NHS CHC Full Day Training Presentation


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NHS CHC Full Day Training Presentation

  1. 1. NHS Continuing HealthcareTrainer: Steven Pruner
  2. 2. Housekeeping Introduction Ground rules – confidentiality Fire alarms, breaks, mobiles, toilets, evaluation forms Objectives & Goal Setting 2 Continuing Healthcare
  3. 3. Agenda Health Care versus Social Care NHS Continuing Healthcare – Framework & Practice Primary Health Need NHS Continuing Healthcare Tools 3 Continuing Healthcare
  4. 4. Health vs. SocialCare NHS Act 1946 National Assistance Act 1948 --------- NHS has a history of providing social care Large NHS institutions for OP, LD, MH 1980s’ closure programme: people moved into the community from free NHS care to means-tested social care Historically, LA care homes were for the frail, vulnerable, confused – now most care homes are in the independent sector, mainly for those very unwell (The LA is now looking after people who in the past would have been in NHS institutions.) 4 Continuing Healthcare
  5. 5. Health vs. SocialCare HEALTH: No legal definition of a healthcare need “in general terms can be said that such a need is one related to treatment, control or prevention of disease, illness, injury or disability, and the care or aftercare of a person with these needs (whether or not the tasks involved have to be carried out by a health professional)”. (PG4.11) SOCIAL CARE: In general terms a social care need “is one that is focused on providing assistance with activities of daily living, maintaining independence, social interaction, enabling the individual to play a fuller part in society, protecting them in vulnerable situations, helping them to manage complex relationships and (in some cases) accessing a care home or other supported accommodation”. (PG4.11) 5 Continuing Healthcare
  6. 6. Social Care Social care needs which are directly related to welfare services that LAs have a duty or power to provide, including: Social work services Provision of meals Advice, support, Facilities for information occupational, social, Practical assistance in cultural, recreational the home activities outside the Assistance with home equipment & home Assistance to take adaptations advantage of educational Visiting & sitting facilities services Assistance with finding accommodation 6 Continuing Healthcare
  7. 7. Health Care Health care needs are related to: Diagnosis, treatment, control or prevention of disease, illness, injury or disability Who Pays? Health care is free at point of delivery Social care is means-tested and subject to FACS criteria If someone is eligible for NHS CHC, the NHS is responsible for meeting both health and social care needs. 7 Continuing Healthcare
  8. 8. Vocabulary 1EXERCISE Continuing Care Continuing Healthcare (CHC) NHS-Funded Nursing Care (FNC) 8 Continuing Healthcare
  9. 9. Documents NHS Continuing Healthcare Fast Track Tool and NHS-funded Nursing Ordinary Residence care – Public Information booklet Who Pays? Responsible Commissioner National Framework for NHS Continuing Healthcare NHS CHC (Responsibilities) Directions 2009 National Practice Guidance (CHC) Delayed Discharges (Continuing Care) Directions National Practice Guidance 2009 (FNC) NHS (Nursing Care in Refunds Guidance Residential Accommodation) (Amendment) (England) Checklist Directions 2009 Decision Support Tool NHS CHC Training Materials 9 Continuing Healthcare
  10. 10. What is it?NHS Continuing Healthcare Package of care arranged and funded solely by the NHS Can receive it in any setting Free Different from NHS-Funded Nursing Care Have to meet eligibility criteria: demonstrate “primary health need” 10 Continuing Healthcare
  11. 11. EligibilityNHS Continuing Healthcare Have to undergo an assessment for CHC and be found eligible under the criteria Not based on particular disease, diagnosis or condition, or where the care is provided Based on the level of care needs the nature, intensity, complexity, or unpredictability of the care needs determines eligibility Primarily health need rather than primarily social care need 11 Continuing Healthcare
  12. 12. EligibilityOTHER ISSUES Eligibility is not based on (NF49): Diagnosis Setting of care Provider ability to manage care Use or not of NHS staff The need for specialist staff That a need is well managed Existence of other NHS-funded care Any other input-related rationale (opposed to needs- related) 12 Continuing Healthcare
  13. 13. What is your role?MULTI-DISCIPLINARY TEAM (MDT) To participate in the determination process to: Complete your own professional assessment and report Engage with other MDT members to discuss care needs based on the MDT assessments / reports Assist to complete the DST, weighing up the level of care needs on each care domain Apply the Primary Health Needs test and make a recommendation on eligibility 13 Continuing Healthcare
