Glossary of Terms Related to NHS Continuing Care
A | B | C | D | E | F | G | H | I | J | K | L | M
N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
- Acute care
- Hospital-based or emergency health services – sometimes referred to as secondary care. ‘Acute’ relates to the care being short-term. It can also mean ’short and severe’.
- Admission
- After-care under Section 117 of the Mental Health Act 1983
- If a patient has been detained under Sections 3, 37, 47 or 48 of the Mental Health Act 1983 and is later released into residential accommodation as part of their after-care package, their accommodation and care costs should be free. The local Primary Care Trust and Social Services Department are obliged to agree a jointly-funded care package for the patient for as long as after-care is considered necessary.
- Assessment
- The overall process for identifying and recording the health and social care risks and needs of an individual and evaluating the impact of these risks on a patient’s daily living and quality of life, so that appropriate action can be planned. See also specialist assessment.
- Assessment tools
- Scales, questions and checklists brought together to support the assessment process. For example the Checklist and Decision Support Tool that are used within the National Framework.
- Attendance Allowance (AA)
- A non means-tested benefit that is payable to people aged 65 or over who have personal care or supervision needs. People under 65 with these needs would claim Disability Living Allowance (DLA).
Entry into a hospital bed or into a care home or care home with nursing. The admission may be planned from a waiting list, or be an emergency.
B
- Background history
- The capture of a full background history (not just medical information) is often required to gain a more holistic view when assessing the needs of an individual with longer term, complex needs.
- Benchmarking
- A method used by public and voluntary sector organisations and companies to gauge their performance by comparing it with the performance of other similar organisations. The Government encourages public sector bodies to compare their scores on various published performance indicators as a way of improving services.
- Capacity
- The ability to make a decision about a particular matter at the time the decision needs to be made. The legal definition of a person who lacks capacity is set out in the Mental Health Act 1983: “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a
disturbance in the functioning of, the mind or brain”. - Care
- Support provided to individuals to enable them to live as independently as possible, including anything done to help a person live with ill health, disability, physical frailty or a learning difficulty and to participate as fully as possible in social activities. This encompasses health and social care.
- Care co-ordination
- The process of coordinating the tasks needed to enable a person to live independently. This will involve the individual, their family and carers, health and social care workers, and any additional support network.
- Care co-ordinator
- A person who coordinates the assessment and care planning process for a person who needs complex and/or multiple services to support them. Care co-ordinators are usually the central point of contact with the individual. Regionally, different terms may be used to describe this role.
- Care home
- A residential home which provides accommodation and personal care to its residents. Care homes used to be called residential homes before the Care Standards Act 2000 came into effect in April 2002.
- Care Quality Commission (CQC)
- The CQC regulates the safety and quality of all health and social care services providers in England. Launched in April 2009, it replaces the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.
- Care home provider
- An organisation that runs a care home. This could be a local authority, a private individual or company or a voluntary organisation such as a charity. Homes run by voluntary organisations may have special rules about who they can admit: for example, some areas have homes especially for people who have served in the armed forces, or for people from particular ethnic groups or religious backgrounds.
- Care home with nursing
- A residential home that provides accommodation, personal and nursing care to its residents. The care provided by NHS registered nurses will be funded by the NHS. There will be generally be at least one registered nurse on duty. Care homes with nursing used to be called nursing homes before the Care Standards Act 2000 came into effect in April 2002.
- Care management
- Care management is the process that a Social Services Department undertakes to assess an individual’s care needs and provide appropriate services. Care management includes: giving information about possible help; determining the level of assessment to be undertaken when a person has been referred to the Social Services Department; assessing their needs; developing a care plan and a care package to meet their needs; implementing the care plan; and monitoring and reviewing the care plan.
- Care package
- Services designed to meet an individual’s assessed needs as part of the care plan arising from their assessment. Consists of one or more services, which may be residential and/or community-based. Also known as a ‘package of care’. If Social Services provide the care package, a cost is often attached and needs to be approved by the budget holder. The individual may also be required to contribute.
- Care pathway
- An agreed and explicit route taken by an individual through health and social care services. Agreements between the various professionals involved will typically cover the type of care and treatment; which professional will be involved and their level of skills; and the location of treatment or care.
