National Framework for NHS Continuing Healthcare and NHSfunded

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Overall Objectives • To have a basic understanding of NHS continuing healthcare and NHS funded nursing care. • They will also have an awareness of where it sits within local processes and how eligibility is determined. • They will also have an understanding of the national tools and when and where to use them especially in relation to screening. • To enable registered nurses to have sufficient skills and understanding to undertake assessments in relation to NHS Funded Nursing Care. • Understand key changes to the Tools and decision – making process. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Background • High Court Rulings. • 2007 National Framework • One set of tools • One flat rate of Nursing Care Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

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. • A revised set of national tools to support and improve consistency in decision making. • Continues with one band for NHS funded nursing care Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Definition • Continuing Care means care provided over an extended period of time, to a person aged 18 or over, to meet physical or mental health needs that have arisen as a result of disability, accident or illness. NHS continuing healthcare means a package of continuing care that is arranged and funded soley by the NHS. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

The Headlines – Key Messages • NHS Continuing Healthcare is part of a whole process of care pathways. • 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 • There is an expectancy that the increase already seen in the eligible numbers will continue. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Key Principles - 1 • Access to assessment for NHS Continuing healthcare and provision of that care should be fair, consistent and free from discrimination on the grounds of race, disability, gender, age, sexual orientation, religion or belief. • The process of assessment and decision making should be person centred. • Eligibility for NHS continuing healthcare is based on an individuals assessed needs and not a diagnosis. • Consideration of eligibility for NHS continuing Healthcare should always precede the decision about NHS funded nursing care. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Primary Health Need • The ‘primary health need’ test should be applied, so that a decision of ineligibility for NHS Continuing Health Care is only possible where, taken as a whole, the nursing or other health services required by the individual: • a] are no more than incidental or ancillary to the provision of accommodation which LA social services are, or would be but for a persons means, under a duty to provide; and • b] are not of a nature beyond which an LA whose primary responsibility it is to provide social services could be expected to provide. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Key Principles - 2 • When carrying out an assessment the potential for further rehabilitation and regaining independence should always be considered. • Eligibility is not determined or influenced by the setting where the care is provided or by the characteristics of the person/s who delivers that care. • Financial issues should not be considered as part of the decision making process. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Key principles - 3 • The evidence and decision making process should be accurately and fully recorded using suitable models in place. Decision and rationale relating to eligibility should be transparent from the outset – for individuals, carers, families and staff. • Eligibility might change and regular reviews must be built into the process. Individuals and their families need to be clear about this from the outset. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Key Changes • Basis of eligibility for CHC has not changed – Primary Health Needs remains the primary criteria, however: • - There is now clearer guidance an expectations set out on a range of issues • - There are changes to the detail of the three Tools and how the Fast Track Tool is to be used Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Process • Where is your role? • Is it clear to individuals and their families and carers? • Where is joint working within this process? Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

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 can help this process run smoothly Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

The Tools • NHS Continuing Healthcare Checklist • Fast Track Pathway tool for NHS Continuing Healthcare • Decision Support tool for NHS Continuing Healthcare Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

How does it work- Care Domains • • • Behaviour Cognition Psychological & Emotional needs Communication Mobility Nutrition • • • Continence Skin & Tissue Viability Breathing Drug Therapies & Medication: Symptom control Altered States of consciousness Other Significant Needs Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

NHS Continuing Healthcare Checklist • 3 options for completion • • • A) B) C) Meets or exceeds described level Borderline or close to described level Does not meet level Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Refer those for full assessment • Two or more ticks in column A • Five or more ticks on column B or one tick in A and four in B • One tick in Column A in one of the boxes marked with an asterisk * ( the domains which carry a priority level in the DST), with any number of ticks in the other columns. • There may be other circumstances where professional judgements overrules the checklist. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Following DOH Review • Redesigned Checklist now showing levels of need below threshold to make it easier for staff to identify correct level • Expanded guidance notes, covering issues such as consent, capacity, written decisions and rights of review • Equality – related data now collected • Wide range of health and social care staff can use it Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

DST - What is it? • The decision support tool enables practitioner 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 Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

What it’s NOT • An another assessment • A decision MAKING tool • Suitable for every individual’s situation • A substitute for professional judgement Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

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 Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Following DOH Review • Expanded personal details, inc. equality-related data • New sections to ensure that individual’s views are fully taken into account for assessment and DST • Where MDT cannot agree on a level, still go for higher one, but record disagreement so that PCT are aware Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Determining Eligibility • ‘Well managed need is still a need’ will frequently apply to behaviour issues however this may be reflected in other domains, e. g. Drug Therapies • ‘Double Counting’ Where needs can fit more than one domain they can be recorded in more than one but care should be taken in final recommendation to check that several needs are not really one need Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Fast track pathway Only for those individuals who have a terminal condition that is deteriorating rapidly 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. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Supporting Information • Brief outline of reason for fast tracking • Care plan describing how immediate needs will be met. • Full assessment should follow at earliest opportunity if not already completed. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Outcomes • Decisions on CHC eligibility to usually be made within 28 days of PCT receiving completed Checklist or appropriate referral. • Those in receipt of CHC are entitled to the full range of other NHS funded services available to all other PCT patients including: • Community nursing • Equipment service Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

NHS funded Nursing Care • ‘NHS funded Nursing Care, ’ introduced in October 2001 under the Health and Social Care Act 2001, refers to the assessment and funding provided to nursing homes, by the NHS, to support the provision of nursing care by a registered nurse for those assessed as eligible. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Links with wider policies • • Mental Capacity Act End of Life Care Strategy Personalisation Draft Children's Framework Discharge Policy and Intermediate Care Section 17 and 117 MHA 1983 Valuing People Now Long Term Conditions Policy Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Personalisation and Personal Health Budgets • • Way to help people get the services they need to get the health and wellbeing results they want by taking more control over how money is spent on their care. HCQFA commitment based on learning from social care and other countries. 3 year pilot programme. 6 key principles, particularly: equity, equality, quality • • Who and what – non – prescriptive, few exceptions. Budgets can be notional , held by a 3 rd party, or direct payments. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

PHB • • • PCT’s were invited to express an interest. NHS Western Cheshire has initial pilot status. Working with key stake holders. Awaiting outcome of award to full pilot status. Clients eligible for NHS continuing healthcare to begin pilot September 2010. Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury

Any Questions Aldford Audlem Blacon Bunbury Chester Cotebrook Delamere Forest Ellesmere Port Farndon Frodsham Helsby Kelsall Lache Malpas Neston Tarporley Tarvin Tilston Willaston Wrenbury