National Framework for NHS Continuing Healthcare and NHS funded Nursing Care

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National Framework for NHS Continuing Healthcare
and NHS funded Nursing Care

• Introduction and Processes

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Overall Objective

• To have a basic understanding of NHS continuing
  healthcare and NHS funded nursing care.
• To gain an awareness of where it sits within
  local processes and how eligibility is
  determined.
• To gain an understanding of the national tools
  and when and where to use them especially in
  relation to screening.
• To enable practitioners to have sufficient skills
  and understanding to undertake assessments.
• To enable you to cascade this briefing to your
  teams

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Myth-bustingExercise (10min)
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Introduction to the National Framework

• The National Framework maps out an overall
  process for England for NHS Continuing Healthcare
  and NHS Funded Nursing Care
• It maps out a process for determining
  eligibility.
• It introduces a set of national tools to support
  and improve consistency in decision making.
• It sets one band for NHS funded nursing care

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Why is this different?

• One framework instead of 28 different sets of
  criteria
• One set of national tools instead of more than 28
  different ways of documenting decisions
• One flat rate (101/week) for nursing care
  instead of three bands. Current patients on high
  band will remain funded at that level until
  reviewed.
• Terminology
• Levels 1 4 replaced by social care, joint
  funded, continuing healthcare

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Definitions

• Continuing Care
• NHS Continuing Healthcare
• NHS Funded Nursing Care
• See Information Pack

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The headlines Key Messages

• The Framework (for all adults) is a change in
  system that will require PCTs and LAs to think
  and act differently
• NHS Continuing Healthcare is a funding stream
• Whatever someones ongoing health and social care
  needs, they still need to be met but NHS
  Continuing Care should always be considered in
  the first place
• The Framework is the first step in making
  continuing care easier for the people who work in
  it and those who are being assessed for it
• We do expect there to be more people eligible for
  full funding
• Timescales for informing individuals, carers,
  representatives not to exceed 2 weeks.

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The process
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COORDINATING THE PROCESS

• Ownership of process beginning to end
• Identify individuals who should be assessed
• Identify if an individual needs to be
  fast-tracked
• Identify all professionals involved in the care
  of the user who may contribute to the assessment
• Complete documentation accurately, clearly and
  comprehensively
• Ensure appropriate care plan put in place
• A Care Coordinator involved in the assessment
  process needs to be identified to help this
  process run smoothly

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The tools

• NHS Continuing Healthcare Checklist
• Fast Track Pathway tool for NHS Continuing
  Healthcare
• Decision Support tool for NHS Continuing
  Healthcare
• NHS funded nursing care documentation
• We must use the National Tools except for the
  Fast Track Pathway tool, which we have developed
  locally.

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NHS Continuing Healthcare Checklist

• When ?
• Hospital discharge planning or initial assessment
  or review or change in needs.
• There are 11 Care Domains (these are the same as
  Decision Support Tool DST) see later slide
• Look at the Checklist provided to you
• Ensure all eleven care domains have a tick in one
  of the three boxes
• A. Meets or exceeds described level
• or
• B. Borderline or close to described level
• or
• C. Does not meet level

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Refer those for full assessment

• Where
• Two or more ticks in column A
• Five or more ticks on column B or one tick in A
  and four in B
• Any tick in column A with an asterisk ( the
  domains which carry a priority level in the DST)
  see later slide
• There may be other circumstances where
  professional judgements overrules the checklist.
• Rationale for decision box must be completed
  legibly (dont forget to sign and date the form)

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Fast track pathway

• Only for those individuals with a rapidly
  deteriorating condition which may be entering a
  terminal phase characterised by an increasing
  level of dependency.
• They need an immediate decision on eligibility
  to be made so that their immediate needs can be
  met.
• Careful decision making is essential to
  avoid undue distress that might result from a
  person moving into and out of NHS continuing
  Healthcare within a very short period of time.

