NHS-Funded Nursing Care

Practice Guide 2007

NHS-funded Nursing Care Practice Guide

NHS-Funded Nursing Care

Practice Guide 2007

NHS-funded Nursing Care Practice Guide

DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical Document Purpose ROCR Ref: Title Author Publication Date Target Audience Estates Commissioning IM & T Finance Social Care / Partnership Working Best Practice Guidance 0 Gateway Ref: 8681

NHS-Funded Nursing Care Practice Guide 2007 Social Care Policy and Innovation (System Reform) 01 Oct 2007 PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Directors of Nursing, Directors of Adult SSs

Circulation List

Lead officials for continuing care in SHAs, PCTs and Councils with Social Services Responsibility

Description

This practice guide sets out the process for determing eligibilty for NHSfunded Nursing Care under the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.

Cross Ref Superseded Docs Action Required Timing Contact Details

The National Framework for Continuing Healthcareand NHS-funded Nursing Care 0 NHS Funded Nursing Care Practice Guide and Workbook, 2001 0 n/a 0 n/a Andrew Palethorpe Social Care Policy & Innovation (System Reform) 8E28 Quarry House Quarry Hill LS2 7UE (0113) 254 6468 0 0

For Recipient's Use

NHS-funded Nursing Care Practice Guide

Crown copyright 2007 First published date Published to DH website, in electronic PDF format only. http://www.dh.gov.uk/publications

NHS-funded Nursing Care Practice Guide

Contents
Background ................................................................................................................................ 6 The National Framework the key principles ............................................................................ 8 Who considers the need for NHS-funded Nursing Care?........................................................... 9 Determining Eligibility ............................................................................................................... 10 Making a decision about NHS-funded Nursing Care ............................................................ 11 Equipment, continence care and other services....................................................................... 13 Equipment ............................................................................................................................ 13 Continence Services............................................................................................................. 13 Chiropody and other therapies ............................................................................................. 14 GP Services.......................................................................................................................... 14 Review and monitoring............................................................................................................. 15 Review of Care Needs.......................................................................................................... 15 Dispute resolution ................................................................................................................. 15 Governance .......................................................................................................................... 15 Special circumstances & changes in circumstances ................................................................ 16 Short periods in residential care, including in emergencies, for respite care and for trial periods.................................................................................................................................. 16 The Multiple Sclerosis Society and Vitalise....................................................................... 16 Admission to hospital, death of a care home resident and retainers .................................... 17 Hospital Admissions.......................................................................................................... 17 Death of a care home resident.......................................................................................... 17 Annex A: Transition from 3-bands to a single band.................................................................. 18 Annex B: Establishing a responsible commissioner ................................................................. 20 General................................................................................................................................. 20 Residency Rules................................................................................................................... 20 Cross-Border Placements..................................................................................................... 20 Out-of-Area placements........................................................................................................ 20 Annex C: The roles of the Care Home Co-ordinator and NHS Lead Nurse ............................. 22 Annex D: Record of nursing care needs .................................................................................. 23 Annex E: MS and Vitalise Care Homes.................................................................................... 25 Annex F: Some special cases .................................................................................................. 26 War Pensioners and Ilford Park............................................................................................ 26 Charitable and voluntary sector organisations...................................................................... 26 Independent hospitals........................................................................................................... 26

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Background
1. This document comprises best practice guidance, includes information and links to other guidance, and sets out the process for the consideration of eligibility for NHS-funded Nursing Care under the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (the National Framework)1 to be implemented from 1 October 2007. It replaces the NHS Funded Nursing Care Practice Guide and Workbook and should be read in conjunction with the other National Framework documents referred to above and included on the website shown in footnote 1. 2. NHS Continuing Healthcare means a package of continuing care arranged and funded solely by the health service for a person aged 18 or over to meet physical or mental health needs which have arisen as a result of illness.. 3. NHS-funded Nursing Care, introduced in October 2001 is the funding provided by the NHS to homes providing nursing, to support the provision of nursing care by a registered nurse for those assessed as eligible. 4. Further important terms are defined in the Glossary in the National Framework.

