What is the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care?

What is the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care?

From NHS Website

In June 2007, the Department of Health published the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, following public consultation during 2006. The guidance in the Framework is part of the Department of Health's continuing care policy in England. This policy covers:
• the criteria used to assess if you're eligible for continuing care, and
• the procedure for investigating cases where people may have been wrongly denied continuing care.
What is continuing care?
The National Framework describes continuing care as:
• care provided over an extended period of time to a person aged 18 or over to meet physical or mental health needs which have arisen as the result of disability, accident or illness.
If you need continuing care, your care needs will be complex, substantial and ongoing, caused by a disability or chronic illness, or following hospital treatment. Continuing care is also commonly known as long-term care.
Who provides continuing care?
If you need continuing care, you may need:
• healthcare services from the NHS, and/or
• social and community care services from your local authority.
Health services are provided through NHS organisations such as Primary Care Trusts, NHS Trusts and Mental Health Trusts.
Local authorities provide social and community care services, such as:
• personal care at home, for example, help with bathing, dressing, getting up and going to bed,
• delivery of hot or frozen meals,
• day centre facilities, and
• care provided in a care home.
Local authorities are bodies such as town, city, borough, metropolitan or county councils. They are allowed to charge for the services they provide, and most of them do so.
Continuing care services may be provided by the NHS or your local authority in various places, for example, in hospital, in a care home or nursing home, in a hospice, or in your own home.
The funding of continuing care is complicated.
What is NHS Continuing Healthcare?
If your main need for care relates to your health, the NHS is responsible for providing for all your needs. NHS Continuing Healthcare is a package of continuing care arranged and funded solely by the NHS. It's also sometimes known as fully funded NHS care.
To be eligible for NHS Continuing Healthcare, your main or primary need must relate to your health. Your needs will be assessed to decide if you're eligible.
If you're eligible, you're likely to have a complex medical condition that requires a lot of care and support; you're also likely to need highly specialised nursing support. Someone approaching the end of their life is also likely to be eligible, if they have a condition that is rapidly getting worse and may be terminal.
NHS Continuing Healthcare may be provided in any setting, for example:
• in your own home - the NHS will fund all the care required to meet your assessed needs, or
• in a care home or nursing home - the NHS will make a contract with the home and pay the full fees for your accommodation, as well as all your care.
If you have a disability, or if you've been diagnosed with a long-term illness or condition, this doesn't necessarily mean that you'll be eligible for NHS Continuing Healthcare.
What is NHS-funded Nursing Care?
If you qualify for NHS-funded Nursing Care, this means that the NHS is responsible for arranging and funding:
• nursing from a registered nurse in a care home which is registered to provide nursing care. (Before April 2002, such care homes were known as nursing homes.)
This nursing care cannot be provided by local authorities. The NHS funds this nursing care through a payment called the Registered Nursing Care Contribution (RNCC).
Your needs will be assessed to decide if you're eligible for NHS-funded Nursing Care.
How will my continuing care be planned?
Whether you're eligible for NHS Continuing Healthcare or not, if you have ongoing care needs a care planning process will decide how best to meet your needs. Your care needs will be identified, and their impact on your daily living and quality of life will be evaluated. The assessment will focus on your needs for care, not on issues such as where your care is provided or who provides it.
As part of the process of planning your care, your eligibility for NHS Continuing Healthcare or NHS-funded Nursing Care will also be assessed.
The assessment process may have two stages - an initial screening and a full assessment. However, where someone is nearing the end of their life, senior doctors or nurses may use a 'fast track tool', to enable care to be put in place urgently.
Having either an initial screening or a full assessment does not mean that your eligibility is likely to be confirmed.
You will be asked to give your consent before the assessment process begins. After your needs are assessed, an overall plan for your care will be drawn up and agreed.
How will my continuing care needs be assessed?
For most people, the first stage in the assessment process is to have their care needs screened against a standard checklist. The screening shows if you'll be referred to the next stage.
Your initial screening will be carried out by a nurse, doctor, other qualified healthcare professional or social worker. They will use the NHS Continuing Healthcare Needs Checklist to decide if you should be referred for a full assessment. For example:
• a nurse or doctor could carry out an initial screening before you're discharged from hospital,
• your GP or a nurse could do this screening in your own home, or
• a social worker could do this screening when carrying out a community care assessment.
If your initial screening shows that you should be referred, a multidisciplinary team of health and social care professionals will carry out a comprehensive assessment of all your care needs, using a 'decision support tool'. As well as your nursing care needs, they will assess your physical, mental, psychological and emotional needs. When your assessment is carried out, you and, where appropriate, your carer will be consulted. The decision support tool ensures that people's needs are assessed consistently and fully.
If you're not referred for a full assessment after your initial screening, your case will be reviewed three months later.
When will a decision be made?
In most cases, it should take no more than two weeks from being referred for a full assessment to receiving a decision.
The decision about your eligibility for NHS Continuing Healthcare will be made first, based on evidence of your needs from the full assessment. If you're not eligible, a decision will then be made about your eligibility for NHS-funded Nursing Care, also using the evidence from the full assessment.
If your initial screening did not refer you for a full assessment:
• Your care needs will be assessed so that your eligibility for NHS-funded Nursing Care can be considered. To carry out this assessment, parts of other assessment processes may be used, for example, the Single Assessment Process or other similar processes.
• You are entitled to ask for a full assessment to be carried out. Your Primary Care Trust (PCT) will consider your request, based on all the information available, but does not have to agree to it. To read about your PCT's role, see the section who runs this in my area below.
