiratory deterioration
Context: Recurrent night-time breathlessness leading to ambulance callouts.
Support approach: Structured monitoring and escalation protocol.
Day-to-day delivery: Scheduled observations, positioning support, prompt escalation and documented responses.
Evidence: Reduced callouts and consistent incident records.
Example 2: Dementia-related distress and care resistance
Context: Distress during personal care creates safeguarding and restriction risk.
Support approach: Distress minimisation and least restrictive practice planning.
Day-to-day delivery: Consistent staffing, adapted timing, clear recording of triggers and responses.
Evidence: Reduced incidents and improved family confidence.
Example 3: Continence and skin integrity risk
Context: Repeated UTIs and skin breakdown risk.
Support approach: Tightened routines and auditing.
Day-to-day delivery: Timed checks, mid-shift audits and observed practice.
Evidence: Improved skin outcomes and audit scores.
Explicit expectations
Commissioner expectation: Clear, timely evidence that supports decision-making and reduces system friction.
Regulator expectation: Safe, person-centred delivery that remains robust during funding uncertainty.
Running reviews without drift
Clear actions, named owners and agreed timescales prevent delay. Interim risk controls should always be documented when decisions are pending.