Patient Advice & Liaison (PALS)

Patient Advice and Liaison Service

NHS Funded Continuing Health Care

A Guide

This leaflet has been written as a brief guide to NHS Funded Continuing Health Care

Norfolk, Suffolk and Cambridgeshire Strategic Health Authority

And

Norfolk, Suffolk, Cambridgeshire & Peterborough Social Services Departments

April 2003

About this policy

The Strategic Health Authority and partner Social Service Departments have produced a Joint Policy and Eligibility Criteria for NHS Funded Continuing Health Care. This is to be implemented across the Health Authority, from April 2003. The purpose of having a single new set of criteria is to ensure:

· Consistency and clarity across the Health Authority

· Compliance with the law and national guidance

· Equitable access to services

· Appropriate and timely involvement of patients and their carers in the decision making process

The criteria will be reviewed on an annual basis.

What does it mean?

NHS Funded Continuing Health Care is the term used to describe a package of care arranged and wholly funded by the NHS. To receive NHS Funded Continuing Health Care, a person must be assessed as meeting the eligibility criteria produced by the Strategic Health Authority. People who meet these criteria will have complex, unpredictable or deteriorating conditions.

Where is it provided?

People may receive NHS Funded Continuing Health Care in a hospital, an NHS funded bed in a suitably registered care home with nursing, a specialist unit or at home.

How will the person’s need be assessed?

The decision that someone is eligible for NHS Funded Continuing Health Care will be made following assessment by health professionals (e.g. doctors, nurses, social workers, occupational therapists). The patient and their carers will be involved in the assessment.

How often will the need be assessed?

Everyone who receives NHS Funded Continuing Health Care will be re-assessed no less than once a year and possibly more frequently. It should be noted that as a person’s needs change, then their eligibility for NHS Funded Continuing Health Care might also change. A decision that NHS Funded Continuing Care is needed at a particular time does not mean it will always be needed, and vice versa.

What to do if you are unhappy or unclear

If you are unhappy or unclear about the decisions being made, please contact the consultant responsible for you or your relative’s care. It is always our intention to provide quick, local resolution to such issues. However, if you have tried this and still have concerns you should contact:

PCT Chief Executive

You have the right to request a review about the way in which the NHS Funded Continuing Health Care Criteria have been applied to you or to your relative. You can contact the PCT Chief Executive, as detailed above, to request a review.

Review Process

If you request a review, you will be advised of the process to be followed and be given help to try and reach an agreement between you and the relevant people in the local health services. If this is unsuccessful arrangements will be made for your case to be considered by a Continuing Care Review Panel consisting of an independent chairperson, a PCT (Primary Care Trust) non-executive director and a local council representative. The results of this review will be reported to the Board of the relevant Primary Care Trust and will then be sent, in writing, to the person who requested the review.

Complaints

If you are dissatisfied with the outcome of the consideration of your case by the Continuing Care Review Panel you can use the NHS complaints procedure and request an Independent Review Panel. Contact the PCT Chief Executive for further information.

Further Information

You can speak to your local PALS (Patient Advice and Liaison Service). Their address and phone number can be obtained by contacting NHS Direct on 0845 4647.

A copy of the full details of the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority’s Policy and Eligibility Criteria for NHS Funded Continuing Care is available from:

Service Modernisation Directorate
NSC Strategic Health Authority
Victoria House
Capital Park
Fulbourn
Cambridge
CB1 5XB

Summary

NHS Funded Continuing Health Care describes a package of care arranged and funded wholly by the NHS.
It can be provided in a hospital, NHS funded bed in a suitably registered care home with nursing, a specialist unit or at home
This is mainly concerned with the following groups:
- People with physical and/or sensory disability
- Older people with mental health disorders
- People with dementia
- People with a learning disability
- People who require specialist palliative health care
- Children and young people
An individual’s continuing health care needs will be assessed and re-assessed at regular intervals
NOTE ESPECIALLY that as a person’s needs change, then their eligibility for NHS Funded Continuing Health Care may also change. A decision that NHS Funded Continuing Health Care is needed at a particular time does not mean it will always be needed, and vice versa
There is a system by which people can request a review of the decisions made about NHS Funded Continuing Care