Topic 2 - Responsibilities of the NHS for healthcare provision

Question 1

Before 2001, most care homes registered to provide nursing care were maintained by

Answer 1

Social Services

Question 2

In 1999, the Royal Commission recommended that personal care should be available after assessment and paid for out of … while … should be subject to co-payment according to means.

Answer 2

General taxation
Housing and Living Costs

Question 3

While there is no precise definition of nursing care, the general understanding is that it relates to

Answer 3

Treatment or prevention of illness or disability

Question 4

Section 49 of the Health and Social Care Act 2001 removed local authorities’ responsibility to

Answer 4

Pay for nursing care in care homes

Question 5

CHC and NHS funded nursing care are set out under the …

Answer 5

National Framework

Question 6

The Health and Social Care Act 2012 represented an extensive reorganisation of the NHS. This included the establishment of … that commission most of the NHS services in the local areas for which they are responsible

Answer 6

Clinical Commission Groups (CCGs)

Question 7

The National Framework describes continuing care as:

Answer 7

[A] package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a ‘primary health need’ […] Such care is provided to an individual aged 18 or over, to meet health and associated social care needs
that have arisen as a result of disability, accident or illness.

Question 8

Continuing care is sometimes referred to as…

Answer 8

Fully funded NHS care

Question 9

Care needs portrayal

Answer 9

document that may be completed when the MDT when assessing eligibility for NHS CHC. Used in conjunction with the DST, records a person’s care needs.

Question 10

Checklist screening

Answer 10

light-touch assessment to identify people who may need CHC, they will then do the full assessment if necessary.

Question 11

The Decision Support Tool (DST)

Answer 11

helps bring together and assess evidence of a persons need to see if they need CHC. Assessor may be a social care professional or local authority staff. Used during full assessment.

Question 12

Multi-disciplinary team

Answer 12

people who carry out the full assessment for CHC. Must include at least 2 professionals from different healthcare professions. Or one HC professional and one SC professional.

Question 13

Eligibility process has 2 stages:

Answer 13

• Initial screening – nurse, doctor or other H or S care professional
• Full assessment – Multidisciplinary team using a DST

Question 14

DST looks at the following care domains:

Answer 14

1. Behaviour
2. Cognition (understanding)
3. Psychological/emotional needs
4. Communication
5. Mobility
6. Nutrition
7. Continence
8. Skin and tissue visibility
9. Breathing
10. Symptom control through drugs and medication
11. Altered states of consciousness (coma)
12. Other significant care needs

Question 15

The DST measures the need of each domain through the following ratings:

Answer 15

None, low, moderate, high, severe priority

Question 16

What are the rules surrounding patient consent with the DST

Answer 16

They must consent before any work is done, and they can withdraw their consent at any time

Question 17

The DST is a tool solely to support the decision making, but what team must make the final recommendation

Answer 17

Multidisciplinary team

Question 18

In most cases, it should take no more than … from being referred for a full assessment to receiving a decision

Answer 18

Two weeks

Question 19

If a patient is assessed as not eligibile for CHC, what 2 steps can the patient take

Answer 19

They can first ask the CCG to reconsider
If not, they can go to the NHS complaints teams

Question 20

If a patient is not eligible for CHC, they can be potentially put forward for…

Answer 20

NHS funded nursing care

Question 21

How long should the first review take place after being assessed as eligible for care, and how frequent are the reviews after that

Answer 21

3 months
At least once a year

Question 22

When did the standard band of NHS funded nursing care come into play?

Answer 22

October 2007

Question 23

What are RNCCs?

Answer 23

Registered nursing care contributions - the pre October 2007 bands of NHS funded nursing care.

Question 24

What were the three bands of RNCCs?

Answer 24

Low, medium and high

Question 25

What has happened to patients who were on the highest RNCCs band pre 30 September 2007

Answer 25

They have stayed on the high band on care contributions unless they are assessed as needing other levels of care.

Question 26

Where the costs of nursing care are not covered by the NHS, then …. will meet the shortfall

Answer 26

the local authority (subject to means testing) or the individual

Question 27

What are the key points of nursing care contributions in Scotland?

Answer 27

If people are living in a care home or assessed and need to be, they receive a flat rate for help. Regardless of age, paid to the patient.

Question 28

What were the key points of the Coughlan Case?

Answer 28

Coughlan was disabled and rejected from NHS CHC.
She did not meet criteria fully, but argued that she still needed help and assistance.
People were being unlawfully charged for social care services
The Court of Appeal agreed and stated that the NHS must take care of anyone whose primary need is a health need, and social services should only assist where they are legallt allowed to
Coughlan test was introduced for fairness
Gov asked health authorities to ensure their criteria was consistent

Question 29

Why did the Parliamentary and Health Service Ombudsman criticise the Department of Health following the Coughlan case?

Answer 29

Lack of direction, and still allowing the individual authoritites to decide who needed care, allowing for further confusion as to who is eligible

Question 30

Why did the NHS turn away nursing care to Grogan?

Answer 30

Because her needs fell within the lower RNCCs band. They were only giving care to people in the higher RNCCs band, which made it nearly impossible to get NHS nursing care.

Question 31

What conclusions did the judge make in the Grogan case?

Answer 31

Professionals had been led to believe assessment for nursing care was still based on RNCCs bands
The criteria was fatally flawed as the DoH had not fully implemented the Coughlan test, and the Health Authority had linked NHS nursing care eligibility to the RNCCs bands

Question 32

The judge criticised the … for failing to produce clear guidance and direction to the NHS.

Answer 32

Department of Health

Question 33

The judge in the Grogan case stressed that H&S servcies should look at …. to see whether the person is eligible for care or not.

Answer 33

The totality of a person’s needs