Making sense of slimming

From 1 October 2007, NHS organisations across England must follow one common process when deciding who is eligible for NHS Continuing Healthcare and NHS-funded Nursing Care.

These and other changes are part of guidance called The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, published by the Department of Health (DH) in June. From 1 October, NHS organisations must comply with the guidance in the National Framework.

What does that mean?

The National Framework is part of the DH’s policy on continuing care.

Commonly known as long-term care, continuing care means ‘care provided over an extended period of time to a person aged 18 or over to meet physical or mental health needs which have arisen as the result of disability, accident or illness’.

If you need continuing care, your care needs will be complex, substantial and ongoing, caused by a disability or chronic illness, or following hospital treatment.

NHS Continuing Healthcare is ‘a package of continuing care arranged and paid for solely by the NHS’. Sometimes it’s called fully funded NHS care.

NHS-funded Nursing Care is ‘nursing from a registered nurse in a care home which is registered to provide nursing care’.

Who will the changes affect?

If your main need for care relates to your health, the NHS is responsible for arranging and paying for care for all your needs - NHS Continuing Healthcare. Sometimes your needs may include, for example, accommodation in a care home or nursing home.

You have to be eligible to receive NHS Continuing Healthcare. Your main need for care must relate to your health. All your care needs will be assessed to decide if you’re eligible. First, you’ll have an initial screening. Then you may be referred for a full assessment.

You’re likely to have a complex medical condition and need specialised nursing support.

Someone approaching the end of their life is also likely to be eligible, if they have a condition that is rapidly getting worse and may be terminal. In circumstances like these, senior doctors or nurses may use a ‘fast track tool’, to enable care to be put in place urgently.

If you’re not eligible for NHS Continuing Healthcare, you may be eligible for NHS-funded Nursing Care. Your needs will be assessed in your initial screening.

Why bring in this guidance?

Previously, there was no national guidance for NHS Continuing Healthcare. NHS organisations set the processes and eligibility criteria for their areas. The approach to assessments, decisions on eligibility and therefore funding varied, depending on where you lived.

Also, there were three bands or rates of payment for NHS-funded Nursing Care. Your band depended on the nursing you needed for your condition. To decide if you were eligible, you had to have another, separate assessment.

By bringing in the National Framework, the DH aims to:

• improve consistency when eligibility is assessed, and
• make NHS Continuing Healthcare easier to understand.

What will be different now?

From 1 October, all NHS organisations must follow the national guidance:

• There will be one common process across England to assess if you’re eligible for NHS Continuing Healthcare.
• The same process will assess if you’re eligible for NHS-funded Nursing Care.
• There will be one band or rate of payment for NHS-funded Nursing Care, so that the NHS makes the same contribution for everyone receiving this type of care.

The changes mean that many more people in England are likely to receive more help from the NHS for their long-term healthcare needs.

Glossary

Chronic

Chronic usually means a condition that continues for a long time or keeps coming back.

Mental

Mental refers to the processes in the mind.