Continuing Healthcare and Funded Nursing Care

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In this section you will find out everything you need to know about Sandwell & West Birmingham CCG's continuing healthcare service. W3.CSS

‘Continuing care’ means care provided over an extended period, to a person aged 18 or over, to meet physical or mental health needs that have arisen as a result of disability, accident or illness. ‘NHS continuing healthcare’ means a package of continuing care that is arranged and funded solely by the NHS.

Eligibility for NHS Continuing Healthcare is not dependent on diagnosis or medical condition. Eligibility is assessed through a process as defined in the Department of Health National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. For the majority of cases the first step in the process will be a screening process, using the NHS continuing healthcare Checklist. This will be completed by a social worker or health professional, usually involving you or, if you choose, your family, carers or representative. Where the Checklist indicates that you may have needs that would make you eligible for continuing healthcare, a referral to the Integrated Continuing Care team for full assessment of eligibility will take place.

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A Continuing Healthcare Co-ordinator will be allocated your case and their role is to co-ordinate the whole process until the decision on eligibility has been made. The Co-ordinator does not make the decision about eligibility. A team of health and social care professionals will carry out an assessment of your healthcare needs, from this a recommendation will be made. This assessment will help complete the Department of Health’s Decision Support Tool. The Decision Support Tool is not an assessment in itself but helps bring together information in a single format to facilitate decision making regarding NHS continuing healthcare eligibility. Eligibility is determined by a detailed assessment which looks at all of aspects of health and social care needs and considers the four key indicators as follows: Nature – the type of condition or treatment required Complexity – symptoms that interact and are therefore difficult to manage or control Intensity – one or more health needs which are so severe that they require regular intervention Unpredictability – unexpected changes in condition that are difficult to manage and present a risk to yourself or others Following your assessment the health and social care professionals will make a recommendation to the CCG about your eligibility for NHS Continuing Healthcare. The CCG will then write to you advising whether you are eligible, giving reasons for their decisions. In most cases decisions are made within 28 days of the CCG receiving the completed checklist, this may be extended in complex cases.

If you are unhappy with the outcome, in the first instance you should speak to the Continuing Healthcare Co-ordinator handling your case and ask for an informal meeting. This will allow you to discuss any concerns and obtain clarification where needed. If you are still unhappy, Sandwell & West Birmingham CCG has a review process which the Co-ordinator will explain to you.

NHS continuing healthcare can be provided by the NHS in any setting, including a care home or at home. If NHS continuing healthcare is provided in a care home, it will cover the care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS continuing care is provided in the home of the person, it will cover personal care and healthcare costs. Those in receipt of NHS continuing healthcare continue to be entitled to access to the full range of health services, eg. GP, Hospital, out-patients, District nursing.

Continuing Healthcare is episodic, if you are assessed as eligible for NHS continuing healthcare, please be aware that it is subject to review and should your care needs change the funding arrangements may also change. Your eligibility for NHS continuing healthcare will be reviewed regularly. If you are not eligible at this assessment, you may be eligible should your needs change over time. You can ask for a reassessment or ask your social worker, health worker or nursing home to refer you.

This is used when a person has a primary health need arising from a rapidly deteriorating condition. This may be entering a terminal phase, with an increasing level of dependency and so should be fast tracked for NHS continuing healthcare. The patient may need NHS continuing healthcare funding to enable their needs to be urgently met (e.g. to allow them to go home to die or to allow appropriate end of life support to be put in place).

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Phone number: 0121 612 1748

 

 

SWB HCWB