What is a joint package of care?

Please note: This article was published prior to January 2024, and some information may be outdated.

Many families report having NHS Continuing Healthcare funding removed – and a joint package of care put in its place

Tip no. 24 in our series of 27 top tips on NHS Continuing Healthcare…

What does it mean to have a joint package of care?

Essentially, a joint package of health and social care is where funding comes from more than one source – it’s usually a mixture of NHS and local authority funding.

One of the alarming trends families have reported is that people with full NHS Continuing Healthcare funding – whose needs have not reduced and are not likely to – are having their funding downgraded to a joint package of care.

The impact of this is, of course, that the local authority element of the funding will be means tested.

Other families report having NHS Continuing Healthcare assessments that show eligibility for full NHS Continuing Healthcare funding, and yet they’re given a joint package of care instead.

A joint package of care (generally speaking) means the NHS won’t have to pay the full cost of care.

The National Framework guidelines state that a joint package of care is given when a person has some healthcare/nursing care needs, but not enough to warrant full funding. It’s says that, “taken as a whole’ their needs are not beyond the powers of a local authority to meet”. At the same time, the NHS retains some funding responsibility.

This could, however, be seen as a contradiction: the National Framework makes it clear that where a person has a level of care needs such that the NHS is legally obliged to pay, the NHS should also cover ALL social care needs as well.

So, in any assessment where a joint package of care is recommended, the key question to ask the assessors is: why is full NHS Continuing Healthcare not being recommended instead.

There are several pages in the National Framework guidelines about joint packages of care. Use this link to help you find what you need in the National Framework document

Tip no. 23: How to write an appeal for NHS Continuing Healthcare

Tip no. 25: Cognition and mental capacity – what’s the difference?

You don’t have to fight this battle alone

Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.

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6 Comments

6 responses to “What is a joint package of care?”

Janis Dobrin says:

5 June 2018 at 20:44

Is it really worth appealing if this happens to you as both the local authority and the NHS Continuing Healthcare nurse seem to be unanimous.

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Jenny says:

25 June 2018 at 11:05

I’ve never understood how a joint package of care arises. It is, as you point out, a contradiction in terms if a Decision Support Tool has been properly completed and the scoring indicates a Health Need. At that point, the totality of needs must be beyond the remit of the local authority.
Shared Care has become another widely used misinterpretation and misunderstanding of The National Framework and Coughlan which benefits the NHS and the Local Authorities wherever they can offload the medical care onto fee paying individuals.

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Meggie says:

16 February 2019 at 01:35

I have been trying to understand how joint package of care arises. I agree with Jenny that if the totality of needs are beyond the legal remit of social services then the NHS is responsible and if the NHS is responsible then it is responsible for funding all assessed needs, social care needs as well as health needs.
I think, having re-read the NF, that what it says is that where someone is not found eligible for CHC a joint package of care can be considered eg social services funding a care home place but with Funded Nursing Care funded by NHS. Clearly joint packages of care are being abused as an alternative to fully-funded NHS CHC. Just another area of CHC that is being misinterpreted to save money, because obviously the social services share of the joint package is means tested so patients/families can be forced to contribute.

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- M Knowles says:
  
  19 February 2019 at 00:44
  
  Joint Funding
  I agree, I think joint funding becomes difficult to understand because it considers the legal responsibilities of each organisation, NHS and Local Authority. The process that determines which needs are beyond what the Local Authority can meet and which needs they can meet, are often unclear. I didn’t know until recently that they are regulations that set out a national eligibility criteria for social care, that determines the needs that the Local Authority can meet.
  
  Care & Support Regulations-eligibility criteria http://www.legislation.gov.uk/uksi/2015/313/pdfs/uksi_20150313_en.pdf
  DHSC Care and Support Statutory Guidance ( Local Authority)
  DHSC National Framework of CHC : Joint Packages pp 263 – 269
  
  263. If a person is not eligible for NHS Continuing Healthcare, they may potentially receive a joint package of health and social care. This is where an individual’s care or support package is funded by both the NHS and the local authority. This may apply where specific needs have been identified through the DST that are beyond the powers of the local authority to meet on its own. This could be because the specific needs are not of a nature that a local authority could be expected to meet, or because they are not incidental or ancillary to something which the Local Authority would be doing to meet ( National Framework for CHC 2018 pp 263)
  
  What are the needs that the local authority (social care)has the power to provide?
  The Care Act 2014 introduced Care and Support Regulations, which set out a national standardised eligibility criteria ( for Adult Social Care). The Eligibility Criteria outlines a list of outcomes that are within the power of the Local Authority to meet, to promote the individual’s wellbeing. The Care and Support Eligibility Criteria state that to be eligible for social care, an individual must be ‘unable to achieve’ 2 or more of the outcomes listed in the regulations . Alternatively, the individual may be able to achieve 2 or more of the outcomes, however this may cause them i) pain, distress, anxiety, ii) endangers the health and safety of themselves or others, iii) or takes the significantly longer than would normally be expected. ( Care and Support Regulations)
  http://www.legislation.gov.uk/uksi/2015/313/pdfs/uksi_20150313_en.pdf
  
  If, following an assessment for NHS CHC, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person’s health needs – either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both an LA and a CCG, this is known as a ‘joint package’ of care. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a local authority to meet. The joint package could also involve the CCG and the local authority both
  contributing to the cost of the care package, or the CCG commissioning part of the package. Joint packages of care may be provided in a nursing or care home, or in a person’s own home, and could be by way of joint personal budget. (DHSW Care and Support Statutory Guidance 6.82)
  
  If a person is not eligible for NHS Continuing Healthcare, the NHS and the Social Worker should use the last DST to determine the needs that beyond the powers of the local authority to meet on its own. This will include needs beyond the Care and Support National Eligibility Criteria AND/OR any needs that require a Registered Nurse ( Section 18-20) Care Act. The Local Authority must provide the care and support as they can lawfully provide.
  
  266. Subject to the national eligibility criteria for adult care and support (refer to paragraph 51) and to means testing where appropriate, each local authority is responsible for providing such care and support as can lawfully be provided. (National Framework for CHC)
  
  The NHS and LA will determine needs that are beyond what the Local Authority can provide. They will agree joint package of care and set out how each will contribute to the package. This may include a) delivering direct services to the individual (through existing NHS services), b) commissioning care/services to support the care package, c) transferring funding between their respective organisations or d) contributing to an integrated personal budget. An agreed assessment and care plan should set this out. ( National Framework for CHC – pp 265)
  264. The NHS and the Local Authority should work in partnership to agree their respective responsibilities in such cases, to ensure the individuals needs are met.
  269. Jointly coordinated CCG and local authority reviews should be considered for any joint package of care in order to maximise effective care and support for the individual.
  
  Reply
Sarah Lepley says:

13 July 2019 at 17:54

My daughter was receiving a joint funded package but now the health element has been refused even though the needs have not changed. The CCG are saying we cannot appeal an end to joint funding. We are going to make a complaint but what else can we do?

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Colleen says:

17 June 2023 at 11:42

My daughter is 50/50 NHD/LA
Funded in a residential home for adults with learning disabilities.
Although she has the higher component for mobility with pip, they have suspended everything and threatening to take her car away. At my Witt’s end can anyone help?

Reply