Framework for
Continuing NHS
Healthcare
Self-Assessment Tool
Contents
Part 1: Introduction and explanation of how to use this self-assessment tool
3
Part 2: Self-assessment tool
5
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Part 1
Introduction and explanation of how to use this
self-assessment tool
Framework for Continuing NHS Healthcare – an introduction
1.
The Welsh Government issued a revised framework for Continuing NHS Healthcare
(CHC) in May 2010, which was to be implemented by 16 August 2010.The Framework
covers adults and sets out the Welsh Government’s revised policy for eligibility for
CHC and the responsibilities of health boards and local authorities. The Framework
sets out a process for the NHS, working with local authority partners, to assess health
needs, decide on eligibility for CHC and provide appropriate care.
2.
The Wales Audit Office has undertaken a review of the implementation of the
Framework and has published a report summarising national findings. A key
recommendation of the report was that health boards use this self-assessment tool,
to assess the local position in implementing the Framework. The tool allows a health
board to answer the question:‘are we meeting the requirements of the CHC
Framework?’It is not an in-depth review or detailed benchmarking exercise.
3.
The Welsh Government is to review the CHC Framework, and, as far as possible,
this self-assessment tool has been designed in such a way as to accommodate any
future changes. For example, the tool refers to ‘prescribed timescales’ rather than the
current timescales contained in the Framework.
Using this self-assessment tool
4.
Part 2 of this tool sets out the detailed requirements that you should be working
to implement, and the questions you will need to answer. The self-assessment is
intended to support you in identifying what is working well and where remedial action
should be targeted.
5.
The table in Part 2 will help you produce an action plan to ensure all aspects of the
Framework are met. It contains prompts for what action is needed, by whom and by
when.
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Index of questions
6.
Set out below are the detailed questions that you will answer as you undertake this
self-assessment.
Is your health board meeting the requirements of the CHC Framework?
1.
2.
3.
4.
5.
6.
7.
Does your health board have the governance arrangements in place as outlined in the
CHC Framework?
a)
Policies and protocols
b)
Training and development
Does your health board assess and decide upon cases as outlined in the CHC
Framework?
a)
Assessment
b)
Decision making
Does your health board deal with fast-track and transition cases in line with the CHC
Framework?
a)
Fast-track arrangements
b)
Transition from children to adult services
Does your health board undertake reviews as prescribed in the CHC Framework?
a)
Review process
b)
Review outcomes
Does your health board have effective joint working in place with local authority
partners as prescribed in the CHC Framework?
a)
Procedures and protocols
b)
Disputes between the health board and local authority partners
Does your health board inform and involve individuals and their families/carers in line
with the requirements of the CHC Framework?
a)
Patient information
b)
Advocacy
c)
Consent
d)
Mental capacity
e)
Patient involvement
Does your health board deal with requests to review a decision in accordance with the
CHC Framework?
a)
Dealing with a request for a review
b)
Independent review panel
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Part 2
Self-assessment tool
Is your health board meeting the requirements of the CHC Framework?
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
1. Does your health board have the governance arrangements in place as outlined in the CHC Framework?
a) Policies and protocols
A comprehensive range of agreed local policies and
protocols are in place in line with any Welsh Government
guidance. (Annex G of the National Framework for NHS
Continuing Healthcare and NHS-funded Nursing Care
in England provides a best practice guide on what to
include when drawing up and updating local protocols
and procedures.)
Policies and protocols are consistently applied across all
front-line operational teams (such as localities and clinical
groups).
Where there is a corporate or central structure there is
effective joint working with operational teams to agree
and implement policies and procedures.
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By whom
By when
Issue
b) Training and
development
Framework requirement/good practice
All relevant health and social care staff have attended the
initial one-day CHC trainingcourse. (This includes all
members of the multidisciplinary team in hospital involved
in hospital discharge, as well as community-based
professionals involved in assessing the need for, and
planning of, long-term care.)
All private care home staff received CHC awareness
training.
Follow-up CHC training is available to support the initial
training day.
In addition to the initial one-day training session and
follow-up session, other training is available on for
example multidisciplinary working or dealing with conflict.
There are readily available records of which staff have
attended CHC training to allow easy analysis of the
extent of attendance across different staff groups.
Alternative ways of developing expertise on CHC within
front-line operational teams and within existing resources
have been thoroughly assessed. (Eg, allocating
responsibility for leading on CHC in a district nursing
team or across a number of hospital wards and then
developing this person’s expertise.)
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Fully
achieved
(Yes/No)
Action required
Action
By whom
By when
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
2. Does your health board assess and decide upon cases as outlined in the CHC Framework?
a) Assessment
In advance of a CHC assessment, all available
interventions that may impact on health needs are
undertaken and the further potential for rehabilitation and
regaining independence considered.
A comprehensive, multidisciplinary assessment of a
person’s care needs is always carried out prior to the
completion of the Decision Support Tool (DST); and this
includes all relevant specialist and non-specialist
assessments.
The DST is only used as a tool to support decision
making.
b) Decision making
All appropriate professionals are involved in the
multidisciplinary decision-making process.
Professional judgement determines the eligibility decision
and a detailed rationale for decisions is documented.