- Care plan
- A document recording the reason why care services are being provided and the outcome that they are seeking to achieve.
Care planning
A process based on an assessment of an individual’s needs that involves determining the level and type of support required to meet those needs, and the objectives and potential outcomes that can be achieved.Carer
Carers look after family partners or friends in need of help because they are ill, frail or have a disability. The care they provide is unpaid.Carer addition (or carer premium)
An extra amount of Pension Credit, Income Support, Housing Benefit or Council Tax Benefit that is paid to a carer instead of Carer’s Allowance.Carer’s Allowance (CA)
A non means-tested, but taxable, benefit that is paid to people who spend at least 35 hours a week caring for a severely disabled person.Care worker
Care workers provide paid support to help people manage the day to day business of living. Support may be of a practical, social care nature or to meet a person’s health needs. See also Carer.Charging for Residential Accommodation Guide (CRAG)
Rules set out by the Department of Health to be used by a Local Authority when means-testing an individual’s financial resources for the purpose of deciding how much the individual should contribute towards the cost of their care in a care home.
The latest version of the Guide can be read or downloaded from the Department of Health’s website.Checklist
In the context of the National Framework, this is one of the Framework’s three tools. The checklist looks at 11 areas of patient need to decide which of these apply to the patient. If a patient is considered as having two or more definite needs or five or more borderline needs, they will qualify for the full continuing care assessment using the Decision Support Tool.Cognition
The higher mental processes of the brain and the mind, including memory, thinking, judgment, calculation, visual spatial skills and so on.Cognitive impairment
This term applies to disturbances of any of the higher mental processes (see cognition), many of which can be measured by suitable psychological tests. Cognitive impairment, especially memory impairment, is the hallmark and often the earliest feature of dementia.Commission for Social Care Inspection (CSCI)
See Care Quality Commission.Community Care Act 1990
The Act made a lot of changes to the organisation of the NHS and its responsibilities. It ruled that Local Authorities had to begin means-tested charging for social and personal care services provided which meant that Local Authority care homes could no longer provide these services free of charge to their residents.Compliance
The extent to which a patient takes, or does not take, medicines as prescribed. See also concordance.Comprehensive assessment
Comprehensive assessments have replaced overview assessments for the most vulnerable and frail people who have many or complex needs. The assessment often involves old age consultants (geriatricians) or psychiatrists and their teams on behalf of, or working with, primary care and social care teams. Such an assessment is only required where the level of support and/or treatment is likely to be extensive and/or prolonged, such as a permanent admission to nursing care or an intensive and/or complex home care package.An agreement between a patient and a health professional regarding the provision of care. Concordance and compliance are frequently used interchangeably.
Respect for the privacy of information.
Continence and continence care
Continence is the ability to control the timing of urination or a bowel movement. Incontinence is the loss of control of the bladder or bowel. The NHS will supply free continence aids and associated services such as continence laundry to patients in care homes with nursing, if the patient is assessed as needing these services. If this is the case, the NHS will make an additional weekly payment to the care home on top of the usual funding for nursing care. Patients living in care homes that do not provide nursing will receive continence services within community health services and district nursing in the same way as people living at home.
A general term describing care provided over an extended period of time to those aged 18 or older to meet physical and mental health needs that have arisen as a result of disability, an accident or illness. It may require services from the NHS and / or Social Services. Continuing care aims to provide the right long-term support, to promote independence, prevent deterioration and maximise a person’s health and quality of life. See also NHS Continuing Healthcare below.
Abnormal, usually permanent, condition of joint flexion and fixation caused by atrophy and shortening of muscle fibres or loss of normal elasticity of skin causing muscle contraction.
This term is used when considering whether local eligibility criteria, application of the criteria or the end decision to award or deny NHS Continuing Healthcare funding is lawful. If these are in accordance with the findings of the Coughlan Judgment, they are said to be Coughlan-compliant and therefore lawful.
