National Framework for Free NHS Continuing Care

In my last article on the subject I confirmed that on June 26th The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care had been published. This document was seen as a significant step towards addressing the considerable difficulties, inconsistencies and lack of fairness so often associated with continuing care.

In addition I would add that people often experience difficulties securing a referral for a Continuing Care Assessment in the first place! (Ask your GP to refer you). In addition many people I talk to are frustrated that NHS funding is not available as a Direct Payment, in effect limiting their choice of care package to an established Care Provider.

The Association of Directors of Social Services (ADASS) have just published advice for Local Authorities in respect of the Framework to achieve constancy on a national basis and ensuring that people receive (free) NHS care when entitled to it.

It is interesting that they foresee a significant increase nationally in the number of people receiving full NHS Continuing Healthcare Funding and a significant increase in the number of people whose care and support is funded jointly by the Local Authority and NHS.

The ADASS stress the importance of Local Authorities appointing a named lead officer for NHS Continuing Healthcare and ensuring professional staff are trained in the use of the eligibility Checklist and Decision Support Tool contained within the Framework. (SCI people should familiarise themselves with these two tools as they will be used during any assessment)

The Checklist is intended to have a low threshold and to ensure that everyone who should be is considered for NHS Continuing Healthcare, whereas the Decision Support Tool is designed to establish whether they actually are eligible. It is likely that anyone who crosses the Checklist threshold, who is ultimately deemed not to be eligible for NHS Continuing Healthace, is likely to have their care jointly funded by the Local Authority and the NHS.

The ADASS go on to say that anyone found to have two or more high needs and three or more moderate needs using the Decision Support Tool, then this would normally indicate a Primary Health Need and should therefore be considered beyond the scope of Local Authority provision (i.e. eligible for NHS Continuing Care). The ADASS strongly recommend a 24-hour diary of needs and interventions be compiled to form part of the assessment documentation so SCI people may wish to prepare this ahead of the panned assessment.

Perhaps more interestingly still the guidance states that it is unlawful for Local Authorities to provide/purchase or charge for care which should be the responsibility of the NHS under Continuing Healthcare Criteria. SCI people should point this out to their Social Worker if they are currently in receipt of means tested Social Care funding and pursuing NHS Continuing Care funding

Helpfully the ADASS paper identifies 3 cases that were decided in the court or adjudicated by the Health Service Ombudsman. These cases give a clear indication of where the correct line between Local Authority and NHS responsibility lies in those particular circumstances. The ADASS advise that where an individual has genuinely similar needs to those outlined in these cases then the same eligibility decision (for NHS Continuing Care) should be the outcome of the assessment. This will be the case regardless of the outcome of the Continuing Care Assessment

One of the 3 cases listed is Pamela Coughlan (C5/6). The court found that her needs were primarily health needs for which the NHS is, as a matter of law, responsible. (Click here to see a summary of Pamela's care regime)

The ADASS guidance supports my view that someone with tetraplegia is entitled to expect free NHS Continuing Care.

To see where your PCT ranks in terms of the number of NHS Funded Continuing Care Packages click here.

References

¹ The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care, June 26th, 2007.

Click to see article.

² Association of Directors of Social Services Commentary and Advice for Local Authorities on National Framework for NHS Continuing Healthcare and NHS funded Nursing Care.

http://www.adass.org.uk/publications/guidance/commentary.pdf