NHS continuing healthcare and NHS funded nursing care.
WARNING: the NHS will consult you personally. Your spouse, children, partner e.t.c have no rights in the matter however nice the NHS staff may be to them. If you can’t make decisions they will be made for you by the NHS, not by your family UNLESS your family hold a Lasting Power of Attorney Health and Welfare which has been registered. If you have lost mental capacity and you need your family to challenge the NHS decision in the courts, then your family must also have an Enduring Power of Attorney or a registered Property and Financial Affairs Lasting Power of Attorney. It is not uncommon for Health Authorities to hide behind the lack of both types of power of attorney to avoid being challenged. Not that we are suggesting that the Eastbourne, Hailsham and Seaford Clinical Commissioning Group would do so.
In busy NHS Departments, the correct procedures are often not followed and an independent review of the paperwork through us may give a quite different result.
If the above Lasting Powers of Attorney are are not yet in place, stop reading this and contact us urgently: Lasting Powers of Attorney can only be prepared whiilst a person is in reasonable mental health.
This is a brief guide for individuals who may be in need of ongoing care and support from health and social care professionals as a result of disability, accident or illness. It explains the process used to decide if a person wil receive care funded by the National Health Service.
The funding arrangements for ongoing care are complex and it is a highly sensitive area, which can affect individuals at a very vulnerable stage of their lives. National guidance has existed since 2007 setting out a single, National Framework for deciding if a person is going to get NHS continuing healthcare. The same applies to NHS-funded nursing care.
The National Framework is intended to provide for fair and consistent access to NHS funding across England, regardless of location, so that individuals with similar needs should have the same chance of getting all of their health and nursing care provided free.
The National Framework was revised in 2012. This has not changed the way decisions are made, nor the level of nursing/healthcare needs that entitles an individual to NHS continuing healthcare.
What is NHS continuing healthcare?
NHS continuing healthcare is a package of care arranged and paid for by the NHS for individuals outside of hospital with continuing health care needs. You can receive NHS continuing healthcare, for example, in your own home or in a care home. NHS continuing healthcare is free. Support provided by Local Authorities may be charged for depending on your income and savings.
If you are eligible for NHS continuing healthcare in your home, the NHS will pay for healthcare (e.g. a community nurse or specialist therapist) and relevant social care needs (e.g. personal care and domestic tasks, assistance with washing, dressing, cooking and shopping).
In a care home, the NHS also pays for your care home fees, including board and accommodation.
Who is eligible for NHS continuing healthcare?
Anyone over 18 years of age having a certain level of care needs may be entitled to NHS continuing healthcare. If your overall care needs assessment shows that you have a ‘primary health need’, you should be eligible for NHS continuing healthcare. Once eligible for NHS continuing healthcare, your care will be funded by the NHS. This is subject to regular reviews and if your care needs change, the funding arrangements may also change or stop.
Do you have a Primary Health Need?
Whether or not someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:
• nature – the characteristics and type of the needs and the overall effect these needs have on the person, including the type of help needed.
• complexity – how those needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or to manage the care.
• intensity – the extent and severity of the needs and the support needed to meet them, which includes the need for sustained/ongoing care.
• unpredictability – how hard is it to predict changes in the needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.
NHS Continuing Care Assessments.
The whole of the decision-making process should be ‘person centred’.
This means putting the individual and their views about their needs and the care and support required at the centre of the process. (We would refer you to the first paragraph once again).
It also means making sure that the individual plays a full role in the assessment and decision making process and gets support to do this where needed. One would assume that such support could come from the family, but this will not necessarily be the case and the family may not even be aware that the assessment is happening. Good practice would be by the individual asking a friend or relative to help them explain their views, but they may be too unwell to ask or to realise they can ask and the family have no right to any involvement without the Health and Welfare Lasting Power of Attorney.
The first step for most individuals is the Checklist Tool. This helps health and social care staff decide whether it is appropriate to proceed to a full assessment for NHS continuing healthcare. The Checklist will usually be completed when someone is assessing or reviewing health or social care needs. The Checklist does not indicate whether the individual is eligible for NHS continuing healthcare, only whether they require full assessment of eligibility for NHS continuing healthcare.
If a Checklist has been completed and indicates there is a need to carry out a full assessment of eligibility for NHS continuing healthcare, the individual completing the Checklist will contact the Eastbourne Hailsham and Seaford Clinical Commissioning Group (CCG) who will arrange for a multidisciplinary team to carry out an up-to date assessment of your needs.
A multi-disciplinary team is made up of two or more health or social care professionals who are involved in your care. The assessment will, with your permission, involve contributions from all of the health and social care professionals involved in your care to build an overall picture of your needs. In some cases the multidisciplinary team will ask for more detailed specialist
assessments from these professionals.
The multi-disciplinary team will use the information from your assessment to complete a “Decision Support Tool’. The Decision Support Tool looks at eleven different types of need,
for example, mobility, nutrition, and behaviour. The purpose of the tool is to help decide on the nature, complexity, intensity and unpredictability of your needs and so whether you have a ‘primary health need’. The multi-disciplinary team will then make a recommendation to the Eastbourne Hailsham and Seaford Clinical Commissioning Group as to whether you are eligible for NHS continuing healthcare. They should usually accept this recommendation except in exceptional circumstances.