5. If a person does not qualify for NHS Continuing Healthcare, consideration of the need for care from a registered nurse is appropriate and so whether the persons needs would be most appropriately met in a care home providing nursing care (and, therefore, eligibility for NHS-funded Nursing Care). 6. The registered nurse input is defined in the following terms: services provided by a registered nurse and involving either the provision of care or the planning, supervision or delegation of the provision of care, other than any services which, having regard to their nature and the circumstances in which they are provided, do not need to be provided by a registered nurse 7. This does not include the time spent by non-nursing staff such as care assistants (although it does cover the time spent by the registered nurse in monitoring or supervising care that is delegated to others). Neither does it cover the personal or social care costs or the cost of accommodation to residents. 8. Consideration of eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care is not an alternative to discussions between providers and commissioners about the appropriate level of fees payable to care homes for accommodation and other non-nursing services. These discussions will take place locally, taking account of local circumstances and the general principles set out in Building Capacity and Partnership in Care2, the agreement between the statutory and independent social care, health care and housing sectors.

1 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076288 2 www.integratedcarenetwork.gov.uk/betterCommissioning/index.cfm?pid=386

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See also Fair Access to Care Services3 . 9. As far as possible, people should be offered a joint NHS/social services assessment before they enter a care home providing nursing care on a long-term basis, although there will be circumstances where people need to be admitted under locally agreed arrangements in emergencies 10. For self-funders in particular, PCTs should work closely with their local providers so that they can refer them to the appropriate person to arrange for an assessment of needs for health and social to be undertaken. It is vital that the criteria for NHS and social services support on entry to care homes are agreed jointly by local health and social services and local care home providers have ready access to that information. 11. This should link in to the Single Assessment Process (SAP)4.

3 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009653 4 www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Socialcare/Singleassessmentprocess/index.htm

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The National Framework the key principles

12. The National Framework provides a common approach for all Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and Local Authorities with Social Services responsibilities (LAs) and includes national tools to support decision making, for the NHS in England. An assessment of the totality of the relevant needs is necessary to establish whether there is a primary health need, and so eligibility for NHS Continuing Healthcare. This decision will take account of the lawful limits of LA provision. 13. The National Framework simplifies the interaction between the process for the assessment of NHS Continuing Healthcare and the assessment of NHS-funded Nursing Care. In all cases, a decision about eligibility for NHS Continuing Healthcare must be made before considering the need for NHS-funded Nursing Care. Once the need for such care is agreed the PCTs responsibility to pay a flat rate contribution towards registered nursing care costs is triggered. 14. There will be transitional arrangements in place so that no individual should be disadvantaged by the move to a single band. See Annex A for details of the arrangements. 15. Three new national tools have been developed, in conjunction with stakeholders, to minimise variation in interpretation of need and to inform consistent decision making when considering eligibility for NHS Continuing Healthcare. The tools are published on the Department website and will be kept under review and updated in the light of your experience in using them5. They are: The Fast Track Pathway tool for people who have a rapidly deteriorating condition which may be entering a terminal phase, who need an urgent consideration of their eligibility for NHS Continuing Healthcare. NHS Continuing Healthcare Needs Checklist, to support practitioners in identifying people who are most likely to be eligible for NHS Continuing Healthcare and refer them for a full consideration of eligibility for NHS Continuing Healthcare. At this stage the threshold for a full assessment has been set deliberately low, to ensure that all those who require a full consideration of their needs do get this opportunity. The Decision Support tool, designed to ensure the full range of factors which have a bearing on persons eligibility are taken into account in making a decision. The result of completing the tool should be an overall picture of the persons needs, which captures their nature, and their complexity, intensity and/or unpredictability and thus the quality and/or quantity (including continuity) of care required to meet those needs. 16. These tools, combined with practitioners own experience and professional judgement, should therefore enable them to make a decision about eligibility for NHS Continuing Healthcare.

