Download Introduction - Central Manchester University Hospitals

CONTENTS
1.
NHS Continuing Healthcare and
NHS-funded Nursing Care
Public Information Booklet
Introduction
NHS Continuing Healthcare
2.
What is the difference between “continuing care”
and “NHS Continuing Healthcare”?
3.
Who is eligible for NHS Continuing Healthcare?
4.
How does the NHS assess your care needs?
5.
Consenting to the assessment
6.
Implications of consenting or refusing consent
7.
How does the NHS decide whether you are
eligible?
8.
What happens if you are eligible?
9.
What happens if you are not eligible?
10.
What you can do if you are not happy with the
eligibility decision?
11.
What you can do if you remain dissatisfied with the
decision?
NHS-funded Nursing Care
12.
What is NHS-Funded Nursing Care?
13.
Who is eligible?
14.
How will the NHS assess your level of nursing care
needs?
15.
How will the NHS decide whether you are eligible?
16.
What you can do if you are not happy with the
eligibility decision
1. Introduction
Page 2
This booklet sets out what you can expect from the
Department of Health’s National Framework for NHS
Page 1
MC CHC Public Info Booklet v8 011210
MC CHC Public Info Booklet v8 011210
Continuing Healthcare and NHS-funded Nursing Care,
introduced on October 1 2007.
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.
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.
NHS CONTINUING HEALTHCARE
4. How does the NHS assess your care needs?
2. What is the difference between “continuing care” and
Page 3 Continuing Healthcare?”
“NHS
The NHS Continuing Health Care Assessment involves three
stages:
Page 4
MC CHC Public Info Booklet v8 011210
MC CHC Public Info Booklet v8 011210
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.
Page 5
MC CHC Public Info Booklet v8 011210
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 withdrawPage
your6
consent at any point in the process.
MC CHC Public Info Booklet v8 011210
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.
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.
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.
Page 7
MC CHC Public Info Booklet v8 011210
Page 8
MC CHC Public Info Booklet v8 011210
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.
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?
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.
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.
If a review shows your health has improved and your needs
have reduced, the PCT will commence another full
Page 9
MC CHC Public Info Booklet v8 011210
Page 10
MC CHC Public Info Booklet v8 011210
*
Another PCT reviewing the case to advise the patient
and PCT of any
shortcomings in the assessment process
that impact on the eligibility
decision.
13. Who is eligible?
11. What can you do if you remain dissatisfied with the
decision?
*
You are living, or have been assessed as needing to
live, in a care
home with registered nursing.
To qualify for NHS-Funded Nursing Care you must fulfil all
these criteria.
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.
*
You have been assessed to need access to a
registered nurse.
NHS-FUNDED NURSING CARE
*
You are not receiving any other registered nursing
care.
12. What Is NHS-Funded Nursing Care?
14. How does the NHS assess your level of nursing care
needs?
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.
Page 11
MC CHC Public Info Booklet v8 011210
*
You do not qualify for NHS Continuing Healthcare.
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.
Page 12
MC CHC Public Info Booklet v8 011210
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.
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.
Involvement of legal representatives in 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
Page 13
MC CHC Public Info Booklet v8 011210
Page 14
MC CHC Public Info Booklet v8 011210
Sources of further information
Department of Health Guidance:
•
The revised Framework for NHS Continuing Healthcare
and NHS-funded Nursing Care, July 2009 at
www.dh.gov.uk/publications
•
NHS Funded Nursing Care. Practice Guide 2009 at
www.dh.gov.uk/publications
•
Guidance on consent at www.dh.gov.uk/consent
•
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: [email protected]
•
Use the website advice kit at
www.advicekit.info/advicekit
•
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:
•
www.manchester.nhs.uk
NHS North West Strategic Health Authority, Independent
Review Procedure
•
www.northwest.nhs.uk or email
[email protected]
•
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 Manchester
at [email protected]
“This leaflet can be produced in other languages
on request. We can also provide the information in
other formats including Braille, large print and
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
[email protected].
You can also find more information about your
local NHS at http://www.manchester.nhs.uk/
This leaflet was produced by NHS Manchester.”
Page 16
Page 15
MC CHC Public Info Booklet v8 011210
MC CHC Public Info Booklet v8 011210
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
Joan Martin, Head of Service, Continuing
Healthcare
T: 0161 765 4140
T: 0161 765 6103/6107
Author
Further
copies from:
Version
8
No.
0.1
Date Issued
01.12.2010
NHS Continuing
Healthcare and
NHS-funded Nursing Care
Public Information Booklet
Purpose
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
MC CHC Public Info Booklet v8 011210
MC CHC Public Info Booklet v8 011210