What's new in 2018 NHS National Framework for CHC? Are you getting an interim care package?

1^st October 2018 saw the introduction of the revised NHS National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. The Framework was published in March this year and its final implementation has been long awaited.

The revised NHS National Framework replaces its 2012 predecessor, but has it been worth the wait?

What is in the new Framework that is going to help you with your relative’s assessment for eligibility for NHS Continuing Healthcare funding?

Unfortunately, there has been criticism of the new Framework in that not much has really changed and it doesn’t go far enough. That is good and bad. Good, in that the core principles and essence of the Framework remains intact which promotes familiarity; but bad, in that certain areas could be clearer with better examples provided in some grey areas that are open to subjective interpretation and hence argument – which invariably means further delays in getting robust assessments and fair decisions.

The format of the revised NHS National Framework is better and easier to follow, and helpfully there is some clearer explanation of some of the more ‘controversial’ issues (i.e. misunderstood by both NHS assessors/practitioners and claimants alike) – such as help with advocacy, unlawful top-up fees, best interests and the ‘well-managed’ needs principle. But, even so, we still feel that these particular topics could have been dealt with better and simplified with clear examples, to help the all parties in this arena understand the issues and remove any doubt.

Make sure you get an interim care package…

One key area of note is in relation to Checklist assessments. The NHS are no longer obliged to do a Checklist assessment in certain circumstances, when for example:

• It is clear to the professionals involved that one isn’t needed at this point in time;
• The CCG agrees that the individual should be referred directly to a full assessment for eligibility for NHS Continuing Healthcare funding (at a Multi-Disciplinary Meeting);
• The Individual has a rapidly deteriorating condition and may be entering a terminal phase that should be referred to a Fast Track Pathway assessment instead;
• The individual is receiving services under Section 117 of the Mental Health Act which are meeting all of their assessed needs;
• The individual has short-term health care needs which are expected to improve significantly with short-term rehabilitation and it is reasonable to allow time to see how they recover.

Another major key issue worth highlighting, is that the NHS no longer have to carry out a ‘Checklist assessment’ in the hospital setting, and in the majority of cases it is stated that is it preferable this assessment should be deferred and dealt with after discharge from hospital ie when the individual returns to their own pre-hospital admission environment (eg back in their own home or back at the care home etc). This is because it is considered that the acute hospital setting “might not accurately reflect an individual’s longer-term needs”. That makes good sense, as a hospital setting may give a false picture of what the daily care needs are and what support is going to be needed; plus of course there may be the potential for the individual’s condition to improve once they are out of hospital.  However, whilst that is all perfectly well and good, more cynically, one could think that the underlying raison d’etre is to free up hospital beds and remove ‘bed blocking’, whilst waiting for the Checklist assessment to be done in hospital. Under the 2012 National Framework, it used to be the case that remaining in hospital was your best negotiating leverage to get the assessment done before discharge.

However, as a compromise, the advantage for your relative now, is that under the revised National Framework (2018), the NHS now have to put an interim package of care in place upon discharge from hospital until the Checklist assessment is undertaken.  So, ensure that that is the case before your relative is discharged! There should be no gap in healthcare.

The point is that it is now in the NHS’s interest (and yours) therefore that the Checklist assessment is carried out as soon as possible once the individual is back in their own pre-hospital admission setting.  The assessment process should in theory move quicker down the pipeline and a decision as to eligibility should equally therefore be made sooner. But in the meantime, the NHS should be paying for all healthcare needs.