Transcript No Slide Title

National Framework for
NHS Continuing Healthcare
and NHS funded Nursing Care
Introduction and Processes
Overall Objective
• To have a basic understanding of NHS continuing healthcare and
NHS funded nursing care.
• To gain an awareness of where it sits within local processes and how
eligibility is determined.
• To gain an understanding of the national tools and when and where
to use them especially in relation to screening.
• To enable practitioners to have sufficient skills and understanding to
undertake assessments.
• To enable you to cascade this briefing to your teams
Myth-busting
Exercise
(10min)
Introduction to the
National Framework
• The National Framework maps out an overall process for
England for NHS Continuing Healthcare and NHS
Funded Nursing Care
• It maps out a process for determining eligibility.
• It introduces a set of national tools to support and
improve consistency in decision making.
• It sets one band for NHS funded nursing care
Why is this different?
• One framework instead of 28 different sets of criteria
• One set of national tools instead of more than 28 different
ways of documenting decisions
• One flat rate (£101/week) for nursing care instead of
three bands. Current patients on high band will remain
funded at that level until reviewed.
• Terminology
• Levels 1 – 4 replaced by ‘social care’, ‘joint funded’,
continuing healthcare
Definitions
• Continuing Care
• NHS Continuing Healthcare
• NHS – Funded Nursing Care
See Information Pack
The headlines – Key
Messages
•
The Framework (for all adults) is a change in system that will require PCTs
and LAs to think and act differently
•
NHS Continuing Healthcare is a funding stream
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Whatever someone’s ongoing health and social care needs, they still need to
be met but NHS Continuing Care should always be considered in the first
place
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The Framework is the first step in making continuing care easier for the
people who work in it and those who are being assessed for it
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We do expect there to be more people eligible for full funding
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Timescales for informing individuals, carers, representatives not to exceed 2
weeks.
The process
COORDINATING THE
PROCESS
Ownership of process beginning to end:
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Identify individuals who should be assessed
Identify if an individual needs to be “fast-tracked”
Identify all professionals involved in the care of the
user who may contribute to the assessment
Complete documentation accurately, clearly and
comprehensively
Ensure appropriate care plan put in place
A Care Coordinator involved in the assessment
process needs to be identified to help this process run
smoothly
The tools
• NHS Continuing Healthcare Checklist
• Fast Track Pathway tool for NHS Continuing Healthcare
• Decision Support tool for NHS Continuing Healthcare
• NHS funded nursing care documentation
We must use the National Tools except for the Fast Track
Pathway tool, which we have developed locally.
NHS Continuing
Healthcare Checklist
When ?
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Hospital discharge planning or initial assessment or
review or change in needs.
There are 11 Care Domains (these are the same as
Decision Support Tool [DST]) see later slide
“Look at the Checklist provided to you”
•
Ensure all eleven care domains have a tick in one of the
three boxes
A. Meets or exceeds described level
or
B. Borderline or close to described level
or
C. Does not meet level
Refer those for full
assessment
Where:
• Two or more ticks in column A
• Five or more ticks on column B or one tick in A and four in
B
• Any tick in column A with an asterisk * ( the domains
which carry a priority level in the DST) see later slide
• There may be other circumstances where professional
judgements overrules the checklist.
“Rationale for decision box must be completed legibly
(don’t forget to sign and date the form)”
Fast track pathway
Only for those “individuals with a rapidly deteriorating
condition which may be entering a terminal phase
…characterised by an increasing level of dependency. “
They need an immediate decision on eligibility to be made so
that their immediate needs can be met.
“Careful decision making is essential to avoid undue distress
that might result from a person moving into and out of NHS
continuing Healthcare within a very short period of time.”
Fast Track local pathway
• Fast Track Pack
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Are eligibility criteria met?- GSF Yellow.
Patients/Carer aware of Fast Track Process.
Patient informed of options.
Referral form to be completed in full. Rationale section to be
completed and signed by Doctor, Specialist Nurse or District
Nurse in liaison with GP.
Identify needs and agree care plan- liase with Fast Track
team.
Refer to Fast Track Teams by phone/fax referral form.
