Chapter 2 - Responsibilities for the provision of long term care

Question 1

What are the Responsibilities for the Department of Health?

Answer 1

The Department of Health (DH) is responsible for public health. They do so by setting health and social care policy in England.

As a key part of this role the DHSC sets national health policy on health issues (including care), conducts research on prevention and provides substantial funds to pay for care provision in England.

Question 2

Clinical commissioning groups (CCGs)

Key roles and responsibilities:

Answer 2

• Clinical commissioning groups (CCGs) determine health strategy and priorities within a geographical area in England.
• CCGs also provide or fund local care, e.g. hospitals and GPs (that was previously provided by PCTs).

CCGs provide funding for services such as:

• GPs
• dentists
• distric nurses
• hospitals
• registered nursing care

CCGs are England specific.

Question 3

Single assessment process (SAP)

Key points:

Answer 3

• The single assessment process (SAP) in England ensures that everyone’s needs are assessed in a consistent way, puts the individual’s needs at the centre of the process, and reduces duplication. The approach is similar in each of the other national regions.
• The SAP sets out a process to ensure a more consistent approach is adopted to assessing someone’s health and social needs.
• The SAP will usually be conducted by adult social services but they will include other specialists as required.
• First, the individual’s eligibility for NHS Continuing Healthcare is determined. If someone is not fully eligible for this, they may be eligible for NHS-funded Nursing Care.
• An individual’s needs are initially assessed through the completion of a checklist tool. If this indicates that the individual might qualify, a full assessment is made using a decision support tool (DST).

Question 4

NHS Continuing Healthcare

Key points

Answer 4

• NHS Continuing Healthcare is provided free by the NHS where the primary need is a health need.
• These services are available based on medical need, i.e. they are needs-based irrespective of where they are provided.

Question 5

NHS-funded Nursing Care

Key points:

Answer 5

• NHS-funded Nursing Care is provided to individuals with medical needs that require the intervention of a registered nurse. They must not also be in receipt of NHS Continuing Healthcare.
• With the devolution of powers over certain health issues to regional assemblies in the UK, there are some important national variations in eligibility criteria for the payment of nursing care.

Question 6

Social care

Key points:

Answer 6

• Social care is non-medical care that is provided by the local authority or adult social services.
• Local authorities are obliged to assess care needs and, in many cases, charge based on the ability to pay for both residential and non-residential care.

Question 7

Discharge and delayed discharge from hospital

Key points:

Answer 7

• When an NHS hospital discharges a patient, it should provide details of the discharge process, assess the needs of the patient and their relatives or carer, determine care options, and draw up a care and support plan which it implements and monitors.
• Part of the assessment that is conducted as part of the discharge process will determine the patient’s eligibility towards NHS Continuing Healthcare and should use the relevant National Framework.

Question 8

Discharge and delayed discharge from hospital

Aims of the discharge process:

Answer 8

1. Time spent in hospital is minimised
2. Patient continues to receive the care they require
3. Care should maximise patients independence
4. NHS and social care provision schould be co-ordinated

Private hospitals are likely to have their own discharge procedures.

Question 9

Background legislation

Key points:

Answer 9

• The Human Rights Act 1998 sets out a wide range of fundamental rights. It only applies to public bodies, such as hospitals, adult social services and local authorities.
• The Care Standards Act 2000 looked to apply a unified national approach across England and Wales. It aimed to improve the standards of care services and ensure that those who need care receive good quality care.
• The Mental Health Act 1983 introduced the compulsory detention of people with a mental condition and s.117 ‘after care services’.
• The Care Act 2014 now governs most elements of care and support provided by local authorities in England.
• In addition to ensuring that residential and non-residential care needs and financial eligibility were brought together, the Care Act 2014 introduced some new elements of care and support such as wellbeing, advocacy and the need to provide information and advice.

Question 10

National variations

Key points:

Answer 10

• In Scotland, the NHS is divided into 14 NHS Boards which serve different parts of the country. Like the commissioning groups in England, they are responsible for meeting the needs of their local population, but each one sets its own criteria.
• Scottish local authorities are legally obliged to assess the individual’s ability to contribute towards the cost of their care by use of a means-test or charging procedure. Care needs must then be provided by the local authority if the individual is unable to meet these requirements.
• Free Personal and Nursing Care (FPNC) consists of two elements: nursing care services and personal care services.
• The Care Inspectorate regulates and inspects care services in Scotland.
• In Scotland, the key legislation governing public health includes the Community Care and Health (Scotland) Act 2002 and the Carers (Scotland) Act 2016, in Wales it is the Social Services and Wellbeing (Wales) Act 2014 and in Northern Ireland, it is the Health and Social Care (Reform) NI Act 2009.
• The Care and Social Services Inspectorate for Wales (CSSIW) and, in Northern Ireland, the Regulation and Quality Improvement Authority (RQIA) is the independent health and social care regulatory body.