A key judgment made by the Court of Appeal in July 1999 and often referred to in cases where continuing care funding is under question. The judgment helped to clarify which healthcare services can legally be provided by a Local Authority under the 1948 National Assistance Act and which services must be provided and funded by the NHS, using the Primary Health Need Test. The judgment also addressed the issues of the location of care and who provides the care, ruling that neither issue is a factor in considering a patient’s eligibility for NHS Continuing Healthcare funding.
A state benefit paid to help people with the cost of their Council Tax. If you qualify for the guarantee credit part of Pension Credit, you are automatically entitled to receive Council Tax Benefit.
The Court responsible for looking after the financial affairs of people who cannot legally do it themselves because of lack of capacity.
The Court can decide on the validity of Lasting and Enduring Powers of Attorney, make wills, and generally give directions and orders for the management of the person’s property and financial affairs.
Facts and information. Qualitative data is descriptive and often describes attitudes, beliefs and feeling. Quantitative data is measurable and is expressed in statistical form.
Data Protection Act 1998 (DPA)
Enables individuals to access information about themselves, e.g. their own medical records. Companies and public bodies that gather personal data about individuals must do so in accordance with the terms of the Act.
In the context of the National Framework, the Decision Support Tool is used during a multidisciplinary assessment to assess whether a patient qualifies for NHS Continuing Healthcare or NHS-funded Nursing Care. The Decision Support Tool looks at the same 11 areas of patient need as the Checklist but looks at them in much greater detail. As well as deciding how severe a patient’s needs are, the Tool takes account of their nature, intensity, unpredictability and complexity to determine the quality and / or quantity of care that will be needed to meet them. The Decision Support Tool helps to establish if a patient has a Primary Health Need which would qualify them for funding but it is not a means to an end for doing so.
An agreement made between a care home resident and their Local Authority that the Authority will pay for some or all the resident’s care home fees until the resident’s property has been sold. The Local Authority places a legal charge on the property. When it has been sold, the care home fees that had been funded by the Local Authority will be repaid from the proceeds of the sale, usually without interest.
Under the NHS Delayed Discharge (Continuing Care) Directions 2007, a patient’s discharge from hospital must be delayed if it has been identified that they will need further support after they leave hospital but a care plan has not been put in place. In particular, the patient cannot be discharged if they may be eligible for funding and must stay in hospital until an assessment of care needs and eligibility for funding has been carried out. If the patient is denied funding and contests this decision, they must stay on in hospital until the funding decision has been reviewed.
General term used to describe different mental illnesses (such as Alzheimer’s disease) that affect the brain and diminish the ability to do everyday tasks. ‘Dementia’ is used to describe symptoms, not the condition itself. Symptoms include loss of memory; difficulty in understanding people and finding the right words; difficulty in completing simple tasks and solving minor problems; mood changes and emotional upsets.
The Department of Health is the Government department that exists to improve the health and wellbeing of people in England. It is responsible for supporting Government ministers in accounting to the public and to Parliament. The Department has responsibility for standards of health care in the country, including the NHS. It sets the strategic framework for adult social care and influences Local Authority spend on social care. It also sets the direction on promoting and protecting the public’s health, taking the lead on issues like environmental hazards to health, infectious diseases, health promotion and education, the safety of medicines and ethical issues.
The practice of deliberately giving away assets such as property or savings to avoid these being included in assessments for a contribution to care home fees or for eligibility for Pension Credit. These assets can be still be included in these assessments and tariff income may be calculated on their value even if the person who disposed of the assets no longer has access to them or to any financial proceeds from their sale.
Disability Living Allowance (DLA)
A non means-tested benefit that is payable to people aged under 65 who have personal care or supervision needs. There is also a mobility component that can be claimed as well as or instead of the care component. People aged over 65 would claim Attendance Allowance.
This is money which a solicitor has to pay to third parties to help prepare a case. Examples include: court fees and fees for medical or other independent reports.
Assistance provided to a person in their home, including home care, equipment and adaptation, and meals-on-wheels. A part of social care.
Elderly Mentally Infirm (EMI) home
A care home with nursing that provides extra care and support to older people with dementia and related mental illnesses, as well as general nursing care, personal care and accommodation.
Set of standards or rules governing access to each particular service outside the NHS. See also local eligibility criteria.
