The aim of the new version is to provide greater clarity to individuals and staff through a new structure and style, including examples which reflect the issues in daily practice, as well as reflecting the legislative changes since the 2012 framework was published and reflect the implementation of the Care Act 2014.

Changes under the new framework:

Set out below are the main changes to the new version of the framework:

  1. Social Care Need: The definition of social care need has been updated in light of the Care Act 2014, which introduced a set of criteria to determine whether the individual had an eligible need. An eligible need is defined as a need which arises from or relates to a physical or mental impairment or illness which results in them being unable to achieve two or more outcomes which will have a significant impact on their wellbeing. The criteria are set out clearly on page 17 of the framework and should ensure that it is easier to determine the distinction between a health and a social need.
  2. CHC review: The annual CHC review process has been improved. The reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is therefore not expected that in the majority of cases that there will be a need to reassess for eligibility.
  3. NHS Continuing Healthcare Co-ordinator: The new guidance sets out that the process for determining whether an individual is eligible for continuing healthcare funding, should be multi-disciplinary throughout. And also sets out guidance at PG20 on the role of the NHS Continuing Healthcare co-ordinator, including whether or not they should be a member of the MDT considering eligibility.
  4. Assessment: Although the CHC process is the same under the new framework, there is a new emphasis on ensuring that the continuing healthcare process should not delay hospital discharge. Under the new framework, the assessment should normally take place when the individual is in a community setting and in the majority of cases, CHC eligibility should be considered after discharge from hospital. This may mean that interim support is required between discharge and assessment and there must be no gap in appropriate support to meet the individual’s needs.
  5. Eligibility checklist: The new version of the guidelines amend the checklist so that the potential outcomes are clearer and the checklist now lists situations where it is not necessary to complete one, including where it is clear that the individual does not have a healthcare need ,or if the individual is rapidly deteriorating and the fast track pathway tool should be used.
  6. Challenges to eligibility: The revised guidelines also include a two stage approach where an individual wishes to challenge a decision about CHC eligibility. The first step is an informal discussion between the CCG and an individual or their representative and then, if the matter is still unresolved, a formal meeting between the CCG (from someone who has the authority to decide the next steps) and the individual.

Even though the new framework as set out above has made a number of amendments to the previous version, none of the amendments are intended to change the eligibility criteria for NHS continuing healthcare.

Capsticks have considerable expertise in continuing healthcare and are happy to assist any organisation with decision making eligibility or case management. Please contact Tracey Lucas, Francis Lyons or Ian Cooper for further information.