1. NHS CONTINUING HEALTHCARE Process Oct 2018(revised)

2. What is Continuing Healthcare Funding? (CHC)
CHC is a package of care for adults (age 18 and over)which is arranged solely through CHC.
It can be in any setting including own home.
Is not based on diagnosis or condition.
Free at the point of delivery
Briefly refer to children healthcare funding:
Explain it is not based on who delivers care: e.g. could be agency in community, untrained staff overseen by RN

3. Assessed Healthcare Needs Associated Social Care Needs
WHAT IS PROVIDED?
Assessed Healthcare Needs
Associated Social Care Needs
Care home fees (if applicable)
No Hotel fees; rent and nursing care

4. The CCG – THE RESPONSIBLE COMMISSIONER
This is the responsible Care Commissioning Group in the area the person is registered with a GP.
For example if the person lives in Sevenoaks, but is registered with a GP in Bromley.
Bromley will be the responsible CCG.
Therefore the completed Checklist would be sent to the Bromley CCG.

5. CHECKLIST: Screening Tool
11 Domains; three levels, A,B, or C.
Minimum Data set must be completed.
Remember to complete all parts of the checklist and to sign and date.
Complete the Ethnicity monitoring as this is audited.
Rationale for Decision with all supporting evidence.
ed to
Emphasise a positive checklist does not mean Eligibility !

6. When not to complete:
Where it is clear there is no need for NHS Continuing Healthcare at this time
Where the individual is recovering from a temporary condition and not reached their optimum potential (e.g. dialysis, rehab) or in an acute setting.
The CCG has agreed the individual should be referred for a full CHC assessment and by-passing the checklist.
The individual has a rapidly deteriorating condition and a Fast Track is more appropriate
An individual is S117 when their health needs do not out-weigh their mental health needs.
It has previously been decided that an individual is not eligible for CHC and it is clear there has been no change in needs
Outlined within the checklist document on page 8.
Explain that Nurse Assessors complete a checklist for individuals in a Nursing Home placement:

7. CONSENT – NHS Minimum Data Set.
Assessors should gain consent and inform the individual, that information may be shared
MCA principles should be applied if the individual lacks capacity
Person centred approach to assessment

8. Who can complete a checklist?
A variety of health & social care
Practitioners, who have been trained
in it’s use.
Registered Nurses and MH Nurses.
L.A care manager, case officer
OT.
Care home managers and care
assistants

9. CHECKLIST
Inform individuals and their families/ representatives that a positive checklist does not indicate eligibility for CHC
Threshold is set low.
DST will be completed if:
1 x A in any domain carrying* (behaviour, breathing, drugs and altered states of consciousness.)
2 or more As in any other domain.
5 Bs or 4 Bs and 1A
NHSE estimate 25% of checklists qualify for CHC

10. Checklist Domains - Behaviour* Cognition Psychological Needs
Communication
Mobility
Nutrition
Continence
Skin
Breathing*
Drug Therapies & Medication*
Altered States of Consciousness*
Other significant care needs.

11. DOMAINS Identify appropriate level A, B, C, in each domain.
Give evidence for your scoring.
Evidence must be relevant, recent, succinct and dated.
A negative checklist should still be sent to the CCG as these are counted by NHS England and form the quarterly data.
Emphasise WHEN it is good practice to undertake a checklist, it need not be at every review!

12. Evidence (care home, not exhaustive)
Care home records/care plans/risk assessments
Behaviour charts
Seizure charts
Waterlow scores
Weight/food/fluid charts
Medication charts
Specialist involvement/GP visits
Therapy reports
Turning charts
Falls charts
If the care home insist there are care needs not recorded, can request they complete a 72 hour diary.

13. We are all responsible for chc -
Get to know the limits of the Local Authority (see pg. 17 CHC Framework) and the Care Act eligibility criteria. Is my resident beginning to show signs/needs greater than social care needs?
Responsibility of person completing the checklist to provide the evidence for the domains especially if these are As or Bs.

14. SOCIAL CARE NEEDS – CARE ACT 2014
MANAGING & MAINTAINING NUTRITION
MAINTAINING PERSONAL HYGIENE
MANAGING TOILET NEEDS
BEING APPROPRIATELY CLOTHED
BEING ABLE TO MAKE USE OF HOME SAFELY
MAINTAINING HABITABLE HOME ENVIRONMENT
DEVELOPING & MAINTAINING FAMILY/PERSONAL RELATIONSHIPS
ACCESSING & ENGAGING IN WORK/TRAINING/EDUCATION/VOLUNTEERING
MAKING USE OF FACILITIES/SERVICES IN COMMUNITY
CARRYING OUT ANY CARING RESPONSIBILITIES ADULT HAS FOR CHILD

15. TIMEFRAMES
CCG should take no longer than 28 days from receiving an appropriately completed checklist
To coordinate DST meeting, make a recommendation and communicate a decision.
You will receive a decision letter regarding the final decision.
The 28 days is from receipt of checklist; DST to be coordinated within a week. Families to be informed by CCG 48 hrs from recommendation. LBB, please don’t send off a checklist then go on holiday and expect the CCG to ‘wait’ to complete a DST on return!

16. F.N.C Funded Nursing Care
Awarded for Registered Nursing element in a nursing home
NOT own home or residential home.
Currently £ per week. (April 2018)
No update yet for 2019.
As of March 19th rates (if uplifted by 2% will be £161.32)

17. *Further questions.

18. LINKS
-framework-for-nhs-continuing-healthcare-and-nhs- funded-nursing-care
National Framework:
framework-for-nhs-continuing-healthcare-and-nhs- funded-nursing-care
MCA:
Services/mental-capacity-act/mca-for-complex- decisions.pdf

19. More links & resources -
nt/uploads/system/uploads/attachment_data/file/ / _National_Framework_for_CHC_and _FNC_-_October_2018_Revised.pdf
onal-framework-for-nhs-continuing-healthcare- and-nhs-funded-nursing-care
uk/documents/factsheets/fs20_nhs_continuing_hea lthcare_and_nhs-funded_nursing_care_fcs.pdf
1.amazonaws.com/s3fs-public/ /Factsheet- Continuing-healthcare-in-england-should-the-nhs- be-paying-for-your-care.pdf