  14. 14. Core ValuesPRINCIPLES Person-centred approach (NF 33, PG 2.3) Consent (NF 36, PG 2.3.4) Capacity (NF 39, PG 3.2) Advocacy (NF 43, PG 3.6) 14 Continuing Healthcare
  15. 15. Framework: ProcessFLOW CHART from NF page 18 15 Continuing Healthcare
  16. 16. Framework: ProcessSteven’s Simplified Version Fast Track Tool YES Use Fast Track Tool NOT Required Checklist NOT Eligible Care Package: LA, PCT, Private or Joint YES Consideration MDT Identified: DST Completed Do Assessments MDT Recommendation to PCT NOT Eligible Care Package: LA , PCT, Private or Joint YES Eligible PCT Validation (Panel) NOT Eligible Care Package: LA, PCT, Private or Joint YES Eligible 16 Continuing Healthcare
  17. 17. Primary NeedsHEALTH or SOCIAL CARE? 17 Continuing Healthcare
  18. 18. Primary Health NeedLEGAL VIEW Primary health need arises when nursing or other health services required by the person are a) where the person is, or is to be, accommodated in a care home, more than incidental or ancillary to the provision of accommodation which a social services authority is, or would be but for the person’s means, under a duty to provide; or b) of a nature beyond which a social services authority whose primary responsibility is to provide social services could be expected to provide. (NF22) 18 Continuing Healthcare
  19. 19. Primary Health NeedLEGAL VIEW The Coughlan Judgment (1999) R v North and East Devon Health Authority, ex parte Pamela Coughlan About the respective responsibilities of NHS and social care regarding nursing care. Court of Appeal said: NHS is not responsible for all nursing care No precise legal line between health & social care services Local authority can provide nursing care that is: a) merely incidental /ancillary to provision of accommodation or b) of a nature which it can be expected to provide under NA Act 1948 This is the quantity/quality test. 19 Continuing Healthcare
  20. 20. Primary Health NeedLEGAL VIEW The Grogan Judgment (2006) R v Bexley NHS Trust, ex parte Grogan Eligibility criteria used did not comply with Coughlin judgment and the level of nursing needs in the Medium and High Band of the RNCC indicated a primary health need. The judge said: Can be an overlap, or a gap, between health and social care depending on test applied Should be no gap in those “health” services provided by NHS and social care PCT did not apply criteria which identified the test used to determine primary health need 20 Continuing Healthcare
  21. 21. Primary Health NeedTHE TEST Each of these characteristics may, in combination or alone, demonstrate a primary health need, because of the quality and/or quantity of care required to meet the individual’s need. NICU NATURE Type of needs, overall effect, type (quality) of interventions INTENSITY Extent (quantity) and severity (degree) of needs and need for regular interventions COMPLEXITY How different needs arise and interact to increase skill needed to manage / monitor UNPREDICTABILITY Unexpected changes in condition which are difficult to manage; degree of risk and timeliness of intervention 21 Continuing Healthcare
  22. 22. NICUEXERCISE 2 Go to NF page 10. Read each of the characteristics of PHN. What kinds of questions would you consider under each characteristic of PHN to capture what is being assessed? 1) Compare answers to PG page 23 22 Continuing Healthcare
  23. 23. DeterminingEligibilityTHE TOOLS Fast Track Pathway Tool Checklist Decision Support Tool 23 Continuing Healthcare
  24. 24. Using the ToolsWHERE and WHEN? Fast Track Pathway Tool Usually in hospital (PG 5.12) Action by PCT within 48 hours (PG 5.11) Checklist & Decision Support Tool Preferably not in an acute setting (NF 60, PG 6.4) After all treatment and rehab completed (PG 6.4) Section 2 and 5 Notifications After CHC process has been concluded (PG 7.1) 24 Continuing Healthcare
  25. 25. Fast Track PathwayTool DECISIONFAST-TRACK Elements to consider: (1) rapidly deteriorating condition that (2) may be entering a terminal phase (3) with an increasing level of dependency Appropriate clinician (consultant, registrar, GP, nurse) with appropriate level of knowledge or experience Supported by prognosis, if possible (but length of time left to live does not determine eligibility) Recommendation sent to PCT: should be accepted for urgent package of care 25 Continuing Healthcare
  26. 26. Fast Track PathwayToolFAST TRACK PATHWAY TOOL Clinician should consider the definition of a Primary Health Need when outlining why it is considered that the individual has a rapidly deteriorating condition that may be entering a terminal phase 26 Continuing Healthcare
