The Department of Health and Social Care published a revision to the National Framework for continuing healthcare funding on 1 March 2018. This revision comes into effect on 1 October 2018. The Compass CHC team analyse the changes and the impact.
The National Framework for NHS continuing Healthcare funding has been revised and these changes come into effect as of 1 October 2018. Ahead of the implementation of these changes the Compass CHC team have analysed the revised National Framework, a link to which can be found here.
What changes have been made in the revised National Framework for NHS Continuing Healthcare funding 2018 document?
The main point to make in relation to the updated National Framework for NHS continuing healthcare funding is that, fundamentally, nothing has changed. The Department of Health confirmed that it was not the intended remit of the updated version of the framework to alter the existing eligibility criteria for NHS Continuing Healthcare funding. Indeed at the outset of the revised document they have stated “none of the 2018 amendments and clarifications to the National Framework, Practice Guidance, annexes or National Tools are intended to change the eligibility criteria for NHS Continuing Healthcare“.
That being said, there has been amendments made. The Department of Health have clarified that the 2018 National Framework is intended to:
1) provide greater clarity to individuals and staff, through a new structure and style
2) reflect legislative changes since the 2012 National Framework was published, primarily to reflect the implementation of the Care Act 2014,
3) clarify a number of policy areas, including:
a) Setting out that the majority of NHS Continuing Healthcare assessments should take place outside of acute hospital settings. This will support accurate assessments of need and reduce unnecessary stays in hospital.
b) Providing additional advice for staff on when individuals do and do not need to be screened for NHS Continuing Healthcare in order to reduce unnecessary assessment processes and respond to a call for greater clarity on this.
c) Clarifying that the main purpose of three and 12 month reviews is to review the appropriateness of the care package, rather than reassess eligibility. This should reduce unnecessary re-assessments.
d) Introducing new principles for CCGs regarding the local resolution process for situations where individuals request a review of an eligibility decision. The aim is to resolve such situations earlier and more consistently.
e) Providing clearer guidance, including dedicated sections, on: the roles of CCGs and local authorities, NHS-funded Nursing Care, inter-agency disputes, well-managed needs, and the Fast Track Pathway Tool.
Examining the policy changes in turn:
The majority of NHS Continuing Healthcare assessments should take place outside of acute hospital settings. This will support accurate assessments of need and reduce unnecessary stays in hospital
In principle this makes sense as there is a clear rationale that a patient’s day to day health needs may not be accurately reflected in an assessment undertaken in hospital whilst there has been an acute period of illness. However, there are clear and obvious concerns that this may result in significant delays in an assessment for NHS Continuing Healthcare assessments being undertaken in the community following discharge. We have experienced circumstances whereby individuals have been informed by CCG’s that there are delays of up to 9 months for checklist assessments to be undertaken when requested. Such an example shows the risks of this change of policy.
Providing additional advice for staff on when individuals do and do not need to be screened for NHS Continuing Healthcare in order to reduce unnecessary assessment processes and respond to a call for greater clarity on this.
Examples provided within the updated National Framework as to situations where it is not necessary to screen for continuing healthcare funding include:
a) where it has previously been decided that the individual is not eligible for NHS Continuing Healthcare and it is clear that there has been no change in needs.
b) It is clear to practitioners working in the health and care system that there is no need for NHS Continuing Healthcare at this point in time. Where appropriate/relevant this decision and its reasons should be recorded. If there is doubt between practitioners a Checklist should be undertaken.
c) The individual has short-term health care needs or is recovering from a temporary condition and has not yet reached their optimum potential (if there is doubt between practitioners about the short-term nature of the needs it may be necessary to complete a Checklist)
The obvious concern we would raise in regards to each of the above situations is that such a decision is will be made on a very subjective basis and we would suggest is open to abuse by CCG’s who are inclined not to undertake assessments of individuals who ought to be assessed. We would submit that this was one area within the previous National Framework that did not require clarification or amendment. The correct avenue for determining if an individual ought to be screened for a full continuing healthcare assessment via a decision support tool assessment is to undertake a checklist assessment and establish if this checklist triggers for a full assessment. The current Framework allows for subjective decision making by individuals to determine they don’t believe that NHS continuing healthcare is required, or that the current needs are short term or that the previously assessed needs haven’t changed and therefore no checklist should be carried out.
The main purpose of three and 12 month reviews for NHS Continuing Healthcare funding is to review the appropriateness of the care package, rather than reassess eligibility. This should reduce unnecessary re-assessments.
This is an exceptionally positive change to the current position where reviews of continuing healthcare funding can be treated as an opportunity to pull the plug on funding being in place. We have experience of CCG’s stating that reviews are entirely new assessments and previous assessments that concluded primary health needs are present are not relevant and will not be considered. This is clearly incorrect and the clarification in the updated National Framework should go some way to reassure patients and their families.
Introducing new principles for CCGs regarding the local resolution process for situations where individuals request a review of an eligibility decision. The aim is to resolve such situations earlier and more consistently.
It is only positive that attempts have been made within the updated National Framework to clarify the local resolution process for appeals of decisions. It is unfortunately presently the case that Clinical Commissioning Groups often operate different systems and different time frames that can be wholly at odds to the process and structure set out by NHS England and within the National Framework.
Providing clearer guidance, including dedicated sections, on: the roles of CCGs and local authorities, NHS-funded Nursing Care, inter-agency disputes, well-managed needs, and the Fast Track Pathway Tool.
Any attempt to ensure greater acceptance and application of the clear processes set out by the National Framework for NHS Continuing Healthcare funding by the various Clinical commissioning groups across England is to be welcomed. Our practical day to day experience is that in practice many Clinical Commissioning Groups simply do not follow and adhere to the National Framework. It is our hope that this further revision of the National Framework and clear additional guidance should result in Clinical Commissioning Groups following and adhering to the National Framework for NHS Continuing Healthcare funding. This would result in a far fairer process than sadly can often be the experience encountered by many patients.
In summary, it is exceptionally positive that the revised National Framework for NHS Continuing healthcare funding has sought to further clarify the role and process that should be adopted and undertaken by Clinical Commissioning Groups. We hope that having been presented with a very clear remit by the Department of Health of what should be done that this is followed through and undertaken by the clinical commissioning groups to ensure that the process of assessment for continuing healthcare funding is a fair and just one for each patient that requires it.
Should you have any queries regarding the National Framework for Continuing healthcare funding, or if you wish to discuss whether your relative may be entitled to continuing healthcare, you should not hesitate to contact an expert member of our team today. We provide FREE, consultations that are strictly confidential.
We can be contacted on 0121 227 8940, or you can complete our assessment here and we shall contact you.
Author: Tim Davies LLB