Care Options forNHS Continuing Health Care

(CHC)

Wirral PCT Board – 12 February 2008

Tina Long - Director of Strategic Partnerships

Sheila Hillhouse - Continuing Healthcare Lead

NHS Continuing Health Care

• Complex and highly sensitive area which can affect people at a very vulnerable time of their lives

• New national guidance sets out a single, national framework for determining eligibility for NHS continuing health care

• Fair and consistent access to NHS funding across England

What is NHS Continuing Health Care?

• Package of services arranged and funded by the NHS for people outside of hospital with ongoing health needs

• In any setting, including your own home or in a care home

• Unlike help from Social Services for which a charge can be made depending on your circumstances

Who is eligible for NHS Continuing Health Care?

• Anyone assessed as requiring a certain level of health care need

• Not dependant on a particular disease,diagnosis or condition, nor on who provides the care or where the care is given

• If your overall care needs show that your primary need is a health need, you should qualify for consideration for continuing healthcare

Four Indicators for Primary Health Need

• Nature - type of condition or treatment required and its quality and quantity

• Complexity - symptoms that interact. Making them difficult to manage or control

• Intensity - one or more severe needs that require regular interventions

• Unpredictability - unexpected changes in condition, difficult to manage and present a risk to you or others

Care Options for Wirral

• To manage the process fairly and constructively and apply resource allocation appropriately, Wirral must be able to identify what care options are available for patients eligible for CHC

Process• Individuals assessed against the national

framework

• Individuals not eligible for CHC may have care package provided by the NHS and Social Services, or solely by Social Services, depending on the nature and level of needs

• Where Social Services are providing care, the individuals may fund some or all of their care themselves based on a financial assessment

• NHS care is provided free at the point of delivery

Care Options

• All decided on a case by case basis:

• in a NHS Hospital• independent hospital• a specialist unit• care home• hospice• patient’s own home.

Factors to be taken into consideration

• Safe delivery of appropriate care by appropriately skilled staff to meet the needs of the individual

• Wishes of the patient and/or family members

• Competing demands on the NHS budget

Suitable Alternatives

• If an individual’s preferred option cannot be supported a clinically suitable alternative would be offered, based on:

• equity• clinical effectiveness• safety• resource availability

Citizens Advisory Group

Consultation Exercise:

• To provide the Board with recommendations regarding resource allocations for individuals who are eligible for CHC, the impact on the Wirral population at large and the competing demands on the NHS budget

• To analyse the success of this approach of involving the public

• Views of CAG participants

Content

• Two sessions. Presentations overview of CHC • Care options paper• Financial report and amount of people on the

Wirral in receipt of CHC• Discussion• Case presentation• Recommendations

Key Areas of Concern

• Understanding the decision making process

• Understanding funding allocated

• Maintain a level of fairness for those potentially eligible for CHC

• To raise awareness of CHC for all potentially eligible

Recommendation

To consider the principles of the Care Options paper to become part of Continuing Health Care Policy for individuals eligible for Continuing Health Care who are registered with a Wirral GP