5 www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/IntegratedCare/Continuingcarepolicy/DH_073912

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Who considers the need for NHS-funded Nursing Care?

17. PCTs are responsible for eligibility considerations for, and for the commissioning of, both NHS Continuing Healthcare and NHS-funded Nursing Care. Information about the responsible commissioner is at Annex B. 18. Whether the decision about NHS-funded Nursing Care is made subsequent to a full determination of eligibility for NHS Continuing Healthcare (using the Decision Support Tool) or on the NHS Continuing Healthcare Needs Checklist, a registered nurse employed by the NHS should be involved in documenting the registered nursing needs and informing that decision. 19. The nurse who undertakes this role should be familiar with recognised models of nursing, have experience relevant to the needs of the individual, and be familiar with the care domains of the Decision Support Tool. In addition they should be informed about local services so they can use their professional judgement to advise the multi-disciplinary team that is responsible for making recommendations about eligibility for NHS Continuing Healthcare. 20. A registered nurse is personally and professionally accountable for practice. This means that the registered nurse is answerable for their actions and omissions regardless of advice or directions from another professional. Professional accountability is fundamentally concerned with weighing up the interests of the patient and clients in complex situations, whilst using professional knowledge, judgement and skills to make a decision. A registered nurse should be able to account for any decision made. 21. Under the guidance issued when NHS-funded Nursing Care was introduced6, each PCT was asked to designate a care home co-ordinator responsible for managing the budget and a lead nurse to monitor the process and outcome of assessments. These two roles could sometimes be combined in one designated person. These roles remain important, but under the changes in the National Framework, PCTs may well find it helpful to combine these roles with other roles in the NHS Continuing Healthcare team. 22. The roles are summarised in Annex C.

6 www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/IntegratedCare/NHSfundednursingcare/index.htm

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Determining Eligibility
23. In any situation where an individual has ongoing health care needs once treatment and rehabilitation have been completed or, when their health care needs are under review, the assessment and care planning process should decide how best to meet those needs. The starting point for decisions about NHS Continuing Healthcare and NHS-funded Nursing Care could therefore be one of a number of different triggers, in a number of different settings. Possible situations include where a person is cared for in the community and their needs change, where they are being discharged from hospital, or where they are resident in a care home and their needs are being reviewed. 24. PCTs should be very clear that the basis of the decision about the need for NHS-funded Nursing Care should be clearly distinct from the basis of the decision about eligibility for NHS Continuing Healthcare. 25. Figure 1 illustrates the process of determining eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care. The National Framework guidance sets out Core Values and Principles, and more detail about the process.
Fast track

Discharge planning, review or other trigger. Other NHSfunded services

yes

Could NHS services enable improvements which could alter the outcome of an eligibility decision in the short term?

Screening: consider possible eligibility for NHS CHC Possible eligibility Full consideration for NHS CHC Establish primary health need: qualify for NHS CHC No eligibility

Care Planning, including determination of requirement for registered nursing care NHS-funded Nursing Care: NHS contribution to services of a registered nurse Other care package NHS and Local Authority contributions

Care planning

Written rationale for decision communicated to individuals, families and carers Care Package provided and funded Review

Figure 1 10

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26. Alternative ways of providing care and support, other than admission to a care home providing nursing, should always be considered as part of the care planning process. These types of services are subject to local variation to meet local need and it is important that assessors are fully aware of the services that are available. Relevant options may include: Support in the community with a package of health and/or social care. Intermediate care (usually up to six weeks). These services are designed to facilitate discharge from hospital; or to avoid inappropriate admission to acute in-patient care. Such services will involve active therapy or interventions to maximise independence. Examples are rapid response support; hospital at home; supported discharge; residential and day rehabilitation. Longer term rehabilitation which is likely to continue for more than 6 weeks. Admission to a care home that does not provide nursing care (usually referred to as a residential home) Social Services Care Package. The individual has no nursing needs but may however require social care services. These will be provided on the basis of an assessment of their social care needs in line with the LAs Fair access to care criteria. The PCT will still be responsible for providing healthcare services as necessary as for anyone eligible for NHS services (e.g. access to a GP and community health services). 27. Whatever the outcome of the consideration for NHS Continuing Healthcare, the persons needs will need to be met. Where the decision is that the person is not eligible for NHS Continuing Healthcare, the need for care from a registered nurse should be considered, and the decision made as to whether registered nursing care in a care home providing nursing is the best option.

