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Continuing Healthcare Reviews

National Framework for NHS Continuing Healthcare

The National Framework sets out the principles and processes of the National Framework for NHS continuing healthcare and NHS-funded nursing care. It sets out the main responsibilities for the NHS and local authorities (LAs) that are in primary legislation, and explains the influence of key court cases. The Coughlan Judgment examined the responsibilities of the NHS and LAs, particularly regarding the provision of nursing care. The Grogan Judgment examined the interaction between NHS continuing healthcare and NHS-funded nursing care.

 

Primary Need for Health

 

It describes how the phrase a ‘primary health need’ developed, and how this concept helps in determining when someone should receive NHS continuing healthcare.

 

Core Values and Principles

 

It sets out the main things to remember when assessing somebody and deciding whether they should receive NHS continuing healthcare. The individual, the effect their needs have on them, and the ways in which they would prefer to be supported should be kept at the heart of the process. Access to assessment, care provision and support should be fair, consistent and free from discrimination.

 

Eligibility consideration

 

The Framework is used to assist in the decision making process in deciding whether someone is eligible for NHS continuing healthcare or NHS-funded nursing care. Assessments should be carried out by a multidisciplinary team, in line with the ‘Core Values and Principles’ section, and should take account of other existing guidance.

 

Commissioning, care planning and provision

 

The primary care trust should identify and arrange all services required to meet the needs of all individuals who qualify for NHS continuing healthcare and for the healthcare element of a joint care package. It sets out the key principles in both circumstances.

 

Access to other NHS-funded services

 

Those entitled to NHS continuing healthcare continue to be entitled to access to the full range of primary, community, secondary and other health services. It sets out how joint packages of health and social care services should operate.

 

Review

 

If you are found to be eligible for NHS Continuing Healthcare, regular reviews should be carried out – the first no later than three months after the initial decision, and then at least once a year subsequently. Some people will need more frequent reviews.

 

Dispute resolution

 

The Framework sets out the processes to follow when there is a disagreement concerning an eligibility decision. Separate procedures are set out for disputes between the NHS and LAs, and for when an individual disagrees with a decision or with the process used to reach it. It also describe the other steps that may be taken if this does not provide a satisfactory solution or if an individual wants to complain separately using the relevant complaints procedure.

 

Governance

 

Both primary care trusts and strategic health authorities have roles in overseeing the process. From March 31st 2013 the responsibility will pass to Clinical Commissioning Groups (CCG's).

 

Source: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

National Framework