  27. 27. ChecklistSCREENING TOOL Consent should be obtained, explain process, give leaflet Completed by health or social care professional Threshold deliberately set low Used to identify who needs a full assessment of eligibility Should be offered to be involved and have representative present Be informed of the outcome and next steps in WRITING with a copy of the Checklist (NF 66, PG 6.7) 27 Continuing Healthcare
  28. 28. ChecklistOUTCOME A full assessment is required if: 2 or more domains in column A (HIGH needs) 5 or more domains in column B, or 1 A and 4 in B (MODERATE needs) 1 domain in column A which carries a PRIORITY need PROCESS: Checklist sent to PCT who is responsible for coordinating the whole process (NF 67, PG 6.8) NOTE: It does not mean that if someone is referred on to the full process that they will be eligible. The threshold is low. It is only to be referred for full consideration. 28 Continuing Healthcare
  29. 29. ChecklistSCREENING TOOL Based on the 11 specific care domains on the DST For each domain, descriptions represent “no and low”, “moderate” and “high” needs Select description that closely matches current needs Evidence of needs should be available C B A Behaviour * Cognition Psychological 29 Continuing Healthcare
  30. 30. ChecklistEXERCISE 3 Behaviour Report (from nursing notes): Occasional episodes of challenging behaviour when providing personal care and toileting; usually shouts “leave me alone”; has only thrown a cup once; never strikes out. Episodes much less frequent now, e.g. x1 on 24/05/10 and x1 on 5/6/10. This was contributed to by other issues on ward and time. Mr W. is able to be diverted and reassured. Also at these times he will accept PRN meds if necessary. 30 Continuing Healthcare
  31. 31. Decision SupportToolDECISION MAKINGINFORMED Coordinator identified; MDT is brought together, made up of 2 or more health and social care professionals Involve the individual or their representative With consent, the assessment process is undertaken and specialist assessments obtained if necessary (mental health nursing needs) MDT, ideally with the individual or their representative, meet and complete the DST together, domain by domain 31 Continuing Healthcare
  32. 32. Decision SupportToolDECISION MAKINGINFORMED Information collected during the assessments used to complete the DST Purpose of DST is help decide: NATURE INTENSITY COMPLEXITY UNPREDICTABILITY DST has 11 specific domains and one “other” = 12 in total 32 Continuing Healthcare
  33. 33. Decision SupportTool12 CARE DOMAINS 1. Behaviour * 2. Cognition 3. Psychological & Emotional 4. Communication 5. Mobility 6. Nutrition 7. Continence 8. Skin 9. Breathing * 10.Drug Therapies * 11.Altered States of Consciousness * 12.Other 33 Continuing Healthcare
  34. 34. Decision SupportToolLEVELS OF NEEDEach domain broken down into between 4 and 6 levels of need no need low moderate high severe priority See NF page 23, Figure 2 for relationship between level of needs and PHN (intensity, complexity, unpredictability) 34 Continuing Healthcare
  35. 35. ChecklistEXERCISE 4 Behaviour Report (from nursing notes): Occasional episodes of challenging behaviour when providing personal care and toileting; usually shouts “leave me alone”; has only thrown a cup once; never strikes out. Episodes much less frequent now, e.g. x1 on 24/05/10 and x1 on 5/6/10. This was contributed to by other issues on ward and time. Mr W. is able to be diverted and reassured. Also at these times he will accept PRN meds if necessary. 35 Continuing Healthcare
  36. 36. MAKING ADECISIONPRIMARY HEALTH NEED Role of MDT is to make a decision on eligibility Inform the PCT of that decision (recommendation) Recommendation of eligibility would be expected by the MDT where there is: one priority level of need two or more severe levels of need Recommendation of eligibility may be expected where there is: one severe with a number of needs in other domains a number of domains with high and/or moderate needs Judgment of PHN is based on evidence All “no needs”; all “low needs” = unlikely PHN 36 Continuing Healthcare
  37. 37. MAKING ADECISIONTHE RATIONAL Rational shows the reasoning for the recommendation Must address: Nature, Intensity, Complexity, Unpredictability See Practice Guidance 8.10 DST supports decision-making (not an assessment tool) Evidence / reports must be attached Everyone in MDT signs and dates Recommendation sent to PCT 28 days from referral (Checklist) to decision (acceptance of MDT recommendation by PCT) 37 Continuing Healthcare