Making a decision about NHS-funded Nursing Care

28. This decision should take into account all the individuals nursing needs based on what is known about the persons condition and their usual behaviour over the course of a week, or a number of weeks. They should also consider the potential outcomes if support were not to be provided, or was provided in different ways. In making their evaluation, the registered nurse should also focus on the impact of any decisions on the persons independence, and risks involved for the person, their family and others close to them. 29. This assessment of registered nursing needs should help the individual, their carer and/or representative understand the extent and nature of the nursing care needed to meet their care needs and find the most appropriate environment in which to meet those needs. 30. A care plan should be developed clearly setting out how those needs entail the provision of care or the planning, supervision or delegation of the provision of care by a registered nurse. This therefore includes not only direct input from a registered nurse, but also time spent in the planning, supervising and monitoring of care delivered by someone else, who may or may not be a registered nurse. 31. From 1 October 2007, the need for registered nursing care needs may be recorded in the form of a care plan using the same comprehensive care domains as those used in the Decision Support tool and the NHS Continuing Healthcare Needs Checklist. The suggested documentation is contained in Annex D. 11

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32. If the decision about registered nursing care is being reached subsequent to a full consideration of eligibility for NHS Continuing Healthcare, there is a space in the Decision Support Tool to record the outcome of that process: the assessor may want in addition to attach the completed table from Annex D to provide more detail about the care necessary. 33. Using all available evidence, and their professional skill and judgement, the registered nurse should record the level and quantity of nursing need and any specific risk factors against each care domain. The summary box should be used to make a recommendation on the type of care needed and the rationale for that recommendation. 34. Only the needs of the individual should be recorded, and this should not be influenced by the restrictions placed on the delivery of care by the hospital or care home environment. For example, an individual who is competent to self medicate will, in a hospital or care home environment, have their medication dispensed by a registered nurse in order to comply with health and safety requirements. This is therefore not a requirement or need for registered nursing care. 35. The registered nurse involved in this decision should help answer the following questions Does the person have registered nursing needs at a level where they require a care home providing nursing care environment? Do they want to/need to be in residential setting or is another option more appropriate? 36. Once it has been agreed with the individual and/or their carer or representative that a care home providing nursing offers the best environment in which their needs can be met, the next phase is to set goals for the care plan. This process should usually be completed before a permanent admission to a care home takes place. Where a LA is involved the relevant professionals should be working closely together to identify the care required which in turn, will inform the selection of a care homes able to meet those needs. In all cases the individual their carer and/or representative is responsible for making the choice of care home providing nursing care. The guidance issued in 2004 on the National Assistance Act (Choice of Accommodation) Directions7 will be relevant where a LA is involved. Arrangements for moving to a care home providing nursing care should follow the locally agreed protocols. 37. In some cases, although the individual is not eligible for NHS Continuing Healthcare, they may still require additional NHS services over and above the provision of registered nursing care. In such cases, the PCT needs to identify the necessary services and arrange provision and funding of those services.

7 www.dh.gov.uk/en/Consultations/Closedconsultations/DH_4071450

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Equipment, continence care and other services

38. Care plans for individuals entering care homes providing nursing care should set out the services to be provided within the LAs standard rate and by the NHS. Individuals should not have to pay for any NHS services included in the care plan, although they may need to contribute towards social services as part of an assessment made by a LA under the National Assistance (Assessment of Resources) Regulations for other services they need. 39. Care home residents should have access to the full range of specialist NHS support that is available in other care settings and to people receiving care at home. In addition to equipment that is provided or secured by the care home in accordance with the minimum standards, the NHS should also consider whether there is a need to provide residents with access to dietary advice, as well as to the full range of available community equipment services, including pressure redistributing equipment, aids to mobility, and communication aids etc. that are available in other settings.

