The Department of Health and Social Care published a revision to the National Framework for continuing healthcare funding on 1 March 2018. This revision comes into effect on 1 October 2018. We analyse the changes and their impact.
What changes have been made in the revised National Framework for NHS Continuing Healthcare funding 2018 document?
Firstly it’s worth noting that fundamentally nothing has changed. The Department of Health and Social Care confirmed that it was not the intended remit of the updated version of the framework to alter the existing eligibility criteria for NHS Continuing Healthcare funding, “none of the 2018 amendments and clarifications to the National Framework, Practice Guidance, annexes or National Tools are intended to change the eligibility criteria for NHS Continuing Healthcare“.
That being said, there has been amendments made. The Department of Health have clarified that the 2018 National Framework is intended to:
1) provide greater clarity to individuals and staff, through a new structure and style
2) reflect legislative changes since the 2012 National Framework was published, primarily to reflect the implementation of the Care Act 2014,
3) clarify a number of policy areas.
Setting out that the majority of NHS Continuing Healthcare assessments should take place outside of acute hospital settings. This will support accurate assessments of need and reduce unnecessary stays in hospital.
In principle this makes sense as there is a clear rationale that a patient’s day-to-day health needs may not be accurately reflected in an assessment undertaken in hospital following an acute period of illness. However, there are clear and obvious concerns that this may result in significant delays in an assessment for NHS Continuing Healthcare being undertaken in the community following discharge. We have experienced circumstances whereby individuals have been informed by CCG’s (now ICB’s) that there are delays of up to nine months for checklist assessments to be undertaken when requested. This example highlights the risks of this change of policy.
Providing additional advice for staff on when individuals do and do not need to be screened for NHS Continuing Healthcare in order to reduce unnecessary assessment processes and respond to a call for greater clarity on this.
Examples provided within the updated National Framework of situations where it is not necessary to screen for continuing healthcare funding include where:
a) It has previously been decided that the individual is not eligible for NHS Continuing Healthcare, and it is clear that there has been no change in needs
b) It is clear to practitioners working in the health and care system that there is no need for NHS Continuing Healthcare at this point in time. Where appropriate/relevant this decision and its reasons should be recorded. If there is doubt between practitioners a Checklist should be undertaken
c) The individual has short-term health care needs or is recovering from a temporary condition and has not yet reached their optimum potential (if there is doubt between practitioners about the short-term nature of the needs it may be necessary to complete a Checklist).
The obvious concern in each of the situations listed above is that decisions will be made on a very subjective basis and we would suggest could lead to inconsistencies or be open to abuse by CCG’s who are inclined not to undertake assessments of individuals who ought to be assessed. We feel that this was one area in the previous National Framework that did not require clarification or amendment. The correct process for determining if an individual ought to be screened for a full continuing healthcare assessment via a decision support tool assessment is to undertake a checklist assessment and then establish if this meets the requirements for a full assessment. The current Framework allows for subjective decision-making by individuals to determine they don’t believe that NHS Continuing Healthcare is required, or that the current needs are short term or that the previously assessed needs haven’t changed, and therefore no checklist should be carried out.
Clarifying that the main purpose of three and 12 month reviews is to review the appropriateness of the care package, rather than reassess eligibility. This should reduce unnecessary re-assessments.
This is an exceptionally positive change to the current position, where reviews of continuing healthcare funding can be treated as an opportunity to remove funding being in place. We have experience of CCG’s stating that reviews are entirely new assessments and previous assessments that concluded primary health needs are present are not relevant and will not be considered. This is clearly incorrect and the clarification in the updated National Framework should go some way to reassure patients and their families.
Introducing new principles for CCGs regarding the local resolution process for situations where individuals request a review of an eligibility decision. The aim is to resolve such situations earlier and more consistently.
It is only positive that attempts have been made within the updated National Framework to clarify the local resolution process for appeals of decisions. It is unfortunately presently the case that CCGs often operate different systems and different time frames that can be wholly at odds to the process and structure set out by NHS England and within the National Framework.
Providing clearer guidance, including dedicated sections, on: the roles of CCGs and local authorities, NHS-funded Nursing Care, inter-agency disputes, well-managed needs, and the Fast Track Pathway Tool.
Any attempt to ensure greater acceptance and application of the clear processes set out by the National Framework for NHS Continuing Healthcare funding is to be welcomed. Our experience is that in practice many CCGs do not follow and adhere to the National Framework. We hope that this further revision of the National Framework and clear additional guidance should result in CCGs following and adhering to the National Framework. This would result in a far fairer process than sadly can often be the experience encountered by many patients.
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