National Framework for NHS Continuing Healthcare and NHS funded Nursing Care Introduction and Processes

Overall Objective To have a basic understanding of NHS continuing healthcare and NHS funded nursing care. To gain an awareness of where it sits within local processes and how eligibility is determined. To gain an understanding of the national tools and when and where to use them especially in relation to screening. To enable practitioners to have sufficient skills and understanding to undertake assessments. To enable you to cascade this briefing to your teams

Myth-busting Exercise (10min)

Introduction to the National Framework The National Framework maps out an overall process for England for NHS Continuing Healthcare and NHS Funded Nursing Care It maps out a process for determining eligibility. It introduces a set of national tools to support and improve consistency in decision making. It sets one band for NHS funded nursing care

Why is this different? One framework instead of 28 different sets of criteria One set of national tools instead of more than 28 different ways of documenting decisions One flat rate (£101/week) for nursing care instead of three bands. Current patients on high band will remain funded at that level until reviewed. Terminology Levels 1 – 4 replaced by ‘social care’, ‘joint funded’, continuing healthcare

Definitions Continuing Care NHS Continuing Healthcare NHS – Funded Nursing Care See Information Pack

The headlines – Key Messages The Framework (for all adults) is a change in system that will require PCTs and LAs to think and act differently NHS Continuing Healthcare is a funding stream Whatever someone’s ongoing health and social care needs, they still need to be met but NHS Continuing Care should always be considered in the first place The Framework is the first step in making continuing care easier for the people who work in it and those who are being assessed for it We do expect there to be more people eligible for full funding Timescales for informing individuals, carers, representatives not to exceed 2 weeks.

The process

COORDINATING THE PROCESS Ownership of process beginning to end: Identify individuals who should be assessed Identify if an individual needs to be “fast-tracked” Identify all professionals involved in the care of the user who may contribute to the assessment Complete documentation accurately, clearly and comprehensively Ensure appropriate care plan put in place A Care Coordinator involved in the assessment process needs to be identified to help this process run smoothly

The tools NHS Continuing Healthcare Checklist Fast Track Pathway tool for NHS Continuing Healthcare Decision Support tool for NHS Continuing Healthcare NHS funded nursing care documentation We must use the National Tools except for the Fast Track Pathway tool, which we have developed locally.

NHS Continuing Healthcare Checklist When ? Hospital discharge planning or initial assessment or review or change in needs. There are 11 Care Domains (these are the same as Decision Support Tool [DST]) see later slide “Look at the Checklist provided to you” Ensure all eleven care domains have a tick in one of the three boxes A. Meets or exceeds described level or B. Borderline or close to described level or C. Does not meet level

Refer those for full assessment Where: Two or more ticks in column A Five or more ticks on column B or one tick in A and four in B Any tick in column A with an asterisk * ( the domains which carry a priority level in the DST) see later slide There may be other circumstances where professional judgements overrules the checklist. “Rationale for decision box must be completed legibly (don’t forget to sign and date the form)”

Fast track pathway Only for those “individuals with a rapidly deteriorating condition which may be entering a terminal phase …characterised by an increasing level of dependency. “ They need an immediate decision on eligibility to be made so that their immediate needs can be met. “Careful decision making is essential to avoid undue distress that might result from a person moving into and out of NHS continuing Healthcare within a very short period of time.”

Fast Track local pathway Fast Track Pack Are eligibility criteria met?- GSF Yellow. Patients/Carer aware of Fast Track Process. Patient informed of options. Referral form to be completed in full. Rationale section to be completed and signed by Doctor, Specialist Nurse or District Nurse in liaison with GP. Identify needs and agree care plan- liase with Fast Track team. Refer to Fast Track Teams by phone/fax referral form. Community referrals City Fast Tract Team will arrange and commission care package. County Fast Track referrals - refer to District Social Services for Home care. Full assessment at earliest opportunity if not already completed. ( Locally- reassessments occur with in 12 weeks )

Decision Support Tool (DST) - What is it? The decision support tool, following assessment, enables practitioners to: Inform consistent decision making in line with the primary health need approach Sets out the evidence in a detailed needs based format Requires practitioners to use their professional judgement to justify how and why a recommendation is made Clarifies the evidence used to make the decision A Care Coordinator will be responsible to work with the MDT to complete the DST (local managers will keep you advised on how this will work on the ground)

What it’s NOT ! Another assessment A decision MAKING tool (it supports professionals to make the decision) A substitute for professional judgement

What are the 11 Care Domains on the DST? Behaviour * Cognition Psychological & Emotional needs Communication Mobility Nutrition Continence Skin & Tissue Viability Breathing * Drug Therapies & Medication: Symptom control * Altered States of consciousness * Other significant care needs can be identified/included on the DST * Asterisk = PRIORITY

Levels Each domain is divided into levels describing a hierarchy of need Each level is given a weighting (not score) no needs, low, moderate, high, severe, priority. Not all domains have the same weighting – based on principle that some domains reflect health needs more than others

Establishing a Primary Health Need Complexity, intensity, unpredictability COMPLEXITY L E V E L S D O M A I N S U N P R E D I C T A B I L I T Y N S T I T E N I Y INTENSITY

Using the Decision Support Tool DST should be used to capture the range of assessments to reflect the patients identified needs and should NOT be used as an assessment tool. Rational for decisions should be documented clearly for each domain. Evidence should be provided to support each decision making reference to supporting assessments. Paraphrasing the levels descriptions should be avoided. Where evidence is not available further assessment may be required.

Consistent application of DST’s Nurse Assessor will co-ordinate MDT assessment and meeting to complete of DST. The MDT will make recommendations ONLY using the DST guided by the Nurse Assessor. Evidence will be provided to support recommendations. Completed DST’s, assessments and evidence will be presented to MDT Commissioning Panel where recommendation will be considered and ratified if appropriate. Panel may request more info if the supporting assessments are insufficient to make decisions.

Reviews After 3 months Annually thereafter (at a minimum) When there is a change of needs Involve the individual, family or carer Outcome to PCT Commissioning Team

Evidence Comprehensive Current Clear care plans/ management plan Intervention by whom qualified or unqualified Duration Number of carers Number of incidents and action taken Whether need managed or unmanaged Does intervention reduce problem or not What other avenues have been explored i.e. further NHS assessment

Communications with Patients, Families and Carers All the way through the process Written confirmation of final decision with detailed rationale Within 14 days of assessment Documented in files

City PCT Contacts Commissioning Team Contacts: Tel: ext: / Fax: Referral Point for Continuing Care Team Tel: Fax: Fast Track/May Scheme Tel: Fax:

County tPCT Contacts Commissioning Team Tel: ext: 4630 Fax: Referral Point for Assessment Team Tel: Fax: Fast Track Tel: ext 4655 or 4694 Fax:

Further Training Resources Will be available on the Change Agent website

ANY QUESTIONS?