Topic 2 - NHS Care Provision Flashcards
What are the Legal Responsibilities of the NHS and how can these be delivered?
NHS responsible for providing all nursing care free of charge wherever delivered. No specific definition of ‘nursing care’, generally assumed to be treatment or prevention of illness or disability. Delivered through:
- Continuing Care
- NHS Funded Nursing Care
Other social care is means-tested.
Section 49 of the Health and Social Care Act 2001 removed local authorities’ responsibility to pay for nursing care in care homes.
What are the different Types of NHS Care?
Continuing Care a.k.a fully funded NHS Care
Package of ongoing care arranged and funded solely by NHS where individual has primary health need. Provided to those 18 and over, to meet needs arisen from disability, accident or illness.
Responsible for covering all needs including acommodation.
NHS Funded Nursing Care
Responsible for arranging and funding nursing from registered nurse in care home (previously nursing homes).
What is the process of assessment of eligibility?
- Two stages -
- Initial Screening - done by doctor, nurse, social worker
- Full Assessment - multidisciplinary team of health and social care professionals using a Decision Support Tool (DST)
- If nearing end of life, senior doctors may use ‘fast track pathway’ to put urgent care in place.
- Following assessment, care plan drawn up and agreed.
- If health needs change then review of care plan is done
What areas does the Decision Support Tools assess?
How is each area scored?
What does the scoring of each need take account of?
Areas of need are assessed and scored low, moderate, high, severe or priority. The DST looks at the following care domains:
- behaviour;
- cognition (understanding);
- psychological/emotional needs;
- communication;
- mobility;
- nutrition;
- continence;
- skin and tissue viability (including wounds and ulcers);
- breathing;
- symptom control through drugs and medication;
- altered states of consciousness (such as a coma); and
- other significant care needs.
The scoring takes account of:
- what help is needed;
- how complex these needs are;
- how intense or severe these needs can be;
- how unpredictable they are, including any risks to the person’s health if the right care is not provided at the right time.
What shouldn’t the assessment decision be based on?
Decisions should not be based on:
- the person’s diagnosis;
- the setting of care;
- the ability of the care provider to manage care;
- the use (or not) of NHS‑employed staff to provide care;
- the need for/presence of ‘specialist staff ’ in care delivery;
- the fact that a need is well managed;
- the existence of other NHS‑funded care; and
- any other input‑related (rather than needs‑related) rationale.
How long does it take for an assessment decision to be reached and what can an individual do if they don’t agree with it?
Normally takes no more than 2 weeks from referral to recieving a decision.
NHS Continuing Care decision is made first, if not eligible then a decision about eligibility for NHS Funded Nursing Care made.
If not eligible then can ask the CCG to reconsider.
If CCG decide against it again then NHS complaints process is available.
How often is Eligibility and Care needs reviewed?
If NHS is providing care, case review will take place to reassess eligibility and care needs with first review no later than 3 months after initial screening.
Each following review at least once per year.
How are payments NHS Funded Care made?
What are the rates?
What is the NHS Funded rate isn’t enough to cover the costs of the nursing care?
If person isn’t eligible for NHS continuing care, they may qualify for allowance for NHS Funded Care.
Only for those who recieve care in home and paid directly to home where they’re resident.
NHS arrange and fund care provided by registered nurses employed by care home and includes planning, supervision and monitoring.
October 2007 - Standard Band replaced previous three band system known as registered nursing care contributions.
If on high band previously the payment remained of £227.59 per week until either:
- They no longer have nursing care needs.
- They no longer live in a care home that provides nursing care.
- Their nursing needs have reduced and they are no longer eligible for the higher rate and move to the standard band payment.
- They become entitled to NHS continuing healthcare instead.
If on low or medium band previously then moved to new single rate of £165.56 per week.
If costs of nursing care not met by NHS payment then local authority or individual will meet the shortfall depending on means-testing.
Why is Case Law relevant to the different types of care funding?
Since Health & Social Care Act 2001 removed Local Authorities’ responsibility to pay for nursing care, legal disputes have arisen due to difference of funding levels between continuing care and funded care and the element of judgement involved.
What is the Coughlan Test?
1999 - Pamela Coughlan disabled woman argued NHS was responsible for her care due to conidtion and type and level of nursing care she needed.
She did not meet eligibility criteria for continuing care as nursing needs were general not specialist. But she claimed they wrongly tried to transfer responsibility from NHS to social services and so unlawfully charged for health care.
Court of Appeal agreed with her. It laid down test for deciding when NHS is responbile for funding i.e reason for placement in home was primarily a health need.
Where the person’s reason for the placement in the home was primarily a health need, then the NHS was responsible for funding the whole package of care.
Local authority is responsible where nursing is ‘merely incidental or ancillary to the provision of the accommodation’ but more importantly within it’s means to be able to provide. Known as the Coughlan Test.
However Georgraphical variations across authorities remained as there was no specification of how this should have been implemented.
What was the detail of The Grogan Case?
What conclusions were made?
2006 - Mrs Grogan argued assessors at Bexley Care Trust only granting fully funded NHS care when needs seen to exceed criteria for highest RNCC band so was almost impossible.
High Court Agreed and made the following conclusions:
- Professionals led to bleieve that if needs were met within RNCC bands then not eligible for continuing care.
- Eligibility Criteria in area were unlawful as
- Health Authority not set out Coughlan Test
- They linked continuing care eligibility to RNCC bands
