The NHS has updated its public information booklet on NHS continuing healthcare and NHS-funded nursing care further to the review of the National Framework that took place from October 2008. The new leaflet reflects the changes made to the National Framework in the revised version that was published in July 2009. Although the basis for eligibility decisions and the overall principles of continuing care remain the same, the tools used during the assessment process have changed slightly to give greater clarity about types and levels of patient need. The tools also require more information to be completed; in particular, input from the patient, their relatives or carers, who should be closely involved throughout the assessment process. The main change is to the Fast Track Pathway Tool, which is completed by an appropriate clinician who considers that a patient’s condition is rapidly deteriorating and may be terminal. The PCT is now obliged to fund continuing care for the patient upon receipt of the completed Pathway Tool – it could previously use its discretion – until such time as a full assessment can be carried out. As well as changes to the decision-making tools, the review process has also been clarified. You can download the new NHS leaflet in PDF format by clicking here.

From 1 October 2009, the changes made in the revised National Framework became mandatory for all PCTs and NHS Trusts in England. Under the National Health Service Act 2006, the NHS has now issued revised NHS Continuing Healthcare (Responsibilities) Directions and Delayed Discharge (Continuing Care) Directions to all PCTs and NHS Trusts. These documents can also be downloaded from the DoH website.

posted by Cheselden Continuing Care at
14:47

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.

posted by Cheselden Continuing Care at
14:09

Care services minister Phil Hope reveals that the National Framework for continuing care, introduced in October 2007, has not achieved its goal of abolishing the ‘postcode lottery’ of care in England. There is still widespread variation in the proportion of people who receive funding for long-term care. Figures released by Mr Hope show that numbers receiving funding vary from 8.9 per 50,000 population in South East Essex PCT to 105.8 per 50,000 in Ashton, Leigh and Wigan PCT. The average figure for the country is 40 people per 50,000 population. The charity Age Concern has responded to Mr Hope’s figures by calling for closer monitoring of those PCTs with unusually low or high levels of funding. It also urges trusts to check that health professionals in their area have been trained in using the Framework.

This news comes as the Government undertakes a review of the Framework, which was designed to end the ‘postcode lottery’ of care funding by introducing a single national standard to be followed by all PCTs. Although this effect has yet to take place, the National Framework has achieved one of its aims, as there has been an overall increase in the numbers of people receiving fully-funded care in 2008-9.

posted by Cheselden Continuing Care at
16:21