NHS Continuing Healthcare

We also have in depth knowledge of Oxfordshire County Council funding for long term care and its related policies, processes and procedures.

NHS Continuing Healthcare is the name given to a package of health and personal care that some people need to receive as a result of a disability, accident or illness. Those who are assessed as eligible for fully funded NHS Continuing Healthcare whilst in a nursing or residential home will have the full cost of their care and accommodation funded by the NHS. However, it is not just restricted to nursing homes but can be provided in any setting including residential homes or your own home. Those who are eligible whilst living in their own home will be provided with a care package to meet personal and health care needs, funded by the NHS.

The care that is arranged by the NHS, whether in the form of a nursing home placement or a home care package must adequately meet the healthcare needs of the client, as determined in the NHS Continuing Healthcare assessment. In Oxfordshire, clients who are found to be eligible for NHS Continuing Healthcare will have their care managed by a healthcare manager. Any extra care that is arranged by the client or their family which is not deemed necessary to meet the client’s healthcare needs may have to be funded and managed privately.

As with much of the rest of the country, in Oxfordshire only a small percentage of nursing home residents are eligible for NHS Continuing Healthcare funding, although this number has increased since the introduction of the National Framework in October 2007. Eligibility is determined through an annual assessment of health care needs. In order to be eligible you must meet the Continuing Healthcare criteria, which essentially states that you must have a ‘primary health need’. There are four key indicators that are used to determine whether or not your needs are primarily for health; these are Nature, Complexity, Intensity and Unpredictability. Continuing Care assessors will use a Decision Support Tool to help them break down an individual’s overall health needs into eleven categories or ‘domains’. Domains include such care categories as communication, impairment, mobility, etc. and each domain carries a number of levels of need which are used by assessors to determine whether the client’s needs meet any of the four key indicators.

Our experience has shown that there is still a lot of understandable confusion surrounding Continuing Healthcare, because of its complex criteria. Some nursing home residents who suffer from dementia, poor mobility, incontinence and an inability to communicate will still not meet the criteria, whereas others with similar needs will. Each client that receives a full assessment must have their care needs assessed individually and it is the totality of these needs that will ultimately inform the decision of whether that person has a primary health need or not. Needs such as washing, dressing and feeding are considered to be personal care needs and not a primary health need.

Continuing Care is not, however, limited to one particular healthcare need or condition and there are a number of people in Oxfordshire receiving NHS Continuing Healthcare for a variety of reasons. The key test should always be whether your care needs could be legally managed by Social and Community Services. If not, your care should be funded by the NHS.

On 1st October 2007, the three-band RNCC system was replaced with a single-band system known as ‘NHS Funded Nursing Care’. Under the new system all residents going into a nursing home who have basic healthcare needs will receive a single rate payment towards their nursing care fees of £101 per week. This money is usually paid directly to the home and taken off your bill, and as such, we advise clients to ask their nursing homes for the £101 payment to be reflected in their invoices. All residents currently on low or medium band RNCC will also be paid at the new higher rate, however, all clients currently receiving high band contributions will remain on the rate of £133 per week until they are assessed as no longer meeting the criteria for the high band.

Eligibility for NHS Continuing Healthcare in Oxfordshire is determined using an assessment carried out by a trained nurse assessor whose job it is to build a ‘picture’ of the resident’s healthcare needs. There is a screening process that uses a checklist with supporting information to determine whether or not a client’s healthcare needs are high enough to warrant a full consideration, so not everybody will automatically receive the full Continuing Healthcare assessment. The screening part tool is based on the NHS Continuing Healthcare principles and is designed to screen people in rather than out. If screened in, the tool should trigger the full NHS Continuing Healthcare assessment. The assessor should carry out the full assessment by assessing the client in person, talking to the nursing home staff, and making every effort to fully involve the client’s family. They should also look through paper records kept at the home (including care plans, daily progress reports, medical charts etc) and gather information from the multi-disciplinary team (MDT) made up of any other health and social professionals involved in the clients care (GPs, consultants, speech and language therapists, community psychiatric nurses etc…).

Once the assessment is completed, the MDT will made a recommendation and this is considered by a panel made up of local health and social care professionals trained in NHS Continuing Healthcare. The panel will then consider each element of the assessment and give a final decision as to whether or not the client has a primary health need and should be funded.

If eligible, funding will be arranged and usually backdated to the date of referral for a full assessment, and the client’s needs will be reviewed annually thereafter. If not found to be eligible, the screening process will be initiated again in a year’s time, unless the client’s need change substantially within that year.

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