Equipment
40. Care homes providing nursing care are expected to be fit for purpose, which, in the main, means they will have in place basic handling, mobility, and lifting equipment and adaptations. There may be some situations where they will need to draw on the resources of the local community equipment service. 41. Where the NHS has determined that an individual requires a particular piece of equipment, it should ensure either that the care home provides it; or provide it on a temporary basis until the care home is able to provide it; or provide it to the individual for as long as they need it. It would be unreasonable to expect care homes to provide items of equipment that, by the nature of the design, size, and weight requirements, need to be specifically tailored to meet the individuals needs and would not be capable of being utilised by other care home residents. Further information on community equipment is available8.

Continence Services
42. Residents of care homes, including those providing nursing care, should have access to professional advice about the promotion of continence. See Good Practice in Continence Services.9 43. As well as prevention and advice services, this should also include the provision of continence products, subject to a full assessment of an individuals needs. Continence products should be made available by the NHS to residents of care homes who are also receiving NHS-funded Nursing Care, if required.

8 www.icesdoh.org/doc_cat.asp?ID=16 9 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005851

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Chiropody and other therapies

44. Chiropody services and other therapies such as physiotherapy, occupational therapy, speech and language therapy and podiatry should be made available to residents of care homes providing nursing care on a similar basis as they are to those in other settings: in care homes or at home. Where such NHS services are not provided, or where individuals choose to pay a care home providing nursing care for these services that it is willing to provide, the NHS has no obligation to provide those services.

GP Services
45. Residents of care homes are as entitled to be registered with a local GP as anyone else so that they can have access to the full range of NHS services that are free for patients. Some residents may remain registered with a GP who provided services prior to their admission to the home, 46. A guide for care home managers on the services provided by GPs is available10.

10 www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/IntegratedCare/NHSfundednursingcare/DH_4000392

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Review and monitoring

Review of Care Needs
47. Following an initial decision about NHS Continuing Healthcare and NHS-funded Nursing Care, a review of eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care should be undertaken within 3 months and then on an annual basis or more frequently if there is a significant change in the health needs of the individual . If the person is receiving NHS-funded Nursing Care, the persons potential eligibility for NHS Continuing Healthcare should always be checked as part of the review, using the NHS Continuing Healthcare Checklist. 48. The same principles and process apply to the review process as for someone entering the National Framework process for the first time. 49. The review plays a critical role in ensuring the nursing needs of the individual are being appropriately met and provides an opportunity to review the goals set in the care plan. It may be pertinent to consider whether the individuals level of independence has improved to the point where permanent admission to a care home providing nursing is no longer appropriate and if so, whether other forms of care should be considered.

Dispute resolution
50. If the person is dissatisfied with the outcome of a decision relating to eligibility for NHS Continuing Healthcare they are entitled to ask for a review of that decision as set out in the National Framework. Challenges to decisions about eligibility for NHS-funded Nursing Care will be dealt with by the PCT according to their local disputes process in the first instance. The individuals rights under the existing NHS Complaints procedure remain unaltered.

Governance
51. In addition to the section on Governance in the National Framework, which refers mainly to NHS Continuing Healthcare eligibility considerations, the PCT will find it helpful to carry out routine analysis of the award of NHS-funded Nursing Care. This should enable the PCT to monitor capacity issues, the consistency of decision making and to inform the commissioning process and take action accordingly.