Care which helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support.
Enduring Power of Attorney (EPA)
Used by an individual who has been diagnosed as having, or as likely to develop, a mental illness (e.g. severe schizophrenia) or a degenerative brain disease leading to mental incapacity (e.g. Alzheimer’s disease) and who wants someone else to manage their financial affairs now or in the future. Unlike a Lasting Power of Attorney, an EPA can come into effect or continue in force after an individual loses their mental capacity.
Eligibility criteria used by Social Services Departments to determine whether a person is eligible for services provided by them. The criteria are based on an individual’s needs and associated risks to independence and includes four eligibility bands: critical, substantial, moderate and low. When placing individuals in these bands, councils should not only identify immediate needs but also needs that would deteriorate for lack of timely help.
One of the three tools of the National Framework. This is used when a patient urgently needs access to continuing care funding because their condition has rapidly deteriorated or has entered a terminal stage. Where possible, the full continuing care assessment process (see Checklist and Decision Support Tool) should follow.
The price paid as remuneration for services, especially to a doctor, lawyer, consultant or member of a learned profession.
A document proving that the person or persons named in it are entitled to collect in and distribute the monies or other assets of a deceased person. The Grant may be produced to those organisations (banks, building societies, etc.) holding such assets. See also Probate and Letter of Administration.
In March 2006, the High Court heard a challenge, on behalf of Mrs Grogan, who argued that she had been wrongly denied NHS Continuing Healthcare. The judge criticised the lack of clarity in the 2001 national guidelines. He also criticised Bexley PCT’s local eligibility criteria which effectively gave no guidance on the primary health need test which is used to determine a patient’s eligibility for continuing care funding. The case also highlighted problems around the assessment process for NHS-funded Nursing Care as local criteria for the high band of RNCC were in some cases as high, or higher than, criteria for NHS Continuing Healthcare. This made it almost impossible for patients in these areas to be awarded NHS Continuing Healthcare. The Grogan case highlighted the need for a single set of eligibility criteria for continuing care funding to be introduced and a few months later, consultation began on the National Framework.
See Strategic Health Authority.
Health Services Ombudsman (Ombudsman)
The Ombudsman carries out independent investigations into complaints about UK government departments and their agencies and the NHS in England with the aim of helping to improve public services as a result.
A state benefit paid to help people with the cost of their rent. If you qualify for the guarantee credit part of Pension Credit, you are automatically entitled to receive Housing Benefit.
A care package that may be offered to older people for up to six weeks, free of charge. It is based around a care plan designed to maximise a person’s independence. The aim is to enable a person to return to their own home after hospital treatment or by providing suitable services, to avoid the need for hospital admission.
A legal document enabling an individual to appoint another person to make decisions on their behalf about their money, property and how their affairs are managed. The Power of Attorney can be drawn up at any time while the individual has capacity but has no legal standing until it is registered with the Office of the Public Guardian. Unlike an Enduring Power of Attorney, a Lasting Power of Attorney cannot be drawn up after an individual loses capacity. In all cases the Office of the Public Guardian can advise on ‘acting for others’ and should be consulted at all stages of setting up a third party authority.
One of the first cases highlighting the issues around continuing care funding that arose after the Community Care Act was passed in 1990. The Health Services Ombudsman upheld a complaint from the wife of a brain-damaged man who had been forced to pay for his care in a private nursing home after he was discharged from hospital by Leeds Health Authority. The investigation found that Leeds Health Authority’s policy was not to fund any continuing care at NHS expense which the Ombudsman described in his report as constituting a failure in service. It was further to this report that the Department of Health published the first set of national guidelines to enable Health Authorities to develop local eligibility criteria for assessing patients for NHS Continuing Healthcare funding.
A document proving that the holder is entitled to collect or distribute the estate (money, property etc) of a deceased person, where the deceased person died without leaving a will. If the deceased person left a will, the document is called Grant of Probate.
