NHS continuing healthcare and NHS-funded nursing care

NHS continuing healthcare and NHS-funded nursing care
DHSC 14 January 2019 updated 11 March 2019

• This updated guidance sets out the principles and processes of the national framework for NHS continuing healthcare and NHS-funded nursing care. 
• Part of the NHS continuing healthcare and NHS-funded nursing care collection.

CHC e-Learning

NHS Continuing Healthcare e-learning programme
NHS England
Revised NHS CHC e-Learning modules are now live on the  e-Learning for Healthcare’s website. The modules are designed to enhance and develop the knowledge of all practitioners involved in the process, with topics including the legal background to NHS CHC policy, high quality assessment and decision-making and dealing with disputes.
The content has been developed to support consistent delivery of the National Framework for Continuing Healthcare and NHS Funded Nursing Care (revised 2018), and supports other key areas of NHS CHC delivery such as effective commissioning and case management.

NHS Continuing Healthcare in England

NHS Continuing Healthcare in England
House of Commons Library Briefing 27 September 2018

• This House of Commons Library briefing paper is intended to help Members respond to queries from constituents about eligibility to NHS continuing healthcare in England. It provides a summary of the key areas within the National Framework for NHS Continuing Healthcare (which was intended to improve the consistency of approach taken by local NHS bodies by providing a common framework for decision making and the resolution of disputes) and other important Department of Health and Social Care documents. 
• The latest version of the Framework was published in March 2018 and will be in operation from 1 October 2018.

"5Q Care Test" in complex care situations

A case study exploring the effectiveness of an innovative "5Q Care Test" to determine whether patients with complex needs require health or social care. [PubMed]
Health Soc Care Community. 2018 Sep 11

• A case study to evaluate the effectiveness of the "5Q Care test", an innovation to enable people with "complex" care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment.

Claimants denied costs for failing to use the NHS Complaints Procedures

Claimants denied costs in Judicial Review proceedings for failing to use the NHS Complaints Procedures
Healthcare Law blog 31 August 2018

• Review of a case regarding a judicial review challenge to the adequacy of a home package of continuing care. The claimant was denied their costs, despite a decision by the CCG to substantially increase the level of care after proceedings were issued. 
• Central to the judge’s decision to make no order as to costs was the CCG’s submission that judicial review was a remedy of last resort, and that the claimant had failed to seek to resolve the matter through the formal NHS Complaints Procedure before applying for judicial review.

NHS Continuing Healthcare and NHS Funded Nursing Care

National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care
DHSC updated 14 March 2018

• The national framework for NHS continuing healthcare and NHS-funded nursing care sets out the principles and processes for deciding eligibility. 
• The checklist, decision support tool and fast track pathway tool will help clinicians and practitioners with the decision-making process. 
• CCGs assumed some responsibilities for NHS continuing healthcare from 1 April 2013
• The 2018 version of the national framework document and the associated tools will take effect on 1 October 2018

NHS continuing healthcare: Effective commissioning approaches

NHS continuing healthcare: Effective commissioning approaches
NHS Clinical Commissioners January 2018

• This document outlines key learning points from those CCGs that have achieved significant efficiency savings and improvements for patients in the provision of CHC in their local area, and the national support that NHS England and others can provide to support local decision-making.

Plans to improve NHS CHC assessment processes

Plans to improve NHS Continuing Healthcare assessment processes
NHS England 17 August 2017

• This letter to CCG Accountable Officers and CCG Clinical Leaders Plans explains the actions that CCGs are expected to take to improve the NHS Continuing Healthcare assessment processes to support reduction in Delayed Transfers of Care (DTOC).

NAO investigation into continuing healthcare funding

Investigation into NHS continuing healthcare funding
National Audit Office 5 July 2017

• Key findings :
• NHS England recognises that the current assessment process for CHC funding raises people’s expectations about whether they will receive funding and does not make best use of assessment staff.
• In most cases eligibility decisions should be made within 28 days but many people are waiting longer.
• Decisions on eligibility for CHC have a significant financial impact on the individual, clinical commissioning group (CCG) and local authority.
• The number of people receiving CHC funding is rising and the funding of CHC is a significant cost pressure on CCGs’ spending.
• There is significant variation between CCGs in both the number and proportion of people assessed as eligible for CHC
• There are limited assurance processes in place to ensure that eligibility decisions are consistent, both between and within CCGs.
• The report confirms the DH has been working with NHS England, local authority representatives and charity groups to understand the impact of the National Framework on delivery of CHC and where there might be scope for improvements. Figure 16, page 37 of the report sets out the areas where the Department of Health and NHS England expect CCGs can deliver CHC savings. The initiatives include investing in CHC workforce skills and capacity and reviewing the CHC checklist and assessment tools.

PHB and IPC quick guide: CHC

Personal health budgets and Integrated Personal Commissioning quick guide: NHS Continuing Healthcare
NHS England, June 2017

• The IPC and PHB quick guide to NHS Continuing Healthcare describes how integrated personal commissioning and personal health budgets can benefit and be delivered to those in receipt of NHS Continuing Healthcare.