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Special circumstances & changes in circumstances

Short periods in residential care, including in emergencies, for respite care and for trial periods
52. There may be occasions where individuals need to go into a care home for short periods of time in an emergency or crisis, or where for example a carer is suddenly taken ill and is unable to look after the individual those placed in a care home who are awaiting the completion of a nursing determination of care by a registered nurse; or for a trial period - to explore whether they would prefer to move into a care home on a permanent basis, though this would not apply to permanent residents of care homes who wanted to find another home for respite care. 53. Short periods in a care home providing nursing care of less than 6 weeks qualify for NHS funding, though there is no need to carry out an assessment if it is known at the outset that the stay will be less than 6 weeks and the person has already been assessed as requiring nursing care (for example, they are an existing client of the community nursing service). 54. Periods of less than a week will also qualify for NHS funding on a pro rata basis. If someone has a series of planned respite care in a care home that is likely to exceed 6 weeks in any 12 month period, an assessment should be carried out at the outset, unless the person is already receiving NHS Continuing Healthcare, in which case the NHS will be responsible for all the costs of care. 55. PCTs that arrange care for their residents out of their area should pay the care home or LA direct. They will need to inform the PCT where the care home is located of the period of care to avoid duplicate payment. 56. Someone who chooses to pay privately for nursing care at home may qualify for NHS-funded Nursing Care for any periods of care in a care home providing nursing care.

The Multiple Sclerosis Society and Vitalise 57. The Multiple Sclerosis Society and Vitalise (formerly known as the Winged Fellowship) both run care homes specialising in short-term respite care for the severely disabled. Nursing care for periods of short-term respite care in the care homes below will be funded by the PCT where the care home is located rather than the PCT where the client or service user is registered. 58. To ease administrative burdens, allocations to the host PCTs were increased to reflect the additional administrative burden placed on them for making payments and for monitoring care on behalf of other PCTs and, where partnership arrangements are in place, local authorities 59. The care homes and the relevant PCTs are listed in Annex E. 16

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Admission to hospital, death of a care home resident and retainers

Hospital Admissions 60. When a care home resident is admitted to hospital, payments for their care by a registered nurse should not be duplicated for the duration of their stay but should resume on their return to the care home. These terms, and any variations to them, should be reflected in local NHS contracts with care homes. LAs and individuals will need to agree separately with care homes the level of fees necessary to secure the place in the care home providing nursing care in the event of such temporary absences. It is clear that in these circumstances the NHS should not continue to pay for NHS-funded Nursing Care. 61. However, in order to secure the place in the care home on return from hospital and to avoid people being asked to pay any shortfall for the time they are in hospital, PCTs will want to consider the payment of an equivalent sum as a retainer. This should be in accordance with the practice of their LA partners. Where someone has been placed in residential care under a Social Services contract, it has been custom and practice for LAs to continue to pay care homes the full fee for a set period (usually 6 weeks), followed by a reduced payment after a further period. 62. In these circumstances, the NHS will need to pay a sum equal to the amount that was being paid towards NHS-funded Nursing Care immediately prior to the admission to hospital. 63. Separate contracts that the NHS has with providers to pay for the nursing care (for self funders) should also provide for retainer to be paid on admission to hospital in order to safeguard the care home bed when the individual is ready for discharge from hospital.

Death of a care home resident 64. Similarly, there is no direct nurse input following the death of a resident. In their contracts with providers, LAs often pay a full fee for a certain period following death in recognition that rooms need to be prepared for new residents. PCTs will need to agree a similar payment in these circumstances to cover the period after death in line with any agreements reached with providers and LAs.

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Annex A: Transition from 3-bands to a single band

Until 30 September 2007, there are two stages to a decision about the assessment of need sufficient to make a decision about the requirement for registered nursing care in a care home, and a determination of the level of funding. Nursing care funding is currently divided into three bands high, medium and low and is paid by PCTs, based on the level of an individuals need, not their income. The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care will be implemented from 1 October 2007, from when there will be one single band for NHS-funded Nursing Care. When NHS-funded nursing care was introduced in October 2001 we made a commitment to regularly reassess the payment attached to the banding, in line with the increases in nurses pay. That commitment will remain, and a further update will be published in time for contracts with care homes to be amended from 1 April 2008. Until then, the weekly rate for eligible care home residents will be 101. Accommodation and personal care costs will continue to be met by the LA and/or the individual (subject to the outcome of means-testing). People who, prior to 1 October 2007, are receiving the low and medium bands, will move immediately onto the standard weekly payment. Any resident currently receiving high band funding should continue to receive this higher level of payment until their case is fully reviewed in line with the National Framework. If, on review, the person: is not eligible for NHS Continuing Healthcare, but their needs are still such that they would have been granted the high band payment, payment should continue at the high rate has needs that would have been medium or low, they move on to the new, flat-rate payment is eligible for NHS Continuing Healthcare then NHS-funded Nursing Care payments cease.

