NHS Continuing Healthcare And

NHS Continuing Healthcare and

NHS-funded Nursing Care

Public Information Booklet

CONTENTS

Introduction

NHS Continuing Healthcare

What is the difference between “continuing care” and “NHS Continuing Healthcare”?
Who is eligible for NHS Continuing Healthcare?
How does the NHS assess your care needs?
Consenting to the assessment
Implications of consenting or refusing consent
How does the NHS decide whether you are eligible?
What happens if you are eligible?
What happens if you are not eligible?
What you can do if you are not happy with the eligibility decision?
What you can do if you remain dissatisfied with the decision?

NHS-funded Nursing Care

What is NHS-Funded Nursing Care?
Who is eligible?
How will the NHS assess your level of nursing care needs?
How will the NHS decide whether you are eligible?
What you can do if you are not happy with the eligibility decision

MC CHC Public Info Booklet v8 011210 MC CHC Public Info Booklet v8011210

1. Introduction

This booklet sets out what you can expect from the Department of Health’s National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, introduced on October 12007.

This new framework has been designed to ensure fair access to NHS funding across England so that people with equal needs have an equal chance of getting their care free of charge irrespective of where they live.

This booklet is designed to provide clear advice on how to ensure you receive the best possible treatment for you and your family from the NHS, local authorities and private sector organisations, such as care homes free of charge or at the appropriate cost.

NHS CONTINUING HEALTHCARE

2. What is the difference between “continuing care” and “NHS ContinuingHealthcare?”

Many people have long term or “continuing” care needs. However, the term “NHS Continuing Healthcare” applies only to people aged 18 or over who need care for an extended period of time to meet their physical or mental health care needs and their primary need is a health need rather than a personal or social care need such as assistance to bathe or prepare meals.

When a person has continuing care needs they receive social services and health services and in some circumstances people may be asked to make a financial contribution to the social services they receive. However, if it is determined that your primary need is a health need, then the NHS will arrange and fund a package of services that you cannot be charged for. This is called NHS Continuing Healthcare funding.

3. Who is eligible for NHS Continuing Healthcare?

The NHS is responsible for assessing whether your primary need is a health need. This detailed assessment takes into account the nature, intensity, complexity and unpredictability of your needs. NHS professionals will examine the type and quality of the necessary care or treatments you need, how difficult it is to manage your conditions and any risks to you if the right care is not applied.

4. How does the NHS assess your care needs?

The NHS Continuing Health Care Assessment involves three stages:

First there is an initial screening to determine whether you should have a comprehensive assessment of your eligibility. This may result in a fast track solution particularly if a care package is needed quickly for people who have a short-term life expectancy.

Stage two is a comprehensive assessment, involving at least a nursing, medical and social care assessment, in addition to any other specialist assessments that may be relevant. For example, we may request an assessment from a physiotherapist or occupational therapist if this is felt it would contribute towards your assessment.

At this stage an Assessment Coordinator is assigned to organise the process and keep you informed and involved. A multi disciplinary team of the relevant health care professionals then considers the assessments, develops a care plan and makes a fair recommendation to the Primary Care Trust (PCT) about whether your need is a primary health need.

If you have given permission for their involvement, you and your family members or representatives, will be invited to contribute to all the assessments and to the multi-disciplinary team meeting.

The PCT has the final decision on whether your primary need is a health need and your eligibility for funding. They review the recommendations; check the process has been completed properly, then write to you with their decision.

If on admission to hospital, staff feel you may have significant long term care needs, they will seek your permission to undertake an initial screening to start the assessment process. This should not delay your discharge, but if you are being discharged to a care home an interim placement maybe arranged for the assessment process to be completed.

If you live in a nursing home you will automatically have an initial screening as part of the annual review conducted by the PCT nursing assessors. If your needs change significantly between reviews, the care home staff, relatives or adult social care staff can ask for the review to be brought forward.

5. Consenting to the Assessment

First you will be informed about the assessment process and its consequences and asked to give consent to the assessment.

Specifically you will be asked which family members or other representatives you would like to be involved; to give permission for your health care and social care records to be accessed and whether you will allow us to share those records and the outcomes of those assessments with other professionals.

This is not a commitment to accept NHS continuing healthcare funding, an NHS Continuing Healthcare package of services or for the NHS to become solely responsible for your care. It is only consent for the assessment to take place and you are entitled to refuse assessments or withdraw your consent at any point in the process.

There are only two circumstances when a third party can give consent on your behalf. These are when the patient no longer has mental capacity to make his or her own decisions and a third party has Lasting Power of Attorney or there is a Court Appointed Deputy.