Community referrals City Fast Tract Team will arrange and
commission care package . County Fast Track referrals - refer
to District Social Services for Home care.
Full assessment at earliest opportunity if not already
completed. ( Locally- reassessments occur with in 12 weeks )
Decision Support Tool
(DST) - What is it?
The decision support tool, following assessment, enables
practitioners to:
• Inform consistent decision making in line with the
primary health need approach
• Sets out the evidence in a detailed needs based format
• Requires practitioners to use their professional
judgement to justify how and why a recommendation is
made
• Clarifies the evidence used to make the decision
• A Care Coordinator will be responsible to work with the
MDT to complete the DST (local managers will keep you advised
on how this will work on the ground)
What it’s NOT !
• Another assessment
• A decision MAKING tool (it supports
professionals to make the decision)
• A substitute for professional judgement
What are the 11 Care
Domains on the DST?
• Behaviour *
• Cognition
• Psychological &
Emotional needs
• Communication
• Mobility
• Nutrition
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Continence
Skin & Tissue Viability
Breathing *
Drug Therapies &
Medication: Symptom
control *
• Altered States of
consciousness *
Other significant care needs can be identified/included
on the DST
* Asterisk = PRIORITY
Levels
• Each domain is divided into levels describing a
hierarchy of need
• Each level is given a weighting (not score)
no needs, low, moderate, high, severe, priority.
• Not all domains have the same weighting – based on
principle that some domains reflect health needs
more than others
Establishing a Primary
Health Need
Complexity, intensity, unpredictability
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Cognition
Communication
Behaviour
Psychological
& Emotional
Needs
Mobility
Nutrition –
Food &
Drink
Continence
Skin &
Tissue
Viability
Drug
Therapies &
Medication:
Symptom
Breathing Control Altered
states of
Consciousness
COMPLEXITY
INTENSITY
DOMAINS
Using the Decision
Support Tool
• DST should be used to capture the range of assessments
to reflect the patients identified needs and should NOT
be used as an assessment tool.
• Rational for decisions should be documented clearly for
each domain.
• Evidence should be provided to support each decision
making reference to supporting assessments.
• Paraphrasing the levels descriptions should be avoided.
• Where evidence is not available further assessment may
be required.
Consistent application
of DST’s
• Nurse Assessor will co-ordinate MDT assessment and
meeting to complete of DST.
• The MDT will make recommendations ONLY using the
DST guided by the Nurse Assessor.
• Evidence will be provided to support recommendations.
• Completed DST’s, assessments and evidence will be
presented to MDT Commissioning Panel where
recommendation will be considered and ratified if
appropriate.
• Panel may request more info if the supporting
assessments are insufficient to make decisions.
Reviews
• After 3 months
• Annually thereafter (at a minimum)
• When there is a change of needs
• Involve the individual, family or carer
• Outcome to PCT Commissioning Team
Evidence
• Comprehensive
• Current
• Clear care plans/ management plan
Intervention by whom qualified or unqualified
Duration
Number of carers
• Number of incidents and action taken
• Whether need managed or unmanaged
• Does intervention reduce problem or not
• What other avenues have been explored i.e. further NHS
assessment
Communications with
Patients, Families and
Carers
• All the way through the process
• Written confirmation of final decision with
detailed rationale
• Within 14 days of assessment
• Documented in files
City PCT Contacts
Commissioning Team Contacts:
Tel: 0115 8454545 ext: 39542 / 39546
Fax: 0115 9123363
Referral Point for Continuing Care Team
Tel: 0115 9691777
Fax: 0115 9568897
Fast Track/May Scheme
Tel: 0115 8831444
Fax: 0115 8831445
County tPCT Contacts
Commissioning Team
Tel: 01623 414114 ext: 4630
Fax: 01623 672568
Referral Point for Assessment Team
Tel: 0115 9617616
Fax: 0115 9613268
Fast Track
Tel: 01623 414114 ext 4655 or 4694
Fax:01623 672568
Further Training
Resources
Will be available on the Change Agent website
www.changeagentteam.org.uk
ANY
QUESTIONS?