National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care in England

1. National Framework for NHS Continuing Healthcare and NHS-funded Nursing Carein England LINCOLNSHIRE PRIMARY CARE TRUST Sue Pearce CHC LPCT What Continuing Health care means for the Patient and Providers of Care in Lincolnshire

2. What is the National Framework? • The National Framework (October 2007) is a single set of principles on eligibility for: • NHS Continuing Healthcare (full NHS funding); and • NHS-funded Nursing Care. • It also describes a standard process for assessment for NHS funding, including national tools to help support consistent decision-making. The assessment process is Multidisciplinary (MDT), this means professionals who are involved with or familiar with patients needs.

3. The Assessment Framework Key Principles • The NHS makes the decision on eligibility for NHS Continuing Healthcare in collaboration with the Local Authority through a multi-disciplinary team. • Full and active involvement of patients and carers. • Screening stage (Health Care Check List) single discipline can complete this is designed to promote proportionate assessments. • Assessment and decision-making processes are co-ordinated. • Fast-tracking available for those who need services quickly, for example to gain care quickly for people with limited life expectancy. • All decisions are fair and consistent, regardless of the care group, type of needs or reason for those needs.

4. TheBasics…….. What is ‘NHS Continuing Healthcare’? • The name given to a package of services which is arranged and funded by the NHS alone for people outside hospital with ongoing care needs. • Assessed as a Prime Need for Health Care • Anyone can qualify for the package, regardless of location or diagnosis, provided they have a certain level of care needs. • It means that the Patients needs are such that they are still considered to be an NHS patient, even though you are not in a hospital. “prime need is for Health Care” • In a patients own home, this means the NHS pays for: • Healthcare (e.g. community nurse, specialist therapist or GP); and • Personal care (e.g. personal carers, care workers). • In a care home, the NHS pays for care home fees (including for board and accommodation).

5. Eligibility for NHS Continuing Healthcare Who is eligible? • A patient will qualify for full NHS funding if your overall care needs show that the primary need is a health need. • This means that their needs cannot be met by Social Services, because they require nursing or other healthcare services beyond those that Social Services are able to provide. Therefore prime need is health • There should be no ‘gap’ in services – NHS responsibility for full funding starts where Local Authority responsibility ends.

6. Eligibility for NHS Continuing Healthcare Key Principles • Eligibility is based on an individual’s overall care needs. • It is not dependent on the individual’s disease, diagnosis or condition, nor on who provides the care or where that care is provided. • There is no discrimination based on age or type of need (e.g. physical v. mental health needs). • Eligibility is not dependent upon finances or budgets. • The PCT Adult Panel consider eligibility only not costs

7. Eligibility for NHS Continuing Healthcare How do The Multidisciplinary Team decide who is eligible? • The ‘primary health need’ is demonstrated by using four key indicators: • Nature – the type of need as presented, and the quality and quantity of skill required to meet the need. • Complexity – one or more needs or symptoms which interact, making overall needs difficult to manage or control. • Intensity – needs which are so severe that they require regular interventions to manage risk. • Unpredictability – unexpected changes in condition that are difficult to manage and cause significant risk • Assessors consider the overall care needs by breaking those needs down into specific areas and comparing them to the key indicators. The assessment tool is called a Decision Support Tool (DST)

8. Eligibility for NHS Continuing Healthcare The Care Domains • The overall care needs are broken down into generic areas of need, to build a complete picture of the person’s needs. • The care domains are:

9. Do Providers Contribute to the process? • If you are involved in a patients care package, either in their own home or a care home, you can contribute to the MDT Assessment, this may involve professional judgement about care need, or providing evidence from carer reports or care plans

10. Implications to providers for patients receiving CHC • This means that Lincolnshire primary Care Trust will fund the persons placement • Funding needs to be agreed before a placement or care package is implemented • Funding within a care home is usually in line with Lincolnshire County Council (LCC) contract price plus the single band nursing care • Any additional funding is by negotiation depending on evidenced need

11. Patient already receiving services • If a care package is already in place, and then the person becomes eligible for CHC, authorisation will be given from the date of approval or DST date, Depending on the outcome from the LPCT Adult Panel • CHC basically means that the NHS pay and not the patient. • If a patient is in a residential home and it is not appropriate to move the patient for example at end of life, CHC can be accessed (within the set criteria) to fund additional care • DN Teams can assist with mainstream services for example Marie Curie Service or hospice at home.

12. If the Prime Need is not for Health • A Jointly funded package may be indicated if the MDT recommend that the Prime Need is Not for Health, but some complexity or unpredictability are evidenced, and the NHS have obligation to meet those specific health needs, this for example, may be some additional funding for one to one support to manage a health care need. • Or The MDT may recommend that the prime need is for Social Care • and

13. NHS Funded Nursing Care – available only in Care Homes with Nursing What is ‘NHS-funded Nursing Care’? • By law, the NHS is responsible for any care which must be provided by a registered nurse. • For people in care homes, the registered nurses are usually employed by the care home itself. • So, to fund the registered nursing care, the NHS makes a payment to the care home to cover the cost of providing the care for those that are eligible. • The Single Band £101 payment from the NHS is set against the person’s care home fees. • This only applies to people in care homes who do not qualify for full NHS funding through NHS Continuing Healthcare. • Used to also be known as ‘Registered Nurse’s Contribution to Care’ or RNCC.

14. Provision of NHS-funded Nursing Care What is registered nursing care? • Registered nursing care can involve many different aspects of care. Typically, those with a need for registered nursing care will receive some of the following: • Supervision/monitoring of nursing needs • Planning/reviewing/amending the care plan • Identifying, and tackling, potential health problems • Referring patients to other healthcare professionals (GP, therapist etc.) • Monitoring and supporting self-medication by the patient • Prescription of drug therapies/medication as necessary

15. Review Period Regular Review (either CHC or FNC) • Case reviews will be undertaken to reassess care needs and eligibility for NHS Continuing Healthcare on a regular basis. • The first review will take place three months after the initial assessment to look for changes in the care needs. • Subsequent reviews will take place at least annually. • Neither the NHS nor Social Services should withdraw from an existing care package without a joint review and reassessment and agreement of the proposed changes.

16. Direct Payments (LCC) to patients cared for within their own home • At the present time it is not lawful for the NHS to pay a person direct for health care provision. • District Nursing should be sought where health care is required within the patients home, and CHC funding should only be agreed where the remit of the DN team has been exceeded. • It can be arranged that where a small element of a persons total needs are health care needs LCC will cross charge LPCT for an element of the direct payment. • This requires monitoring, joint working, patient/family involvement to ensure it is the best option for the patients quality of life • Risk assessments are essential to manage this situation • The DoH are to commence a pilot during the next 2 years exploring the possibility of individual health care budgets

17. Questions • CHC is a complex system, but must be considered in the first instance where a persons needs may indicate that the NHS would be responsible for funding • Tools and policy are available on the DOH website – Google DoH Continuing Health Care • Thank you