All patients are presumed to have mental capacity. However, if an assessment of mental capacity shows that a patient is not capable of giving informed consent then a decision will be taken, when possible in consultation with family members or representatives, to begin the assessment in the Best Interests of the patient.

6. Implications of Consenting and Refusing Consent

If you consent and are found to be eligible for NHS Continuing Healthcare funding you will then be asked if you want to accept the funding, the package of care the NHS can offer and the NHS becoming solely responsible for arranging your care.

During your assessment any social services care provided by your local authority that you currently receive will have been identified. If those services are still required and you want them, we will endeavour to include them in your package.

However, the PCT must choose effective options and at present does not have the power to make cash payments to individual patients so they can purchase their own care services.

Although the PCT is committed to working with you to ensure you have valued services that meet your needs, we cannot guarantee it will always be the same provider you currently use.

If you are found to be eligible and NHS Continuing Healthcare funds all your care needs, it may affect any state benefits and allowances currently used to fund your care. These regulations change periodically and, if this is a concern, we suggest you seek further advice from the Manchester City CouncilAdvice Service (details at the end of this booklet).

Very few people refuse consent to an assessment, but if consent is refused it does deny access to NHS Continuing Healthcare funding and means the PCT cannot become solely responsible for arranging and funding your continuing care.

However, refusal to consent does not prevent care, discharge planning from proceeding or deny mainstream hospital and community service. In many cases this means that you will receive joint services from the NHS and local authority.

7. How does the NHS decide whether you are eligible?

Your PCT decides whether your primary need is a health need on the evidence of all the assessments and the recommendations of the multi-disciplinary assessment team. The PCT must ensure:

*Consent has been given or that a decision has been made in the Best

Interests of the patient.

*The assessment process has been comprehensive and the right professionals have been involved

*You, your family or representative has had a chance to be involved and given opportunities to contribute.

*The multi-disciplinary team has correctly applied the Department of

Health’s Decision Support Tool.

8. What happens if you are eligible?

Once you have agreed, the PCT becomes responsible for arranging and funding your care according to your needs based on the assessments and care plan.

These services are kept under review to ensure they continue to meet your needs. There is an automatic review no later than three months after the initial assessment, and every year thereafter unless there are significant changes in which case the review will be brought forward.

If a review shows your health has improved and your needs have reduced, the PCT will commence another full assessment process to determine eligibility for NHS Continuing Healthcare funding. If the PCT decides you are no longer eligible they will write to you and explain the change.

9. What happens if you are not eligible?

If you are not eligible or do not wish to accept NHS Continuing Healthcare funding, the PCT cannot become solely responsible for arranging and funding your care, though the PCT does remain responsible for providing health services to meet your health needs free of charge.

However, the local authority will be responsible for arranging and funding any social care service you require and you may be asked to make a financial contribution.

10. What can you do if you are not happy with the eligibility decision?

When the PCT advises you of its eligibility decision, it will supply information about the Local Dispute Resolution Procedure, which allows you to exercise your right to a review of its decision.

The procedure aims to provide a resolution as soon as possible and involves one or more of the following.

*A meeting with the patient, family or representative to address specific

objections.

*Another PCT reviewing the case to advise the patient and PCT of any shortcomings in the assessment process that impact on the eligibility

decision.

11. What can you do if you remain dissatisfied with the decision?

If after the Local Dispute Resolution Procedure, the PCT’s decision is unchanged, you can request the Strategic Health Authority undertakes an independent review. The PCT will give you information about how to request this review following the local dispute resolution procedure.

NHS-FUNDED NURSING CARE

12. What Is NHS-Funded Nursing Care?

NHS-funded Nursing Care is the funding the NHS provides for registered nursing care in care homes. It is paid directly to the care home and is based on the national average weekly costs of providing registered nursing services in a care home. It does not cover the accommodation and social care costs charged by a nursing home, which are paid by the local authority, which may require you to make a financial contribution.

It is only available in care homes with registered nurses and covers the planning, supervision or delegation of the care by a registered nurse. It excludes any services, which do not need to be provided by a registered nurse.

13. Who is eligible?

To qualify for NHS-Funded Nursing Care you must fulfil all these criteria.

*You are living, or have been assessed as needing to live, in a care

home with registered nursing.

*You have been assessed to need access to a registered nurse.

*You do not qualify for NHS Continuing Healthcare.

*You are not receiving any other registered nursing care.