If you need an urgent package of care due to a rapidly deteriorating condition which may be entering a terminal phase, then the Fast Track Tool may be used instead of the Decision Support Tool to confirm eligibility for NHS continuing healthcare funding. If this is the case, an appropriate clinician will complete the Fast Track Tool and send it directly to the CCG which will arrange for care to be provided as quickly as possible. Occasionally, a CCG may arrange for a review of your needs and arrange a Decision Support Tool to be completed after immediate support has been provided following the completion of a Fast Track Tool. This could lead to a decision that the individual is no longer eligible for NHS continuing healthcare funding.
Following every assessment or review you should be sent a written decision as to whether you are entitled to NHS continuing healthcare together with reasons for the decision.
What services will be provided if you are entitled to NHS continuing healthcare?
If you are entitled to NHS continuing healthcare, the CCG will discuss options with you as to how your care and support needs will best be provided for and managed and your preferred setting in which to do that (e.g. at home or in a care home) and which organisation/s will be responsible for meeting your needs.
When deciding on how your needs are met, your wishes and expectations of how and where the care is delivered should be documented and taken into account.
You will have a review of your needs after three months and then at least every year. Neither the NHS nor the local authority should withdraw from an existing care or funding arrangement without a joint review and reassessment of your needs and without first consulting with one another and with you about any proposed changes and ensuring that alternative funding or services are in place.
What if I am not eligible for NHS continuing healthcare?
If you are not eligible for NHS continuing healthcare, the CCG can refer you to your local authority who can discuss with you whether you may be eligible for support from them. If you are not eligible for NHS continuing healthcare but still have some health needs then the NHS may still pay for part of the package of support. This is sometimes known as a “joint package” of care. One way in which this is provided is through NHS-funded nursing care (see below). It can also be by the NHS providing other funding or services towards meeting your needs.
Where the local authority is also part funding your care package then, depending upon your income and savings, you may have to pay a contribution towards the costs of their part of the care. There is no charge for the NHS part of a joint package of care. There are more details about NHS-funded nursing care below.
Whether or not you are eligible for NHS continuing healthcare, you are still able to make use of all of the other services from the NHS in your area in the same way as any other NHS patient.
Who do I contact if I am not happy with the outcome?
If you disagree with a decision not to proceed to full assessment of eligibility for NHS continuing healthcare following completion of a Checklist you can ask the CCG to reconsider the decision.
If you disagree with the eligibility decision made by the CCG (after a full assessment and the Decision Support Tool has been completed) or if you have concerns about the process
used to reach the decision, you can ask the CCG for an independent review of your case. The CCG local resolution procedures should be used first unless such procedures would cause unreasonable delay. To request an independent review, please write to your CCG which will contact the National Commissioning Board (the Board) and ask them to arrange a review, unless the matter can be resolved locally.
Any individual has a right to complain about any aspect of the service they receive from the NHS, the local authority or any provider of care. The details of the complaints procedure are
available from the relevant organisation, including details of your local Independent Complaints Advocacy Service (ICAS).
What is NHS-funded nursing care?
By law, local authorities cannot provide registered nursing care. For individuals in care homes with nursing, registered nurses are usually employed by the care home itself and in order to fund this nursing care, the NHS makes a payment direct to the care home. This is called ‘NHS-funded nursing care’ and is a standard rate contribution towards the cost of providing registered nursing care for those individuals who are eligible.
Registered nursing care can involve many different aspects of care. It can include direct nursing tasks as well as the planning, supervision and monitoring of nursing and healthcare tasks to meet your needs.
Who is eligible for NHS-funded nursing care?
You should receive NHS-funded nursing care if:
• you are resident within a care home that is registered to provide nursing care; and
• you do not qualify for NHS continuing healthcare but have been assessed as requiring the services of a registered nurse.
In all cases individuals should be considered for eligibility for NHS continuing healthcare before a decision is reached about the need for NHS-funded nursing care. Consequently most individuals will not need to have a separate assessment for NHS-funded nursing care if they have already had a full multidisciplinary assessment for NHS continuing healthcare as this process will give sufficient information to judge the need for NHS-funded nursing care.
However, if an assessment is needed, the Eastbourne Hailsham and Seaford Clinical Commissioning Group will arrange this. If you are not happy with the decision regarding NHS-funded nursing care, you can ask the CCG for the decision to be reviewed and/or use the CCG complaints process.
Are there different levels of payment for NHS-funded nursing care?
NHS-funded nursing care is paid at the same rate across England. However, until 30 September 2007 there were three different banded payment rates for nursing care. Any individual that was on the high band of NHS–funded nursing care under the previous three band system was entitled to continue on this band until;
• they no longer have nursing needs, or
• they no longer live in a care home that provides nursing or
• their nursing needs have reduced so that they do not qualify for the high band anymore (they would move onto the single band rate instead) or
• they are entitled to NHS continuing healthcare instead.
If you are eligible for NHS-funded nursing care the NHS will arrange for the payment to be made directly to your care home and this payment should be reflected in the care home
fee actually charged to you .
If you disagree with a decision and are considering a challenge and wish to arrange to speak to one of our specialists, please call 01323 406299 for an appointment.