The National Service Framework for Continuing Care
What is Continuing Care?
On 1 October 2007 the government introduced a new national framework for determining eligibility for NHS Continuing Healthcare across England. This aims to provide fairer access to NHS funding, eliminating variations in local criteria, so that everyone has an equal chance of having all their care needs met by the NHS.
Continuing Care is defined in the framework as care provided over an extended period of time to an adult to meet physical or mental health needs arising from disability, accident or illness. If the main need for care relates to health, the NHS is responsible for providing for all care needs ("fully funded NHS care"), which could mean free NHS Continuing Healthcare rather than having to pay for local authority community care support. There have been several successful challenges to funding decisions recently which mean that more people are able to claim continuing care. Since October 2007 all Strategic Health Authorities and Primary Care Trusts in England have had to comply with the National Service Framework and adopt the new national eligibility criteria.
To be eligible for continuing care, the patient’s main need must relate to their health. This is likely to be a complex medical condition requiring lots of care and support such as highly specialised nursing support. Someone approaching the end of their life is also likely to be eligible, if they have a condition that may be terminal. NHS Continuing Healthcare may be provided in any setting: home, care or nursing home.
Initial screening is carried out by a qualified health professional or social worker using the NHS Continuing Healthcare Needs Checklist. This decides if the person should be referred for a full assessment, carried out by a multidisciplinary team of health and social care professionals, using a 'decision support tool'.
Both the NHS Continuing Healthcare Needs Checklist and Decision Support Tool are avaliable to download from the NHS Direct website
As well as the person’s nursing care needs, physical, mental, psychological and emotional needs are assessed. The NSF says that the decision is about the patient’s health care needs, not diagnosis, so PCTs cannot make blanket decisions to exclude people with particular diagnoses, but must assess them as individuals. Some people will be assessed as being eligible for a package of continuing care jointly funded by health and social services.
Those supporting carers should familiarise themselves with the initial checklist: showing that enough checklist criteria are met is the way in to continuing care. The NSF says: "When your assessment is carried out, you and, where appropriate, your carer will be consulted." There are many further mentions of carers in paras 32 onwards, which talk about ensuring carers "understand the process, and receive advice and information to enable them to participate in informed decisions about their future care." Also, "Any person may elect a family member or other person (who should be independent of LA or NHS body) to advocate on their behalf. Even where this is not the case, the views and knowledge of family members may be taken into account, where consent has been given to seek these views." And, "PCTs and LAs should bear in mind that a carer providing regular and substantial care has a right to an assessment of their needs as a carer."
PCTs have historically had less involvement in supporting carers than councils, so this is an area of work that will need to develop to ensure smooth care pathways for carers.