The same procedure should be followed at all subsequent reviews. The legal basis for these arrangements are set out in The National Health Service (Nursing Care in Residential Accommodation) (England) Directions 2007(11)

11 www.dh.gov.uk/en/Publicationsandstatistics/Legislation/DH_078061

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For the foreseeable future, the NHS-Funded Nursing Care Practice Guide and Workbook 200112 will remain available, to enable this decision to be reached. Other guidance, published in HSC2001/17 / LAC2001(18), and HSC2003/006 / LAC(2003)7 will also remain available on the Departments website for reference purposes.

12 www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/IntegratedCare/NHSfundednursingcare/index.htm

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Annex B: Establishing a responsible commissioner

General
Many care home placements are made at some distance away from the individuals place of residence. The PCT where the individual lives prior to entering a care home should carry out the assessment and should notify the PCT responsible for the care home so that the receiving PCT can fund and plan nursing care services in its area effectively. There should be no need for the receiving PCT to repeat the assessment, although it would need to arrange a review within three months of the person transferring to the care home providing nursing care. Determinations carried out in one PCT should be accepted by another PCT that subsequently becomes responsible for that person and reviewed at 3 months. Depending on the reasons for the decision to place away from their previous place of residence, the 3 month review will also provide an opportunity to review with the person and their representatives whether alternative services are available locally that more fully meet their needs.

Residency Rules
The residence rules for NHS Continuing Healthcare and NHS-funded Nursing care are included in the guidance on Establishing a Responsible Commissioner that is available at
www.doh.gov.uk/pricare/responsiblecommissioner/index.htm

Local authorities placing residents in care homes will need to apply the rules for ordinary residence set out in LAC (93) 7 and relevant case-law.

Cross-Border Placements
A protocol governing placements between English and Welsh NHS bodies and LAs either side of the border to care homes that provide nursing care is available at
www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/IntegratedCare/NHSfundednursingcare/DH_4000400

Out-of-Area placements
There may be partnership arrangements in place between the area in which the person is placed and their local PCT which provide for the delegation of the nursing care function to the LA, either under a pooled budget or a lead commissioner arrangement. These partnership arrangements may also be used where the LA is providing residential care for persons placed by another LA. The LA in which the home is situated would contract with the care home for the provision of social care services with the consent and agreement of the placing authority. It is also able to contract for the provision of nursing care because this function has been delegated to it under the partnership arrangements. Thus, it is possible to have one set of contractual arrangements for the provision of the total care package. The function of conducting the assessment to determine whether the person is in need of nursing care would be conducted by the responsible PCT. Otherwise LA, having assessed a person as being in need of care and attention, may make arrangements under section 21 of the National Assistance Act to place a person in a 20

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residential care home situated within the area of a different LA. It may be that some LAs have regular arrangements for placing large numbers of people in the area of another LA. Alternatively, they may have needed to make ad hoc arrangements, for example where care homes within their area are full, or where people are placed in an area some distance away where the person has family ties.