In the context of continuing care, these are criteria that were drawn up by a Health Authority to assess the eligibility of a patient in their area for NHS Continuing Healthcare funding between 1996 and 2002. After 2002, Health Authorities were replaced by Strategic Health Authorities who developed criteria for use by the Primary Care Trusts in their area. Local eligibility criteria were first applied in April 1996, when the first set of national guidelines came into effect and were used until 1 October 2007 when use of the National Framework became mandatory. Before April 1996, there was no requirement for a Health Authority to have formal, written criteria in place for assessing patients for funding.
The use of information about a person’s income and other resources such as savings or ownership of a property to determine their entitlement to a particular benefit which might otherwise be funded by the state.
Defined in the 1983 Mental Health Act as “mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind”. The Act does not define mental illness, which is a matter for clinical judgment.
How an individual thinks, feels, and acts when faced with life’s situations. This includes handling stress, relating to other people and making decisions. A mental health problem is a psychiatric disorder that results in a disruption in a person’s thinking, feeling, moods, and ability to relate to others.
A formal assessment of mental health under the 1983 Mental Health Act. The assessment should lead to the least restrictive alternative, so hospital admission will not always follow. However where a person’s mental state is seen to be a risk to their own health or safety or for the protection of others, compulsory admission to hospital or sectioning may be needed for assessment and/or treatment. An application for sectioning is completed by an Approved Social Worker based on the recommendations of two doctors.
The Mental Health Act 1983 governs the admission of people to psychiatric hospital against their will, their rights while detained, their discharge from hospital, and after-care. The Act applies in England and Wales.
MRSA (Methicillin-Resistant Staphylococcus Aureus)
A type of bacteria that lives harmlessly on skin and in the lining of the mouth and nose (mucosa) of about one third of healthy people. It can cause infection once it enters the body through a cut or abrasion. Staphylococcus Aureus is a very common cause of boils, impetigo and abscesses and can lead to serious infections like septicaemia (blood poisoning) and heart-valve infection. MRSA includes several strains (types) of the Staphylococcus Aureus germ that are not killed by the usual antibiotics.
Multidisciplinary refers to when professionals from different disciplines – such as social work, nursing and occupational therapy – work together.
Multidisciplinary assessment (MDA)
Multidisciplinary assessment is an assessment of an individual’s needs that actively involves professionals from different disciplines in collecting and evaluating assessment information. A MDA using the national Decision Support Tool is required under the National Framework when assessing a patient’s eligibility for NHS Continuing Healthcare funding.
A team of at least two professionals, usually from both health and social care backgrounds.
A term coined in the July 2009 Government Green Paper on the reform of adult social care services and funding in England. The national care service is what the Green Paper aims to implement – a fair, affordable and simple to understand social care system that is jointly funded by the Government and by the individual.
National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (National Framework)
In June 2007 a new national framework was introduced for assessing a patient’s eligibility for NHS Continuing Healthcare and NHS-funded Healthcare. This replaced the previous assessment process whereby Strategic Health Authorities (SHAs) developed their own local eligibility criteria. The Framework became mandatory on 1 October 2007.
National guidelines (or national guidance)
In the context of continuing care, these are the guidelines that were published by the Department of Health and used by a Health Authority (later Strategic Health Authority) to develop local eligibility criteria for assessing patients for NHS Continuing Healthcare funding. The guidelines were revised on a number of occasions between the publication of the first set in April 1996 and the introduction of the National Framework on 1 October 2007. Before April 1996, there was no requirement for a Health Authority to have formal, written criteria in place for assessing patients for funding.
National Minimum Standards (NMS)
Standards set by the Department of Health for a range of services, including care homes, domiciliary care agencies and adult placement schemes. The Commission for Social Care Inspection (CSCI) must consider the NMS when assessing a social care provider’s compliance with statutory regulations
National Service Frameworks (NSF)
Documents that set out national standards for the best ways of providing health and social care services for particular diseases or population groups, e.g. older people.
The Mental Health Act 1983 defines a list of certain people who can be treated as an individual’s ‘nearest relative’. A ‘nearest relative’ has a number of important powers and functions, including the right to discharge an individual who has been formally detained in hospital, to make an application for a person to be admitted for assessment, treatment or guardianship and also to object to applications for treatment or guardianship that are made by a social worker.
