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Published 21 March 2018
As of 1 October 2018, the national framework which sets out how decisions are made about NHS Continuing Healthcare (CHC) will be changing.
Although CHC eligibility criteria will be staying the same, the revised framework includes a number of important changes which will impact on local NHS Continuing Healthcare protocols, including:
We look at what CCGs need to be doing to get ready for these changes.
When CCGs make decisions about whether someone is eligible for CHC funding, they must have regard to the national framework.
CCGs now need to familiarise themselves with a new version of the framework because, as of 1 October 2018, the current 2012 version will be replaced by a revised 2018 version.
The CHC eligibility criteria themselves are not changing, meaning that - whilst the layout and wording of the 2018 version is generally more 'user friendly' than before - the substance of what is says about the core issue of 'primary health need' and the respective funding responsibilities of CCGs and Local Authorities remains as before.
The revised version is easier to navigate and a number of key issues previously covered only in the Practice Guidance at the back have now been incorporated into the main body of the framework (e.g. 'top-ups' and who pays for what in a person's own home). It also reflects legislative changes since the current version came out, especially the Care Act 2014 and how this assists with distinguishing between health and social care needs. Plus, there is a greater focus on the importance of strong leadership and governance in relation to implementation of the framework.
The most substantive changes, however, are aimed at minimising unnecessary stays in hospital, reducing unnecessary assessments and resolving challenges/disputes more quickly and consistently.
The Checklist is the screening tool used to help identify individuals who may need a full CHC assessment. Whilst the Checklist itself will remain largely the same (apart from updated user notes and the care domains being arranged in a different order), the revised version of the framework:
Although the CHC assessment process itself will be largely unchanged under the revised framework (e.g. the revised Decision Support Tool is essentially the same apart from updated user notes and a re-arranging of the care domains), the guidance on where and when assessments should be done is different, with a new emphasis on the importance of not letting the process delay hospital discharge.
Key points to note:
In terms of timescale from the CCG receiving a positive checklist to an eligibility decision being made, this will remain 28 days (max) as currently, although the revised framework includes an additional expectation that CCGs will normally respond to MDT recommendations within 2 working days.
Under the revised framework, the system of an initial 3 month review and 12 month reviews thereafter will continue, but with a notable change of focus. Whereas the current framework says the purpose of these reviews is to reassess care needs and eligibility for CHC, the revised version says:
The current version of the framework requires CCGs to have a 'local review process' to address situations where someone wishes to challenge a decision about CHC eligibility, but gives little steer on what this process should look like.
The revised version gives more detailed guidance on this, including a suggested 'two-stage' approach to local resolution, as follows:
Once the outcome of any next steps is known, the CCG should either uphold or change the original eligibility decision. If resolution is still not reached, the next stage would be to apply for an IRP, as currently.
The revised version also gives a stronger steer on the elements to be encompassed within local processes for resolving disputes between CCGs and Local Authorities about whether someone is CHC eligible or about the contribution each agency should make to a joint package of care, including:
Ahead of the revised national framework coming into effect, CCGs will need to review their local NHS Continuing Healthcare protocols to ensure they incorporate the changes.
In particular, local protocols will need to reflect the new emphasis on CHC assessments taking place after discharge from hospital and the revised guidance on the purpose of 3 and 12 month reviews, plus the expanded guidance on local processes for resolving challenges to CHC decisions and inter-agency disputes.
Our national team of healthcare regulatory lawyers regularly advises CCGs on a wide range of issues relating to NHS Continuing Healthcare and joint packages of care, including:
We also provide tailored training packages covering these issues and the implications of the revised national framework.
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