The National Framework for NHC Continuing Healthcare and NHS Funded Nursing Care

This article is the second of a series of articles looking at what you need to think about if you or someone close to you is likely to need residential or nursing care in the relatively near future.

It is prompted by the coming into force from the 1st October 2018 of the revised National Framework, which sets out the principles and processes of NHS continuing healthcare and NHS funded nursing care. The revised National Framework replaces the previous version published in November 2012. There is also an update to the Practice Guidance, the annexes which accompany the Framework and the various user notes.

The idea behind the 2018 revision is to provide greater clarity to individuals and staff, through a new structure and style, reflect legislative changes since 2012, primarily to reflect the implementation of the Care Act 2014, and clarify a number of policy areas.

Now, the main points to note are:

1. The majority of NHS continuing healthcare assessments should take place outside of acute hospital settings.  The aim is to support accurate assessments of need and reduce unnecessary stays in hospital.  CCGs will need to support the individual until they are appropriately assessed but the individual can be discharged to a care package that comes under existing commissioning arrangements.  Reimbursement would be backdated to the date of discharge if the individual was subsequently deemed eligible for CHC funding.

2. In order to reduce unnecessary assessments, individuals should not be screened in the following situations:
• Practitioners agree that there is no need for NHS continuing healthcare and they have recorded their decision and its reasons.
• The individual has short-term health care needs or is recovering from a temporary condition.
• The CCG agrees that the individual should be referred directly for a full assessment of eligibility.
• The individual has a rapidly deteriorating condition and may be entering a terminal phase –the fast track pathway tool should be used instead.
• The individual is receiving services under section 117 of the Mental Health Act that are meeting all of their assessed needs.
• The individual was not eligible for NHS continuing healthcare previously and it is clear that there has been no change in their needs.

3. The 3 and 12 month reviews are to review the care package, not reassess eligibility.  Eligibility should only be reviewed if the CCG can show that the needs have substantially changed.  Where eligibility reviews are carried out, they must, like the first full assessment, involve a multidisciplinary team and use the Decision Support Tool.

4. It is now the responsibility of CCGs to meet assessed health and wellbeing needs in full, rather than in part, with the family paying a top up.

5. There is guidance around the very limited circumstances in which an individual can pay their own top-up (essentially for non-needs-based services).

6. There are new principles for CCGs regarding the local resolution process for situations where individuals request a review of an eligibility decision.  The individual must receive a clear and comprehensive explanation of the rationale for the CCG’s decision.

7. Funding should be put in place within 48 hours of a referral for fast tracked eligibility.

This series of articles covers topics including: what makes a good care home, checking your care home contract and care fees funding, but you can always contact our Private Client Team, headed by Chris Milne, a full member of the Society of Trust and Estate Practitioners, a full accredited member of Solicitors for the Elderly and a holder of their Older Client Care in Practice award, on 01630 652405 or for more immediate help.