A process by which health and social care professionals assess, and then make conclusions on, the risks to and needs of a patient. The assessment sets out what is necessary for an individual to maintain their life at a certain standard.
Comprehensive health system provided by the state and free at the point of delivery.
A complete package of continuing care that is arranged and funded solely by the NHS, where it has been assessed that the individual’s primary need is a health need. It can be provided in a range of settings, including hospital, a care home or hospice and the individual’s own home. In a person’s own home, it means that the NHS funds all the care that is required to meet their assessed health needs, including personal and social care. In care homes, it means that the NHS makes a contract with the care home and pays the full fees for the person’s accommodation as well as all their care.
The funding provided by the NHS to care homes with nursing care to support the provision of care from a registered nurse for their eligible residents. It was first introduced in October 2001. Since October 2007, there has been one single band of funding for the care. See also Registered Nursing Care Contribution (RNCC) below.
Hospital or other organisation that operates as an independent commercial unit within the NHS.
Income that is not taken into account when assessing a person’s entitlement to a state benefit such as Pension Credit. See also Qualifying income.
Notification Arrangements to Social Services
Part of the system designed to reduce the number of delayed transfers of care under the Community Care (Delayed Discharges) Act 2003. NHS bodies have to make two notifications to the appropriate social services departments. The first, an Assessment Notification (Section 2), gives notice of the patient’s possible need for services on discharge. Following this notification, social services departments have a minimum of three days to carry out an assessment and arrange care. The second, a Discharge Notification (Section 5), gives notice of the day on which it is proposed to discharge the patient. The two notifications should be part of existing or good practice information flows and are designed to ensure prompt communication as part of the planning process, not to replace care plans. See also Delayed Discharge.
The active holistic care of patients with advanced, progressive illness. Management of pain and other symptoms and provision of psychological, emotional, social and spiritual support is paramount. The goal of palliative care is to achieve the best possible quality of life for patients and their families.
Patient Advice & Liaison Services (PALS)
A NHS service that offers patients and their families advice and information about the NHS and its services. PALS can be used to address concerns about NHS services and the level of care that a patient is receiving.
In January 2007, the Health Services Ombudsman ruled that Torbay Primary Care Trust should repay Mike Pearce £50,000 of care costs that he had wrongly paid out for his mother, Ruby, who suffered from Alzheimer’s disease. The case highlighted the problem of patients or their families having to sell their homes to fund continuing care costs as Mike had sold the family home to pay for Ruby’s care. The case was also notable as the Ombudsman reached its decision by assessing Ruby’s eligibility for NHS Continuing Healthcare against the draft National Framework’s new Decision Support Tool which was not published until five months after the complaint was upheld. Like the Pointon case, the Pearce case is an important point of reference for dementia sufferers and their families who have sometimes found it difficult to get access to continuing care funding because the patient has been wrongly assessed as not having a primary health need because their health problems are mental and not physical.
A means-tested benefit that provides older people with a guaranteed minimum income and gives extra money to people with modest incomes who have made savings for their retirement. There are two elements to the benefit: guarantee credit (available from age 60) and savings credit (available from age 65). For people over 60, Pension Credit is the equivalent benefit to Income Support for people under 60.
A general term relating to a patient’s more intimate care needs such as help with washing, feeding and using the toilet. Unless a patient has been assessed as eligible for NHS Continuing Healthcare (in which case the NHS will fund personal care), the Local Authority is responsible for providing personal care services either in the patient’s own home or in a care home. The Local Authority will means-test a patient’s ability to pay for these services. In Scotland, the situation is different as the Local Authority will fund personal care in a care home for patients aged 65 or over who are self-funding and who are assessed as in need of personal care services.
Personal expenses allowance (PEA)
The amount of money that a care home resident who contributes to the cost of their own care is allowed to keep per week, to pay for personal expenses that are not included in the home’s fees.
In November 2003, the Health Services Ombudsman upheld a complaint made on behalf of Mr Pointon, a man with dementia cared for at home by his wife. This complex case raised a number of issues around local eligibility criteria and the assessment of individuals:
- The need to ensure criteria for funding NHS Continuing Healthcare at home are clearly defined,
- The need to ensure assessment takes account of mental health and psychological as well as physical needs of patients with illnesses like dementia,
- Recognition that it is possible for the standard of care provided and co-ordinated by a carer to reach that which a registered nurse could provide.
