Bedford Borough Council and the Bedfordshire Clinical Commissioning Group has agreed policies in place which are directly linked to the National Framework (2012) for NHS Continuing Health Care and NHS Funded Nursing Care as well as other joint funder care. These are detailed in the following:
• BCCG Continuing Healthcare Operational Procedures;
• Memorandum of Understanding;
• BCCG Continuing Healthcare Joint Disputes Resolution Policy.
Continuing Healthcare is care arranged and funded by the NHS, and provided to adults with ongoing healthcare needs. It is free of charge, unlike care from adult social care for which there may be a charge depending on the adult’s income and savings (see Charging and Financial Assessment).
It can be provided in any setting, including a care home, nursing home, hospice or the home of the adult with the healthcare needs. It will cover the person’s care home fees (including board and accommodation), personal care (help with bathing, dressing and laundry for example) and healthcare costs (community nursing or specialist therapy services for example).
For adults living at home, it will cover their personal care and healthcare costs.
Support for carers may also be available – see NHS Continuing Care: Information for Carers.
To be eligible for NHS continuing healthcare, the adult must be assessed as having:
Not all those with a disability or long term health condition will be eligible.
A decision about whether or not an adult is eligible should usually be made within 28 days of completion of the assessment.
If the person is not eligible for continuing healthcare funding, the local authority maybe responsible for assessing their care and support needs and providing services if they are eligible to receive such services.
If the adult is not eligible for NHS continuing healthcare but are assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For an adult who lives in their own home, this may be provided as part of a joint package of care and support, where some services come from the NHS and some from adult social care services (see Integration, Cooperation and Partnerships, Eligibility and Charging and Financial Assessment).
If the adult moves into a nursing home, the NHS may contribute towards their nursing care costs.
Once eligible for NHS continuing healthcare, care will be funded by the NHS but this is subject to review, should care needs change the funding arrangements may also change.
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health, 2012) sets out the principles and processes which should be applied in order to assess an adult’s eligibility for NHS continuing healthcare and NHS funded nursing care. NHS funded nursing care is also referred to as ‘single band nursing’ or ‘FNC’.
Joint working between NHS and adult social care and any other partner organisation who are involved, is essential in order to ensure the person’s needs are met in the right way and that their care is effectively coordinated. The National Framework sets out Local Authority responsibilities in relation to NHS continuing healthcare. These are supported by legislation in The NHS Continuing Healthcare (Responsibilities of Social Services Authorities) Directions 2013 (see The NHS Continuing Healthcare (Responsibilities of Social Services Authorities) Directions 2013).
In order to understand and be able to implement continuing healthcare procedures, staff should:
as well as the primary health need test to the adult’s assessed needs;
Where at all possible the same staff member should be involved with the adult and their carers throughout the continuing healthcare assessment process.
Before completing the Checklist and the Decision Support Tool (DST) (see below), consent must be obtained and recorded. Consent is sought for:
If there is a concern that the person may not have Capacity to give consent, this should be determined in accordance with the Mental Capacity Act 2005 and Code of Practice (see Independent Advocacy). A third party cannot give or refuse consent for an assessment of eligibility for NHS continuing healthcare on behalf of a person who lacks capacity, unless they can demonstrate they have a valid Lasting Power of Attorney for Welfare or that they have been appointed a Welfare Deputy by the Court of Protection. A third party holding Enduring Power of Attorney or Lasting Power of Attorney for Finance cannot give consent for continuing healthcare.
The Decision Support Tool is used to inform the decision as to whether a person is eligible for NHS continuing healthcare. It is not an assessment in itself; the information gathered will need to be supplemented with professional analysis and conclusion. It is designed to assist data collection, analysis and presentation of information of the adult’s healthcare needs, including evidence from assessments and reports completed by other members of the multidisciplinary team (MDT).
All assessments should be completed before the adult attends the MDT meeting. Adult social care staff should actively participate in deciding the MDT’s recommendation regarding the adult’s eligibility.
Where they do not agree, they should state their opinion / recommendation/s which should be supported in writing using the four key indicators as listed in Section 3.2 Issues for Adult Care Practitioners and apply the primary health need test.
Both the MDT recommendation and the decision should be recorded in the adult’s case records. The continuing healthcare process regarding an adult’s eligibility for NHS continuing healthcare, including assessment and decision, should not take longer than 28 days for to completion. This target is set by the Department of Health.
There are two types of disputes that may arise in relation to NHS continuing healthcare:
Adults who are eligible for fully funded NHS continuing healthcare should have access to joint equipment services, where appropriate, the equipment provided, however, will be funded by the NHS. Standard catalogue items will be funded by local community health services; specialist items will be funded by NHS continuing healthcare.
An adult’s eligibility for NHS continuing healthcare may vary, due to changing needs. Eligibility, therefore, is not necessarily permanent. Following a review, this may mean someone who is receiving fully funded NHS continuing healthcare becomes eligible for local authority service provision and funding.
Where an adult is an ordinary resident in a local authority area when they are awarded fully funded NHS continuing healthcare and placed in an out of county care home, they remain the responsibility of that adult social care if, following a review, they are no longer eligible for fully funded NHS continuing healthcare.
See also Ordinary Residence.
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