14. How does the NHS assess your level of nursing care needs?

The PCT can consider your eligibility for NHS-Funded Nursing Care only after a consideration for NHS Continuing Healthcare.

This process will have included a Nursing Needs Assessment, which takes into account the nature of your condition and your nursing needs assessed over the course of a week or a number of weeks.

If you were not eligible for NHS Continuing Healthcare, the nursing assessment may still determine that you need the services of a registered nurse in a care home with nursing. This process normally takes place before a permanent admission to a care home.

15. How does the NHS decide whether you are eligible?

The PCT is responsible for taking into account the nursing assessment and the answers to the following questions:

*Does the person have a registered nursing need that requires a care

home providing nursing care?

*Does the person want or need to be in a care home setting or is

another option more appropriate?

16. What can you do if you are not happy with the eligibility decision?

If you are not satisfied that the PCT has made as fair decision you can ask for a review, based on the Local Dispute Resolution Procedure. If you remain dissatisfied after the PCT’s review you can ask the Strategic Health Authority for an independent review.

Involvement of legal representativesin the assessment process

You are entitled to take legal advice at any stage. However, the CHC assessment process is a clinical process and in order that clinical judgements can be made without pressure of legal arguments, it is not acceptable for legal representatives to attend any part of the CHC assessment and dispute resolution process to make legal representations or argument, or for staff to be presented with letters or documentation that present legal arguments. These representations may become appropriate after the clinical assessment processes have been exhausted and when a patient notifies the PCT that he/she wishes to pursue a legal challenge after the dispute resolution procedure has been exhausted.

Legal representatives, acting as advocates for a patient, can attend the multidisciplinary team meeting if the patient nominates them to do so, and can provide information about the patient’s presenting health needs to the meeting if they so choose. The health and social care professionals attending the meeting will take account of all the evidence available before recommending whether the patient has a primary health need. If any professional member of the team feels that a legal representative in attendance at a meeting is straying beyond this advocacy role, they are entitled to ask the representative to leave or they may bring the meeting to a close.

Sources of further information

Department of Health Guidance:

•The revised Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, July 2009 at

•NHS Funded Nursing Care. Practice Guide 2009 at

•Guidance on consent at

•NHS Continuing Healthcare and NHS Funded Nursing

Care: Public Information Booklet 2009

For information about how eligibility might affect your benefits and allowances contact the Manchester City Council Advice Service, open Monday – Friday 10am – 4pm:

•Phone and textphone: 0161 234 5678

•Visit the advice centre at the Town Hall Extension in the City Centre

•Email:

•Use the website advice kit at

•Send a letter to: Manchester City Council Advice, P.O. Box 536, Town Hall Extension, Manchester M60 2AF

Manchester PCT’s eligibility decision-making process and Local Dispute Resolution Procedure:

•

NHS North West Strategic Health Authority, Independent Review Procedure

• or email

•SHA Continuing Healthcare Lead, NHS NW

4th Floor, 3 Piccadilly Place, Manchester M1 3BN

© Manchester Primary Care Trust. All rights reserved. Not to be produced in whole or in part without the permission of the copyright owner. Organisations wishing to use all or part of this guide should contact Continuing Healthcare

“This leaflet can be produced in other languages on request. We can also provide the information in other formats including Braille, large printand audio CD. Please contact us if you require help”

“For general information and advice about local NHS services please contact the Patient Advice and Liaison Service (PALS) on 0161 219 9451, or .

You can also find more information about your local NHS at

This leaflet was produced by NHS Manchester.”

MC CHC Public Info Booklet v8 011210 MC CHC Public Info Booklet v8011210

CHC/FNC NATIONAL FRAMEWORK IMPLEMENTATION

DOCUMENT CONTROL SHEET

Document Title / NHS Manchester Continuing Healthcare Public Information Booklet
Owner / Chris O’Gorman, Associate Director of Commissioning
Author / Joan Martin, Head of Service, Continuing Healthcare
T: 0161 765 4140
Further copies from: / T: 0161 765 6103/6107
Version / No. / Date Issued / Purpose
8 / 0.1 / 01.12.2010

This guide has been developed by the Manchester Continuing Healthcare Practice Development Forum, in conjunction with the organisations listed below, and approved by a multi-agency Steering Group for implementation across the city of Manchester by the following organisations: NHS Manchester, Manchester Community Health, Manchester City Council, Central Manchester and Manchester Children’s University Hospitals NHS Trust, University Hospital of South Manchester NHS Foundation Trust, Pennine Acute Hospitals NHS Trust, The Christie NHS Foundation Trust, Manchester Mental Health and Social Care Trust