Even if it's decided that you're not eligible for NHS Continuing Healthcare, the process of planning your care will continue. Depending on your circumstances:
• the NHS and your local authority may share responsibility for providing, and possibly funding, your care, or
• your local authority may be responsible for providing, but not necessarily funding, your care.
When is responsibility for continuing care shared?
If you don't qualify for NHS Continuing Healthcare, you may be eligible for a package of continuing health and social care. This means that the NHS and your local authority may share responsibility for providing, and possibly funding, the care agreed in your care plan. Such arrangements are sometimes known as a joint package of continuing care.
Under the National Framework, NHS organisations and local authorities are responsible for working together to ensure that:
• assessments of eligibility for continuing care are consistent and timely, and
• continuing care is provided in a consistent and timely way.
As well as registered nursing care, the NHS may fund other services if they are agreed as part of your care plan. These services could include, for example:
• primary health care,
• community health services,
• specialist health care support, and
• palliative care.
How will my care needs be reviewed?
The NHS's responsibility to provide or arrange care (including NHS Continuing Healthcare) may not be long-term, as your needs may change.
If the NHS is providing any part of your care, a case review will take place:
• to reassess your care needs,
• to ensure that the care package still meets your needs, and
• to reassess your eligibility for NHS Continuing Healthcare.
This ensures that your eligibility for NHS funding will be reassessed regularly, regardless of the outcome of any previous full assessments or your initial screening. Your eligibility will be reassessed if:
• your full assessment showed that you were eligible for NHS Continuing Healthcare,
• your full assessment showed that you were not eligible for NHS Continuing Healthcare, or
• your initial screening did not refer you for a full assessment.
If the case review shows that your needs have changed, your package of care may need to be changed. Responsibility for funding your care could also change.
Your first review should be no later than three months after your initial screening, followed by further case reviews at least once a year. Some people will need reviews more often than this.
What if I'm not eligible for NHS Continuing Healthcare or NHS-funded Nursing Care?
If you're not eligible for NHS funding for your care, you may be eligible for a social care benefit from your local authority. For example, you may need care to be provided in your own home, or you may need respite care (temporary care given by someone else instead of your main carer, so that your main carer can take a break).
Local authorities are allowed to charge for the services they provide, and most of them do so. Some authorities have set maximum amounts that you can be charged; the maximum varies from area to area.
Social care benefits are means-tested. This means that when your ability to pay for the services you need is assessed, your income and savings will be taken into account.
Why was the National Framework introduced?
Previously, there were no national eligibility criteria for NHS Continuing Healthcare. Each Strategic Health Authority was responsible for the criteria used by the Primary Care Trusts in its area. The approach to assessments, decisions on eligibility and therefore funding varied, depending on where you lived.
For NHS-funded Nursing Care, there were three bands or rates of payment, depending on the level of nursing required for your condition. To decide if you were eligible, you had to have another, separate assessment.
In 2004, the Department of Health announced it intended to develop a national framework for NHS Continuing Healthcare, aiming to:
• improve consistency when eligibility is assessed, and
• make NHS Continuing Healthcare easier to understand.
In 2006, the Department of Health confirmed it wanted to simplify how NHS Continuing Healthcare and NHS-funded Nursing Care work together.
Published in 2007, the National Framework aims to create consistent access to fully funded care. It sets out a process for the NHS, working with local authorities, to:
• assess health needs,
• decide on eligibility for NHS Continuing Healthcare, and
• provide that care.
As a result of the National Framework, many more people in England are likely to receive more help towards the costs of their care.
What are the changes?
The major changes in the National Framework are:
• There will be one common process across England to assess if you're eligible for NHS Continuing Healthcare.
• The same process will assess if you're eligible for NHS-funded Nursing Care.
• There will be one single band or rate of payment for NHS-funded Nursing Care in a nursing home, so that the NHS provides the same contribution to everyone receiving this type of care.
The National Framework is supported by a set of tools and checklists to help with decision-making, including notes explaining how to use them. These tools include the Checklist Tool, the Decision Support Tool and the Fast Track Tool.
When is the National Framework effective?
The Department of Health has announced that compliance with the National Framework is mandatory from 1 October 2007. From that date, all Strategic Health Authorities and Primary Care Trusts will therefore adopt the national eligibility criteria.
The National Framework will be reviewed on 1 October 2008.
Who will run this in my area?
Primary Care Trusts (PCTs) fund health services for people who live in their area. These services include:
• services for people registered with a GP in their area who are eligible for NHS Continuing Healthcare, and
• NHS-funded Nursing Care in nursing homes in their area.
PCTs are responsible for assessing eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care, as well as ensuring that the national eligibility criteria are used consistently. They also identify, arrange and fund all the services required to meet your needs:
• if you qualify for NHS Continuing Healthcare, or
• for the healthcare part of a joint care package.
The PCT for your area can provide more information on the eligibility criteria and assessment process. If you think you have care needs that should be assessed, or if someone you care for has needs that you think should be assessed, you should contact your PCT.
You can get contact details for PCTs by calling NHS Direct on 0845 4647 or visiting the NHS Choices website. When you contact your PCT, ask to speak to the co-ordinator for NHS Continuing Healthcare.
Reviews of continuing care decisions
The Department of Health's continuing care policy covers the procedure for investigating cases where people may have been wrongly denied continuing care. Reviews of continuing care decisions have been taking place since 2003.
The Department of Health has asked for any new cases for review to be raised by 30 November 2007. These are cases:
• where eligibility decisions for fully funded NHS care were made before April 2004, or
• which involve a period of time mainly before April 2004.
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