Continuing HealthcareWhat is NHS Continuing Healthcare?
NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals outside of hospital who have ongoing healthcare needs. You can receive continuing healthcare in any setting, including your own home or a care home.
Who is eligible for NHS Continuing Healthcare?
Anyone assessed as having a certain level of care needs may receive NHS continuing healthcare. It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided. If your overall care needs show that your primary need is a health need, you should be eligible for NHS continuing healthcare. Once eligible for NHS continuing healthcare, your care will be funded by the NHS but this is subject to review, and should your care needs change the funding arrangements may also change.
Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators:
Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs.
Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care.
Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/ongoing care.
Unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided.
How are decisions made about who is eligible for NHS continuing healthcare?
The whole of the decision making process should be ‘person centred’. This means putting the individual and their views about their needs and the care and support required at the centre of the process. It also means making sure that the individual plays a full role in the assessment and decision making process and gets support to do this where needed. This could be by the individual asking a friend or relative to help them explain their views. Advocacy service will be provided should an individual need it.
The first step for most individuals is the Checklist Tool. This is a screening tool to help health and social care staff work out whether needs might possibly be of a level or type that might make the individual entitled to NHS continuing healthcare. The Checklist will usually be completed when someone is assessing or reviewing health or social care needs. The Checklist does not indicate whether the individual is eligible for NHS continuing healthcare, only whether they require full assessment of eligibility for NHS continuing healthcare.
If a Checklist has been completed and suggests that there is a possibility that you might be eligible for NHS continuing healthcare, the individual completing the Checklist will contact our Continuing care team which will arrange for a multidisciplinary up-to-date assessment of your needs. A multidisciplinary team is made up of two or more health and social care professionals who are involved in your care. The assessment will, with your permission, involve contributions from all of the health and social care professionals involved in your care to build an overall picture of your needs. In some cases, the multidisciplinary team will ask for more detailed specialist assessments from these professionals.
The multidisciplinary team will use the information from your assessment to complete a Decision Support Tool. The Decision Support Tool looks at 11 different types of need such as mobility, nutrition and behaviour. The purpose of the tool is to help decide what are the nature, complexity, intensity and unpredictability of your needs and so whether your primary needs are health needs. The multidisciplinary team will then make a recommendation to the NHS Brent as to whether you are eligible for NHS continuing healthcare.
In all cases, you should be sent a written decision as to whether you are entitled to NHS continuing healthcare together with reasons for the decision.
Who do I contact if I am not happy with the outcome?
If you disagree with a decision not to proceed to full assessment of eligibility for NHS continuing healthcare following completion of a Checklist, you can ask NHS Brent to reconsider the decision.
If you disagree with the eligibility decision made by NHS Brent (after a full assessment and the Decision Support Tool has been completed) or if you have concerns about the process used to reach the decision, you can ask NHS Brent to review the decision or you can ask for an independent review of your case. The NHS Brent local resolution procedures should be used first.
The Continuing Care Team
NHS Brent
020 8795 6339 If you remain dissatisfied of the outcome of the local resolution process you may request for an independent review of your case to be undertaken by the strategic health authority.
Any individual has a right to complain about any aspect of the service they receive from the NHS, the local authority or any provider of care.
Page updated on 24 November 2009, Chafick Peerun |