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Annex C: The roles of the Care Home Co-ordinator and NHS Lead Nurse
A care home co-ordinator (the budget manager) to: Manage, on behalf of the NHS, the budget for NHS funded nursing care, including responsibility for agreement that the NHS funded nursing care budget will fund individuals registered nursing care, and day-to-day budget management Monitor spending on nursing care against the allocated budget to ensure that spend stays within budget Liaise closely with nurses carrying out determinations of care by a registered nurse for existing and future care home residents, approving the funding of all nursing determinations that are carried out by nurses Manage, in conjunction with nurses, the reviews of determinations of care by a registered nurse Act as the lead manager for NHS funded nursing care within the PCT Liaise with PCTs and local LAs on placements in local care homes out of area Act as a focal point for any complaints about NHS funded nursing care in as far as these might relate to the provision of NHS services and channel for complaints elsewhere (in the SHA, Councils with Social Services Responsibilities, Ombudsman, etc) as necessary.

A lead nurse for NHS-funded Nursing Care to: Provide professional nursing advice to care homes, LAs and the care home co-ordinator about the carrying out of determinations and use of NHS-funded Nursing Care Monitor the quality and consistency determinations carried out by registered nurses within the PCT Ensure that a sufficient number of nurses receive appropriate training.

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Annex D: Record of nursing care needs

Template for local adaptation Name Home Address

DOB ID No Current Location Date Completed Name & Address of care home Placement Registration Category of home Relevant dates

Placement Reviews

First review

Subsequent

Name of Assessor (Printed) & Signature

Contact Details of Assessor(s) Other relevant information such as carer or representative

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Care Domains

Registered Nursing Care Needs

Date

Behaviour

Cognition

Psychological and Emotional Needs Communication

Mobility

Nutrition food & Drink Continence

Skin

Breathing Drug therapies & Medication

Altered States of Consciousness Summary of Needs & Recommendation

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Annex E: MS and Vitalise Care Homes

Multiple Sclerosis Society Care Homes
Brambles, Horley Helen Ley, Leamington Spa Woodlands, York East Surrey PCT (managed in association with Elmbridge and Mid Surrey PCT) South Warwickshire PCT Selby and York PCT

Vitalise Care Homes/Centres

Sandpipers, Southport Skylarks, Nottingham Netley, Eastleigh Jubilee Lodge, Epping Southport and Formby PCT Gedling PCT Eastleigh and Test Valley South PCT Epping PCT

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NHS-funded Nursing Care Practice Guide

Annex F: Some special cases

War Pensioners and Ilford Park
A very small number of residents of care homes receive nursing care and the whole of their care costs, including care from a registered nurse, funded by the State either by the Veterans Agency (including the Ilford Park Polish Home). Although not self-funders, they continue to receive funding for their care from the Agency and so are not eligible for NHS-funded Nursing Care. The NHS will however be involved in ensuring that they are receiving other appropriate NHS services and care that they may need, as well as continence advice. The vast majority of War Pensioners who live in care home is the same as any other resident. LAs will need to take account of the receipt of a war pension as they would for any other social security benefit when carrying out financial assessments. In these circumstances, eligibility for NHS-funded Nursing Care would be unaffected by whether or not they qualify for any support from a LA.

Charitable and voluntary sector organisations

The policies of a number of charities has been for them to subsidise all the costs of care by a registered nurse for the residents of their homes. In the majority of cases, those charitable and voluntary sector bodies are also the providers of care. The individual is usually asked to pay for all the other costs of their care, other than nursing care. In these circumstances, they are likely to be eligible as a self-funder. In order for the charity to benefit from NHS-funded Nursing Care, they would need to nominally charge but not receive from the individual a fee for the care from a registered nurse. With the agreement of the individual, the charity may retain the NHS funding in full. Alternatively, the charitable and voluntary sector bodies could amend their rules so that the care from a registered nurse is no longer subsidised and it receives and retains the NHS funding. Whatever option is chosen, individual residents or their representatives, would need to be informed and the position explained to them, in particular if and how this is likely to affect the level of fee they will be expected to pay to the care home in fees.

Independent hospitals
Some care homes mainly providing care for those with mental health problems that used be registered as a care home providing nursing care under the Registered Homes Act have opted to register as independent hospitals under the Care Standards Act. Residents are entitled to NHS-funded Nursing Care and so should first be considered for NHS Continuing Healthcare.

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