NHS CHC Half Day Training Presentation


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NHS CHC Half Day Training Presentation

  1. 1. NHS Continuing Healthcare Half-day Awareness TrainingTrainer: Steven Pruner
  2. 2. Housekeeping Introduction Ground rules – confidentiality Fire alarms, breaks, mobiles, toilets, evaluation forms Objectives 2 Continuing Healthcare
  3. 3. Agenda Health Care versus Social Care NHS Continuing Healthcare – Framework & Practice NHS Continuing Healthcare – The Tools Primary Health Need 3 Continuing Healthcare
  4. 4. Health vs. SocialCare National Care Service? No…. NHS Act 1946 (cradle to grave) National Assistance Act 1948 (the left-overs) 4 Continuing Healthcare
  5. 5. Health vs. SocialCare Two Care Services NHS Social Care Free at point of use Means-tested Non-means tested FACS criteria Can legally provide Cannot legally health and social care provide healthcare Both services rationed but differently 5 Continuing Healthcare
  6. 6. Health vs. SocialCare Some History 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.) 6 Continuing Healthcare
  7. 7. Health vs. SocialCare HEALTHCARE NEED: 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 …” (PG4.11) SOCIAL CARE NEED: 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, accessing a care home or other supported accommodation”. (PG4.11) 7 Continuing Healthcare
  8. 8. 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 8 Continuing Healthcare
  9. 9. Vocabulary 1EXERCISE Continuing Care Continuing Healthcare (CHC) NHS-Funded Nursing Care (FNC) 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. EligibilityBASED ON LEVEL OF CARE NEEDS 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 11 Continuing Healthcare
  12. 12. 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) 12 Continuing Healthcare
  13. 13. Framework: ProcessFLOW CHART from NF page 18 13 Continuing Healthcare
  14. 14. 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 14 Continuing Healthcare
  15. 15. 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. 15 Continuing Healthcare
  16. 16. 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) 16 Continuing Healthcare
  17. 17. 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 17 Continuing Healthcare
  18. 18. 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) 18 Continuing Healthcare
  19. 19. 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 19 Continuing Healthcare
  20. 20. 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) 20 Continuing Healthcare
  21. 21. 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. 21 Continuing Healthcare
  22. 22. 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 22 Continuing Healthcare
  23. 23. ChecklistEXERCISE 2 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. 23 Continuing Healthcare
  24. 24. 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 24 Continuing Healthcare
  25. 25. 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 25 Continuing Healthcare
  26. 26. 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) 26 Continuing Healthcare
  27. 27. 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. 27 Continuing Healthcare
  28. 28. 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 28 Continuing Healthcare
  29. 29. 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) 29 Continuing Healthcare
  30. 30. 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 30 Continuing Healthcare
  31. 31. 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 31 Continuing Healthcare
  32. 32. 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) 32 Continuing Healthcare
  33. 33. 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 33 Continuing Healthcare
  34. 34. 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 34 Continuing Healthcare
  35. 35. 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
  36. 36. 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