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Fast Track local pathway

• Fast Track Pack
• Are eligibility criteria met?- GSF Yellow.
• Patients/Carer aware of Fast Track Process.
• Patient informed of options.
• Referral form to be completed in full. Rationale
  section to be completed and signed by Doctor,
  Specialist Nurse or District Nurse in liaison
  with GP.
• Identify needs and agree care plan- liase with
  Fast Track team.
• Refer to Fast Track Teams by phone/fax referral
  form.
• Community referrals City Fast Tract Team will
  arrange and commission care package . County Fast
  Track referrals - refer to District Social
  Services for Home care.
• Full assessment at earliest opportunity if not
  already completed. ( Locally- reassessments occur
  with in 12 weeks )

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Decision Support Tool(DST) - What is it?

• The decision support tool, following assessment,
  enables practitioners to
• Inform consistent decision making in line with
  the primary health need approach
• Sets out the evidence in a detailed needs based
  format
• Requires practitioners to use their professional
  judgement to justify how and why a recommendation
  is made
• Clarifies the evidence used to make the decision
• A Care Coordinator will be responsible to work
  with the MDT to complete the DST (local managers
  will keep you advised on how this will work on
  the ground)

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What its NOT !

• Another assessment
• A decision MAKING tool (it supports professionals
  to make the decision)
• A substitute for professional judgement

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What are the 11 Care Domains on the DST?

• Behaviour
• Cognition
• Psychological Emotional needs
• Communication
• Mobility
• Nutrition

• Continence
• Skin Tissue Viability
• Breathing
• Drug Therapies Medication Symptom control
• Altered States of consciousness

Other significant care needs can be
identified/included on the DST Asterisk
PRIORITY
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Levels

• Each domain is divided into levels describing a
  hierarchy of need
• Each level is given a weighting (not score)
• no needs, low, moderate, high, severe, priority.
  
• Not all domains have the same weighting based
  on principle that some domains reflect health
  needs more than others

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Establishing a Primary Health NeedComplexity,
intensity, unpredictability
L
E
V
E
L
S
COMPLEXITY
INTENSITY
D O M A I N S
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Using the Decision Support Tool

• DST should be used to capture the range of
  assessments to reflect the patients identified
  needs and should NOT be used as an assessment
  tool.
• Rational for decisions should be documented
  clearly for each domain.
• Evidence should be provided to support each
  decision making reference to supporting
  assessments.
• Paraphrasing the levels descriptions should be
  avoided.
• Where evidence is not available further
  assessment may be required.

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Consistent applicationof DSTs

• Nurse Assessor will co-ordinate MDT assessment
  and meeting to complete of DST.
• The MDT will make recommendations ONLY using the
  DST guided by the Nurse Assessor.
• Evidence will be provided to support
  recommendations.
• Completed DSTs, assessments and evidence will be
  presented to MDT Commissioning Panel where
  recommendation will be considered and ratified if
  appropriate.
• Panel may request more info if the supporting
  assessments are insufficient to make decisions.

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Reviews

• After 3 months
• Annually thereafter (at a minimum)
• When there is a change of needs
• Involve the individual, family or carer
• Outcome to PCT Commissioning Team

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Evidence

• Comprehensive
• Current
• Clear care plans/ management plan
• Intervention by whom qualified or unqualified
• Duration
• Number of carers
• Number of incidents and action taken
• Whether need managed or unmanaged
• Does intervention reduce problem or not
• What other avenues have been explored i.e.
  further NHS assessment

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Communications with Patients, Families and Carers

• All the way through the process
• Written confirmation of final decision with
  detailed rationale
• Within 14 days of assessment
• Documented in files

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City PCT Contacts
Commissioning Team Contacts Tel [phone]
ext 39542 / 39546 Fax [phone] Referral
Point for Continuing Care Team Tel 0115
9691777 Fax [phone] Fast Track/May
Scheme Tel [phone] Fax [phone]
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County tPCT Contacts

• Commissioning Team
• Tel [phone] ext 4630
• Fax [phone]
• Referral Point for Assessment Team
• Tel [phone]
• Fax [phone]
• Fast Track
• Tel [phone] ext 4655 or 4694
• Fax[phone]

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Further Training Resources

• Will be available on the Change Agent website
• www.changeagentteam.org.uk

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• ANY QUESTIONS?