  38. 38. PCCHCT PANELS PCTs do not have to use a panel, but where they do, it is to check for consistency and quality of decision making (NF 80, PG 9.1 to 9.3) PCT can ask the MDT to carry out further work (NF 81) PCT should not make a decision without a recommendation from the MDT (NF 82) Checklist, DST, Reports, Recommendation to relevant PCT Mid Essex: June Murphy 0300 123 8095 Fax: 0300 123 8096 NE Essex: Sue Chan 01206 286758 Fax: 01206 286763 SE Essex: Nicky Justice 01702 226550 Fax: 01702 224666 SW Essex: Jan Crozier 01277 695502 Fax: 01277 695221 W Essex: Beau Klusko 01992 566132 Fax: 01992 566133 38 Continuing Healthcare
  39. 39. ELIGIBLEWHAT HAPPENS? PCT becomes responsible for care planning, commissioning & funding The PCT will decide how best to meet assessed needs Require a nursing care home? Can express preferences, but do not have the right to choose location or specific care home Remain at home? PCT will consider if needs can be met there It cannot be provided through Direct Payments If at home, informal carer? Carers’ Assessment 39 Continuing Healthcare
  40. 40. ELIGIBLEAFFECT ON BENEFITS If receiving NHS CHC in a care home (self-funder or not), will lose Attendance Allowance and Disability Living Allowance If receiving NHS CHC in your own home, can keep AA and DLA State Pension not affected; pension credit may be affected if you are receiving the severe disability element of the pension credit 40 Continuing Healthcare
  41. 41. REVIEWSTILL ELIGIBLE? Review held 3 months after initial eligibility (Fast Track or DST route) At 3-month review, could be found not eligible if PHN not demonstrated After 3 month review, subject to an annual review (minimum) 41 Continuing Healthcare
  42. 42. FUNDED NURSINGCARE ELEMENT IN CARE HOMEPAYS FOR NURSING Not eligible for NHS Continuing Healthcare Paid directly to nursing home: £108.70 per week Cover cost of register nurse who may be providing: Direct nursing care Supervision / monitoring of care provided by non- registered nurse Planning & reviewing care plans Monitoring & reviewing medication Identifying & addressing potential health problems 42 Continuing Healthcare
  43. 43. APPEALLOCAL and INDEPENDENT REVIEW PANEL If found not eligible, can appeal: 1. PCT - Attempt local resolution first 2. SHA - Independent Review Panel 3. Health Service Ombudsman 43 Continuing Healthcare
  44. 44. END OF LIFE CARE Fast Track Pathway Tool to get an immediate decision on eligibility, if PHN demonstrated Subject to 3-month review IMPORTANT: PHN still needs to be demonstrated: Nature, Intensity, Complexity and Unpredictability If eligible: should have choice about where the care will be delivered 44 Continuing Healthcare
  45. 45. ODDS &SODS If you go into a nursing home for 6 weeks or less, you will qualify for NHS funding (nursing respite or emergency placement because your carer is ill) – must be agreed with PCT first If receiving FNC and you go into hospital, FNC stops during your stay in hospital 45 Continuing Healthcare
  46. 46. QUESTIONSMORE INFORMATION Department of Health website Age UK Counsel and Care Citizens Advice Bureau PCT / NHS services 46 Continuing Healthcare
  47. 47. Twelve Golden Quality PrinciplesThe people of Essex have identified twelve key quality principles they expect ; the aim for the organisation is to achieve consistently high targets relating to these principles1. I know where to find the information I need about options for care and support2. My communication needs are understood and addressed3. My dignity has been respected at all times4. I am given enough time and help to express my needs and wishes and to identify desired outcomes5. I am supported to make my own decisions about my care6. My preferences relating to culture, ethnicity, religious beliefs and sexuality are considered7. I am satisfied with the quality of service I am receiving8. I feel in control of the services and support I receive9. I live my life free from abuse and harassment10. My quality of life has improved since receiving/managing my support11. I have enough help and support to maintain my independence12. I am achieving (have achieved) the personal goals set out in my support plan
  48. 48. The Dignity ChallengeHigh-quality services that respect people’s dignity should: 1. Have a zero tolerance of all forms of abuse 2. Support people with the same respect you would want for yourself or a member of your family 3. Treat each person as an individual by offering a personalised service 4. Allow people to maintain the maximum possible level of independence, choice and control 5. Listen and support people to express their needs and wants 6. Respect people’s right to privacy 7. Ensure people feel able to complain without fear or retribution 8. Engage with family members and carers as care partners 9. Assist people to maintain confidence and a positive self-esteem 10. Act to alleviate people’s loneliness and isolation