NHS CONTINUING HEALTHCARE Process Oct 2018(revised)

What is Continuing Healthcare Funding? (CHC) CHC is a package of care for adults (age 18 and over)which is arranged solely through CHC. It can be in any setting including own home. Is not based on diagnosis or condition. Free at the point of delivery Briefly refer to children healthcare funding: Explain it is not based on who delivers care: e.g. could be agency in community, untrained staff overseen by RN

Assessed Healthcare Needs Associated Social Care Needs WHAT IS PROVIDED? Assessed Healthcare Needs Associated Social Care Needs Care home fees (if applicable) No Hotel fees; rent and nursing care

The CCG – THE RESPONSIBLE COMMISSIONER This is the responsible Care Commissioning Group in the area the person is registered with a GP. For example if the person lives in Sevenoaks, but is registered with a GP in Bromley. Bromley will be the responsible CCG. Therefore the completed Checklist would be sent to the Bromley CCG.

CHECKLIST: Screening Tool 11 Domains; three levels, A,B, or C. Minimum Data set must be completed. Remember to complete all parts of the checklist and to sign and date. Complete the Ethnicity monitoring as this is audited. Rationale for Decision with all supporting evidence. Emailed to nelcsu.chcreferrals@nhs.net Emphasise a positive checklist does not mean Eligibility !

When not to complete: Where it is clear there is no need for NHS Continuing Healthcare at this time Where the individual is recovering from a temporary condition and not reached their optimum potential (e.g. dialysis, rehab) or in an acute setting. The CCG has agreed the individual should be referred for a full CHC assessment and by-passing the checklist. The individual has a rapidly deteriorating condition and a Fast Track is more appropriate An individual is S117 when their health needs do not out-weigh their mental health needs. It has previously been decided that an individual is not eligible for CHC and it is clear there has been no change in needs Outlined within the checklist document on page 8. Explain that Nurse Assessors complete a checklist for individuals in a Nursing Home placement:

CONSENT – NHS Minimum Data Set. Assessors should gain consent and inform the individual, that information may be shared MCA principles should be applied if the individual lacks capacity Person centred approach to assessment

Who can complete a checklist? A variety of health & social care Practitioners, who have been trained in it’s use. Registered Nurses and MH Nurses. L.A care manager, case officer OT. Care home managers and care assistants

CHECKLIST Inform individuals and their families/ representatives that a positive checklist does not indicate eligibility for CHC Threshold is set low. DST will be completed if: 1 x A in any domain carrying* (behaviour, breathing, drugs and altered states of consciousness.) 2 or more As in any other domain. 5 Bs or 4 Bs and 1A NHSE estimate 25% of checklists qualify for CHC

Checklist Domains - Behaviour* Cognition Psychological Needs Communication Mobility Nutrition Continence Skin Breathing* Drug Therapies & Medication* Altered States of Consciousness* Other significant care needs.

DOMAINS Identify appropriate level A, B, C, in each domain. Give evidence for your scoring. Evidence must be relevant, recent, succinct and dated. A negative checklist should still be sent to the CCG as these are counted by NHS England and form the quarterly data. Emphasise WHEN it is good practice to undertake a checklist, it need not be at every review!

Evidence (care home, not exhaustive) Care home records/care plans/risk assessments Behaviour charts Seizure charts Waterlow scores Weight/food/fluid charts Medication charts Specialist involvement/GP visits Therapy reports Turning charts Falls charts If the care home insist there are care needs not recorded, can request they complete a 72 hour diary.

We are all responsible for chc - Get to know the limits of the Local Authority (see pg. 17 CHC Framework) and the Care Act 2014 eligibility criteria. Is my resident beginning to show signs/needs greater than social care needs? Responsibility of person completing the checklist to provide the evidence for the domains especially if these are As or Bs.

SOCIAL CARE NEEDS – CARE ACT 2014 MANAGING & MAINTAINING NUTRITION MAINTAINING PERSONAL HYGIENE MANAGING TOILET NEEDS BEING APPROPRIATELY CLOTHED BEING ABLE TO MAKE USE OF HOME SAFELY MAINTAINING HABITABLE HOME ENVIRONMENT DEVELOPING & MAINTAINING FAMILY/PERSONAL RELATIONSHIPS ACCESSING & ENGAGING IN WORK/TRAINING/EDUCATION/VOLUNTEERING MAKING USE OF FACILITIES/SERVICES IN COMMUNITY CARRYING OUT ANY CARING RESPONSIBILITIES ADULT HAS FOR CHILD

TIMEFRAMES CCG should take no longer than 28 days from receiving an appropriately completed checklist To coordinate DST meeting, make a recommendation and communicate a decision. You will receive a decision letter regarding the final decision. The 28 days is from receipt of checklist; DST to be coordinated within a week. Families to be informed by CCG 48 hrs from recommendation. LBB, please don’t send off a checklist then go on holiday and expect the CCG to ‘wait’ to complete a DST on return!

F.N.C Funded Nursing Care Awarded for Registered Nursing element in a nursing home NOT own home or residential home. Currently £158.16 per week. (April 2018) No update yet for 2019. As of March 19th rates (if uplifted by 2% will be £161.32)

*Further questions.

LINKS https://www.gov.uk/government/publications/national -framework-for-nhs-continuing-healthcare-and-nhs- funded-nursing-care http://www.beaconchc.co.uk/faqs/coughlan-case-law National Framework: www.gov.uk/dh www.gov.uk/government/publications/national- framework-for-nhs-continuing-healthcare-and-nhs- funded-nursing-care MCA: https://shareweb.kent.gov.uk/Documents/adult-Social- Services/mental-capacity-act/mca-for-complex- decisions.pdf

More links & resources - https://assets.publishing.service.gov.uk/governme nt/uploads/system/uploads/attachment_data/file/74 6063/20181001_National_Framework_for_CHC_and _FNC_-_October_2018_Revised.pdf https://www.gov.uk/government/publications/nati onal-framework-for-nhs-continuing-healthcare- and-nhs-funded-nursing-care https://www.ageuk.org.uk/globalassets/age- uk/documents/factsheets/fs20_nhs_continuing_hea lthcare_and_nhs-funded_nursing_care_fcs.pdf https://independent-age-assets.s3.eu-west- 1.amazonaws.com/s3fs-public/2016-05/Factsheet- Continuing-healthcare-in-england-should-the-nhs- be-paying-for-your-care.pdf