The case is widely referred to by dementia sufferers or their families who are attempting to secure current or retrospective continuing care funding. However, the Ombudsman stated that its ruling in the Pointon case should not be seen as implying that all patients with dementia should be eligible for fully funded care.
See Lasting Power of Attorney and Enduring Power of Attorney.
Area of damage to the skin or underlying tissue which has occurred as a result of prolonged pressure to that area.
Also known as decubitis ulcer or bed sore. Area of local damage to the skin and underlying tissue due to a combination of pressure, sheer and friction.
Primary care (or primary healthcare)
Primary care is the term for the health services that play a central role in the local community such as GPs, pharmacists, dentists and midwives. Every citizen should have the best possible access to these services. Most primary care services are fully-funded by the NHS but others, like dentists, are means-tested for the majority of adults.
These were replaced by Primary Care Trusts.
Local NHS organisation responsible for the provision of primary care and community based health services (also secondary care) and the commissioning, administration and performance management of healthcare within a defined geographical area. PCTs work closely with clinicians and practitioners and other organisations such as NHS Trusts and Local Authorities, particularly Social Services Departments. PCTs work with Local Authorities and other agencies that provide health and social care locally to make sure that their local community’s needs are being met. They must make sure there are enough services for people within their area and that these services are accessible. The number of PCT’s in England was reduced from 303 to 152 in October 2006.
Click here to see a full List of SHAs & PCTs in england
A patient’s overriding need for health care services rather than social care or personal care services. A patient with a primary health need would usually qualify for NHS Continuing Healthcare.
A test that should be applied when a patient is being assessed for NHS Continuing Healthcare and NHS-funded Nursing Care to ascertain if they have a Primary Health Need. A patient would NOT pass the primary health need test if the healthcare services that they need are:
- No more than incidental or ancillary to the provision of accommodation which
Local Authority Social Services are under a duty to provide; and
- Not of a nature beyond which a Local Authority whose primary responsibility is to provide
Social Services could be expected to provide.
The process of officially proving the validity of a will and the right of entitlement of its beneficiaries. See also Grant of Probate.
Income that is taken into account when assessing a person’s entitlement to a state benefit such as Pension Credit. See also Non qualifying income.
A nurse registered with the Nursing and Midwifery Council. Within the UK all nurses, midwives and specialist community public health nurses must be registered with the Nursing and Midwifery Council and renew their registration every three years to be able to practice.
Registered Nurse Care Contribution (RNCC)
The set amount paid to support NHS-funded Nursing Care in care homes between October 2001 and October 2007. There were three bands of funding – low, medium and high – depending on the patient’s needs. From 1 October 2007, the bands were replaced with a single rate of funding.
A programme of therapy and re-enablement designed to maximise independence and minimise the effects of disability.
Respite care is a service provided to a carer who cares for a relative or friend at home. Respite care is offered if a carer is ill or to give them a break. Usually, a Local Authority will apply means-tested charging to respite care so it will not normally be free. Various charities will also provide respite care but again, it may not be free of charge.
Respite health care is provided to the patient whilst their carer is receiving respite care. Usually it is provided if the patient may benefit from a period of rehabilitation. The local Primary Care Trust (PCT) will pay for the respite health care if the patient is receiving NHS-funded Continuing Healthcare at home. Otherwise, the Local Authority may arrange respite health care but the patient will be means-tested for their ability to pay for it. If the Local Authority arranges for respite health care to take place in a care home, the NHS will fund any care provided there by a registered nurse.
The name given to a form of legal relief in which the plaintiff recovers something from the defendant that belongs, or should belong, to the plaintiff. For example, care home fees paid for by an individual (the plaintiff) that should have been funded by the NHS (the defendant).
Formal re-evaluation of an individual’s assessed risks, needs and personalised care plan at an arranged time. Informal reviews take place as required.
