DoH issues revised National Framework for Continuing Care

The Department of Health has issued a revised version of the National Framework for Continuing Care. The new version was published on 22 July 2009 and will come into effect in October. It replaces the first edition of the Framework that was published in June 2007 and that was in force from October that year. The Department of Health has also said that it will re-issue directions under the National Health Service Act 2006 and the Local Authority Social Services Act 1970 so that they are in line with the new Framework.

The new Framework is notable for its length – over twice that of the original. The extra detail included gives more clarity around the ways that an individual’s needs should be considered when they are being assessed for continuing care. The Framework does not change the basis of eligibility decisions for continuing care nor its overall principles, but seeks to enable a fairer, more consistent approach to patient assessment. The new guidance notes that are supplied to the three tools of the National Framework – the Checklist, Decision Support Tool and the Fast Track Pathway Tool – aim to improve the ways that the tools are used to aid decision-making during the assessment process.

Changes from the original document include:

• Clearer descriptions within the domains of the Checklist and the Decision Support Tool (DST) to help assessors decide on the severity of the patient’s needs in each area and how needs interact with each other.
• Increased emphasis on the importance of not allowing any gaps to occur in a patient’s care, for example after they leave hospital. Primary Care Trusts (PCTs) and Local Authorities (LAs) are also urged to ensure that any joint care package they provide addresses all of a patient’s individual needs and are reminded that continuity of care should be prioritised over financial considerations.
• A twelfth field within the DST entitled ‘Other significant needs’ which enables assessors to record details of a patient’s needs that do not fall into the other 11 categories of the tool and which can be classified up to the level of ‘Severe’.
• Changes to the Fast Track Pathway Tool which is used when a patient’s condition deteriorates rapidly and may be entering a terminal phase. In the new Framework, an ‘appropriate clinician’ such as a consultant, GP or registered nurse can assess a patient under the FTT and if they are found to be eligible for continuing care, the PCT must accept this decision and provide immediate funding which continues until the patient can be re-assessed using the DST. The Framework states that ‘It is not appropriate for individuals to experience delay in the delivery of their care package while disputes over the use of the Fast Track Pathway Tool are resolved.’
• PCTs are encouraged to take the likelihood of a patient’s deterioration ‘in the near future’ into greater account when assessing them for continuing care. If assessors consider that the patient’s condition is likely to deteriorate shortly, the PCT can either award continuing care straightaway or ensure that a review takes place very soon after the original assessment.
• PCTs and LAs are asked to consider the rights and welfare of unpaid carers. They are reminded of their responsibility to make carers aware of their right to have their needs assessed and of the PCT’s and LA’s joint obligation to fund respite care.
• The new Framework clarifies the relationship of continuing care funding with related legislation and other forms of fully-funded care, such as care provided under section 117 of the Mental Health Act 2005. It also gives clearer guidance on a person’s transition from child to adult health services and how this should be managed from the age of 14 onwards to ensure continuity of care into adulthood.
• The concept of personal care budgets is introduced. Although the Framework acknowledges that direct payments are not currently permitted for health care purposes, it states that the Department of Health is seeking powers in the Health Bill to allow a direct payment scheme to be piloted. Throughout the Framework, emphasis is placed on the personalisation of care and the importance of taking the patient’s and their families’ wishes into account wherever possible.
• New guidance is given on the operation of Independent Review Panels (IRPs) by Strategic Health Authorities (SHAs). This clarifies both their obligations and the procedures to be followed if a dispute over eligibility for continuing care funding cannot be resolved by the PCT and is referred to the SHA for review.

You can read or download the Framework document from the Department of Health’s website.