Continuing to care? Recommendations for NHS CHC

Continuing to care?: Is NHS continuing healthcare supporting the people who need it in England?
Parkinson’s UK in association with the Continuing Healthcare Alliance, March 2017

• This report is based on surveys of individuals who had applied for NHS CHC and professionals who work on NHS CHC as well as data from FOI requests to CCGs.
• Their recommendations include 
• use of multidisciplinary teams composed of experienced professionals 
• a mandatory training programme of training for professionals who organise and assess people for NHS CHC 
• the checklist and Decision Support Tool should be rewritten
• introduction of an option for professionals to select if they agree that someone should not be reassessed for eligibility of NHS CHC and where people are marked down as permanently eligible reviews should only look at changing needs.
• ensure packages of care are needs-driven and not purely financially motivated to prevent people with long-term, serious health conditions being forced into residential care, or living at home with unsafe levels of care
• Publish data on how many people apply for NHS CHC as well as the number of people who proceed past the checklist stage to the full assessment.

NHS Continuing Healthcare Strategic Improvement Programme

NHS Continuing Healthcare Strategic Improvement Programme
NHS England 5 December 2016

• Read the letter from NHS England Chief Finance Officer, Paul Baumann, and Chief Nursing Officer, Jane Cummings to launch a new national transformation programme to support the commissioning system for NHS Continuing Healthcare.
• To introduce the programme and its Collaborative, the programme team are running informative webinar sessions on 10 and 12 Jan 2017.

Care and Support Statutory Guidance updated

Care and Support Statutory Guidance - updated
Department of Health 27 October 2017

• This guidance sets out how a local authority should go about performing its care and support responsibilities. No substantive amendments to the sections covering NHS Continuing Healthcare, Working with the NHS, section 117 Mental Health Act or chapter 14 on Safeguarding.
• The Department has published a list of changes

Burstow Commission: DTOC - causes and how to address them

Right Place, Right Time: Better Transfers of Care: A Call to Action

Commission chaired by Rt Hon Paul Burstow
NHS Providers, 11 November 2015

• The Commission report collates evidence and good practice in transfers of care in all provider settings – across acute, community, mental health and ambulance services - and offers practical approaches to tackle the causes of delayed transfers of care.
• Causes of delayed transfer of care include:
• complex challenges within the patient journey from health settings back into the community or social care.  
• workforce capacity and skills mix
• flow within and between organisations 
• Specific messages for a number of national organisations with a wide range of recommendations are presented. These include a call to the Department of Health for further guidance to speed up the process of Continuing Healthcare assessments, including these assessments in arrangements for assess to discharge.
• The report also includes a wide ranging "Call to Action" for Providers, CCGs,  Local Councils and HWBs. 
• "In the end this report boils down to three calls to action. These calls to action are addressed to every part of the health and care system. First, start with the person (the patient or service user). They are your common cause. Second, ask yourself how do we help this person get back to where they want to be? Third, agree what the data tells you. A shared understanding of the numbers can help with tracking down the root causes."p3

See the monthly statistics on Delayed Transfers of Care here. 

CHC Operating Model

NHS England OperatingModel for NHS Continuing Healthcare
NHS England 31 March 2015

• This Operating Model for NHS Continuing Healthcare sets out the strategic importance of NHS CHC and also sets out the arrangements for NHS England to be assured of compliance with the National Framework for NHS CHC and an Improvement Tool.

Maximising personal (health) budgets for older people

Getting Better Outcomes for Older People using personal budgets
TLAP, 5 March 2015

• Recent work of the Think Local Act Personal partnership to highlight what does and doesn't work well for older people using personal budgets, and what can be done to improve practice. 
• Includes case studies from councils across England.
• Common themes which appear to have fostered the right conditions for the provision of personal health budgets for older people across demonstrator sites (Oxfordshire, Central Manchester, Nottingham City) are outlined.
• The report concludes that Personal Health Budgets can work effectively for older people,  and can allow older people and their carers to maintain their chosen care and support when transitioning to Continuing Health Care.

Draft NHS CHC Redress guidance

NHS Continuing Healthcare Redress Guidance for CCGs
NHS England, February 2015

• Draft refreshed NHS CHC Redress Guidance for CCGs, is open for feedback until Thursday 19 March 2015.
• The document has been updated to reflect the ‘Principles for Remedy’ from the Parliamentary and Health Service Ombudsman for all public bodies.

Personal Health Budgets - what do they mean for CCGs?

Five Minute Digest: Personal health budgets - what will they mean for GP commissioners?
Pulse 24 September 2013

• Personal health budgets come into force in the health service from April 2014.
• They are designed to enable people with long-term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive.
• People who are already receiving NHS Continuing Care will have a right to ask for a personal health budget from April 2014 and CCGs will be able to offer personal health budgets to others with the aim of making them available to anyone with a long-term condition who could benefit by 2015.