The rights that individuals have to:
- be respected
- be treated equally and not be discriminated against
- be treated as an individual
- be treated in a dignified way
- privacy
- be protected from danger and harm
- be cared for in a way that meets their needs, takes account of their choices and also protects them
- access information about themselves.
The evaluation of risk should focus on the following aspects that are central to an individual’s independence: autonomy and freedom to make choices; health and safety including freedom from harm, abuse and neglect, taking wider issues of housing circumstances and community safety into account; the ability to manage personal and other daily routines; and the involvement in family and wider community life, including leisure, hobbies, unpaid and paid work, learning and volunteering.
Royal Commission for Long Term Care
The Commission reported to the Government in March 1999. One of its main recommendations was that, if assessed as required, personal care for the elderly such as help with feeding and washing should be funded by general taxation. When the English Parliament responded in 2000, it did not accept this proposal but instead announced its intention to make nursing care available free of charge in care homes by funding it through the NHS (see NHS-funded Nursing Care). However the Scottish Parliament did elect to introduce free personal care for self-funding care home residents aged 65 and over, if they were assessed as needing these services.
Secondary care (or secondary healthcare)
Secondary care usually refers to care that is provided in a hospital setting rather than within the patient’s home community. Secondary care services are provided by a NHS Trust on an in-patient or out-patient basis as appropriate. Many, but not all, services are funded by the NHS. Funding of the same service will vary in different parts of the country, e.g. IVF fertility treatment is funded differently by different Trusts.
Compulsory detention in hospital or a secure unit under the Mental Health Act 1983. Typically Section 2 for Assessment and Section 3 for Treatment. See also Mental Health Act Assessment.
A resident living in a care home who funds the cost of their accommodation and personal care, sometimes jointly with the Local Authority. Residents who are self-funding qualify for NHS-funded Nursing Care if they are assessed as requiring the services of a registered nurse.
Severe disability addition (or severe disability payment)
An extra amount of Pension Credit, Income Support, Housing Benefit or Council Tax Benefit that is paid to a person who is severely disabled. If the person is looked after by a carer who claims Carer’s Allowance, the additional benefit will be lost. But if the carer claims a carer addition instead, the severe disability addition will still be paid.
Social care refers to the wide range of services designed to support people to maintain their independence, enable them to play a fuller part in society, protect them in vulnerable situations and manage complex relationships. It is provided by statutory and independent organisations and can be commissioned by a Local Authority’s Social Services Department on a means-tested basis, in a variety of settings. If a patient is assessed as qualifying for NHS Continuing Healthcare funding, then the NHS will fund social care as part of their overall care package.
Social services are provided by 150 Local Authorities in England through their Social Services Departments. Individually and in partnership with other agencies they provide a wide range of care and support for people who are deemed to be in need.
A professionally qualified Local Authority Social Services staff member who assesses the needs of service users and plans the individual care packages that support them.
An assessment undertaken by a clinician or other professional who specialises in a branch of medicine or care e.g. stroke, cardiac care, bereavement counselling.
Strategic Health Authority (SHA)
Statutory agency responsible for strategic planning and performance management of health services in their area. These health services are provided by the Primary Care Trusts within each SHA’s area. The Department of Health formed 28 SHAs in April 2002 to replace the 95 existing Health Authorities. In July 2006 the Department of Health reduced the number of SHAs to 10.
SHAs are responsible for:
- Developing plans for improving health services in their local area
- Making sure local health services are of a high quality and are performing well
- Increasing the capacity of local health services so they can provide more services
- Making sure national priorities such as programmes for improving cancer services are integrated into local health service plans.
The name given to a notional weekly income that is worked out on the value of a person’s savings and other capital. Tariff income is used by the Pension Service when calculating a person’s entitlement to Pension Credit and by a Local Authority when working out how much a care home resident should contribute to the costs of their care. The Pension Service and Local Authorities use different rules when calculating tariff income.
Last Updated 30/01/09
Disclaimer:
This information is not intended to amount to advice on which reliance should be placed. Cheselden therefore disclaims all liability and responsibility arising from any reliance placed on such materials by any reader of these glossary terms or visitor to our website, or by anyone who may be informed of any of its contents.
