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NHS Continuing Healthcare

NHS Continuing Healthcare. What does Continuing H ealthcare mean?. A package of ongoing care to meet primary health need. Arranged and funded by the NHS. Age 18 or over. Meeting health needs arising from disability, accident or illness.

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NHS Continuing Healthcare

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  1. NHS Continuing Healthcare

  2. What does Continuing Healthcare mean? A package of ongoing care to meet primary health need. Arranged and funded by the NHS. Age 18 or over. Meeting health needs arising from disability, accident or illness. Provided in any setting, residential care or home (para 13 National Framework tab 4).

  3. Why does NHS continuing healthcare matter?

  4. Why does NHS continuing healthcare matter? • 2011 survey Laing & Buisson cost of residential care £24,076 - £31,096 • Nursing Home fees range from £32,448 to £42,692.

  5. Why does NHS continuing healthcare matter? • Per Lord Woolf in Coughlan at pargraph 1; • The critical issue in this case is whether nursing care for a chronically ill patient may lawfully be provided by a local authority (in which case the patient pays according to means) or whether it is required to be provided by law free of charge as part of the NHS.

  6. Primary Care Trusts (PCTs) until 31 March 2013 • From 1 April 2013 Clinical Commissioning Groups (CCG’s) or National Health Service Commissioning Board. Who provides NHS Continuing Healthcare?

  7. Legal Framework

  8. No definition in primary legislation of ‘continuing care’, ‘NHS continuing healthcare’ or ‘primary health need’. Legal Framework

  9. No definition in primary legislation of ‘continuing care’, ‘NHS continuing healthcare’ or ‘primary health need’. • s.1 of the National Health Service Act 2006 as amended by s.1 of the Health and Social Care Act 2012 requires the Secretary of State to promote a comprehensive health service free of charge (tab1) Legal Framework

  10. No definition in primary legislation of ‘continuing care’, ‘NHS continuing healthcare’ or ‘primary health need’ • s.1 of the National Health Service Act 2006 requires the Secretary of State to promote a comprehensive health service (tab 1) • Section 1H of the 2006 Act establishes NHS Commissioning Board and Clinical Commissioning Groups (tab1) Legal Framework

  11. No definition in primary legislation of ‘continuing care’, ‘NHS continuing healthcare’ or ‘primary health need’ • s.1 of the National Health Service Act 2006 requires the Secretary of State to promote a comprehensive health service • Section 1H of the 2006 Act establishes NHS Commissioning Board and Clinical Commissioning Groups (tab1) • Local authority duty to assess for community care services s.47 NHS and Community Care Act 1990 including residential accommodation s.21 National Assistance Act 1948, s.21(8) prohibits provision of nursing care which should be provided by the NHS (tab 1) Legal Framework

  12. Case Law

  13. R v North and East Devon Health Authority ex parte Coughlan [2000] 2 W.L.R. 622 (tab 2) • R v Bexley NHS Care Trust ex parte Grogan [2006] EWHC 44 Admin (tab 3) Case Law

  14. Case Law • Coughlan facts • Serious injury in RTA 1971 (para 3) • Newcourt Hospital until 1993 • Health Authority promise Mardon House “home for life” • 1998 Health Authority decision to close Mardon House and transfer patients to local authority provision (para 4).

  15. Case Law • Coughlanpoints of law (para 30) • NHS does not have sole responsibility for nursing care • Nursing incidental to s.21 can be provided • Where primary need is health need responsibility is NHS even if in LA residential home • Assessment of primary health need must include nature and quality • Mrs Coughlan’s needs were clearly beyond scope of LA duty

  16. Case Law • Grogan facts d. • MS • Oedema • Risk of falls • Wheelchair user • Admitted to hospital • Unable to live independently • transferred to care home • Assessed as not qualifying for NHS continuing healthcare

  17. Case Law • Grogan points of law • Trust had no criteria for deciding primary health need • There can be an overlap or gap between NHS and LA provision • Legal limit to NHS provision • Policy of no gap • Assessment of primary health need must take onto account limit of LA power

  18. The meaning of Primary Health Need

  19. The meaning of Primary Health Need • Ineligibility for continuing healthcare only where: • the nursing or other health services required are no more than incidental or ancillary to the provision of accommodation and • not of a nature which LA could be expected to provide. • Neither CCG nor LA can dictate to the other. • (paras 33-41 National Framework)

  20. The meaning of Primary Health Need • Practical approach to be taken • Characteristics of a primary health need: • nature, • intensity, • Complexity • unpredictability

  21. Principles of Assessment • Individual at the heart of the process • Informed • Consulted • Preferences recorded and taken into account. • No discrimination nb including type of health need eg psychological pr physical

  22. Principles of Assessment Consent Capacity Advocacy Guidance – The National Framework (tab 4)

  23. The Assessment The Checklist (tab5 ) • Used as a screening tool (para 5) • 12 domains of need (p 10) • Three levels of need A-C

  24. The Assessment • Decision Support Tool (DST) (tab 6) • CCG duty to co-ordinate • DST not an assessment in itself (p 9 para 6)

  25. The Assessment • DST 12 domains (p 12/46) • Behaviour • Cognition • Psychological and emotional needs • Communication • Mobility • Nutrition – food and drink • Continence • Skin (including tissue viability) • Breathing • Drug therapies and medication: • symptom control • Altered states of consciousness Other significant care needs

  26. The Assessment • 7 degrees of need • none - priority. • primary Health Need indicated if one domain priority, or • two as severe, or • number as high. • Once the multi disciplinary team has reached agreement a recommendation is made to CCG.

  27. The Assessment • CCG may use a panel to ensure consistency. • Recommendation should be followed unless exceptional circumstances. • Should not be refused or referred because the CCG would have come to a different decision on the same evidence. • Time should not exceed 28 days (National Framework para 35)

  28. The Assessment • Fast Track Tool (tab 7) • Rapidly deteriorating condition • Completed by ‘appropriate clinician’

  29. Joint NHS/LA care packages • When a person is not entitled to continuing healthcare • But DST identifies needs • CCG partnership with the LA to agree joint package of care • (para 113 National Framework)

  30. Transition from child to adult services • Continuing care different meanings in child and adult services. • Specific Guidance • Children’s Services identify young people at age 14 • Referral from screening at age 16 • Eligibility determined age 17. • (para 124 National Framework)

  31. At 3 months • Thereafter at least ever 12 months • Continuing duty to consult • No unilateral withdrawal • (Para 139 National Framework) Review

  32. Dispute resolution • CCG duty to inform of proceedure • Local resolution procedures in first instance • Then NHS Independent Review Panel • (para 145 National Framework)

  33. Dispute resolution • Key principles • Full disclosure • Inclusion • Evidenced decision making • Legal representation not necessary but is permitted. • Role of the IRP advisory • Recommendations should be accepted by the Board in all but exceptional circumstances. • A decision by the Board is susceptible to Judicial Review

  34. Concluding Comments • Decisions on NHS continuing healthcare may have very significant cost consequences for clients. • Opportunities to initiate, influence and challenge decisions are real and should not be ignored. • ROBIN POWELL • 16 April 2013

  35. Bye bye

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