Scrutiny processes are fit for purpose with panels having
an appropriate number, scope, size and membership.
Page 8 of 18-Framework for Continuing NHS Healthcare-Self-Assessment Tool
By whom
By when
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
Arrangements are in place to ensure consistency
between the way scrutiny panels operate.
Social services are either involved in scrutiny processes
or there are effective communication and joint working
arrangements in place with social services over eligibility
decisions.
The time taken to complete a CHC assessment and
make a decision on eligibility is within prescribed
timescales.
3. Does your health board deal with fast-track and transition cases in line with the CHC Framework?
a) Fast-track
arrangements
Fast-track arrangements achieve their purpose in all
cases and are undertaken in a timely manner.
Local authorities and the health board have systems in
place to ensure that appropriate referrals are made
whenever either organisation is supporting a young
person who, on reaching adulthood, may have a need for
services from the other organisation.
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By whom
By when
Issue
b) Transition from
children to adult
services
Framework requirement/good practice
There is appropriate representation from adult services in
transitional arrangements for individual young people.
Transition planning routinely commences when the child
is aged 14.
At the age of 17, eligibility for adult CHC is always
determined in principle so that, wherever applicable,
effective packages of care can be commissioned in time
for the individual’s 18th birthday (or later, if it is agreed
that it is more appropriate for responsibility to be
transferred then).
A consistent package of support is provided during
the years before and after the transition to adulthood.
(The nature of the package may change because
the young person’s needs or circumstances change.
However, it should not change simply because of the
move from children to adult services or because of a
switch in the organisation with commissioning or funding
responsibilities.)
Potential improvements to the way transition is handled
have been thoroughly assessed (eg, appointment of
transition nurses or teams).
Page 10 of 18-Framework for Continuing NHS Healthcare-Self-Assessment Tool
Fully
achieved
(Yes/No)
Action required
Action
By whom
By when
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
4. Does your health board undertake reviews as prescribed in the CHC Framework?
a) Review process
Prior to the review, individuals and their families are
offered the opportunity to reassess their own needs
and are offered appropriate support to do so.
Reviews follow the format of an assessment, use the
DST, and clearly identify any change in needs.
Social services are routinely involved in reviews,
and in particular, joint reviews are undertaken when
the local authority is also responsible for any part of
the individual’s care.
A joint reassessment of the individual by the health
board and local authority takes place prior to a
withdrawal of, or change of, CHC funding.
b) Review outcomes
People appropriately move in and out of CHC eligibility
over time.
CHC reviews are undertaken to the prescribed
frequency and times.
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Action required
Action
By whom
By when
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
By whom
5. Does your health board have effective joint working in place with local authority partners as prescribed in the CHC Framework?
a) Procedures and
protocols
The health board and local authority partners have in
place locally agreed procedures or protocols for dealing
with any disputes about the apportionment of funding in
jointly funded care packages.
The health board and local authority partners have in
place a locally agreed procedure or protocol for dealing
with any disputes about eligibility for CHC.
The health board and local authority partners have
effective joint working with regards CHC including the
commissioning and contracting of care homes.
b) Disputes between the
health board and local
authority partners
Disputes between the health board and local authority
partners over CHC eligibility decisions are very rare.
Any disputes between the health board and local
authority partners over CHC eligibility decisions are
resolved in a timely manner (ie, from the time the dispute
is raised to a resolution).
CHC funding is never withdrawn prior to the dispute
being resolved.
Page 12 of 18-Framework for Continuing NHS Healthcare-Self-Assessment Tool
By when
Issue
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
By whom
By when
6. Does your health board inform and involve individuals and their families/carers in line with the requirements of the CHC Framework?
a) Patient information
The patient CHC information leaflet is always made
available to patients and their families/carers.
The CHC patient guide, or similar, is always
madeavailable to patients and their families/carers.
The adequacy of patient information has been reviewed
and any identified gaps addressed.
Review timescales are always communicated in writing to
the individual and their relatives.
b) Advocacy
The health board has considered whether any action is
needed to ensure the adequacy of advocacy services for
those who are eligible, or potentially eligible, for CHC.
Details of the available local advocacy are always made
available to patients and their families/carers.
c) Consent
A standard consent form is in place that separately
captures consent to share information and for consent for
the CHC assessment.
The standard consent form is always completed and
placed in the individual’s CHC file.
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Issue
Framework requirement/good practice
All staff undertaking CHC assessments are trained in the
health board’s consent process.
There is a locally agreed protocol on the process to be
followed if there is a refusal of consent for a CHC
assessment.
Health board staff effectively identify and signpost on to
social services people who receive social security and
other welfare benefits that may be affected by eligibility
for CHC.
d) Mental capacity
Standard CHC documentation prompts for the
consideration of mental capacity.
If there is a concern that an individual may not have the
mental capacity to give their consent or to participate
effectively in the decision-making process, consent is
always determined in accordance with the Mental
Capacity Act 2005 and the associated code of practice.
The consideration of mental capacity, and when
applicable, copies of ‘best interest’ forms are always
included in the individual’s CHC file.
All staff undertaking CHC assessments are trained in the
Mental Capacity Act 2005 and the associated code of
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Fully
achieved
(Yes/No)
Action required
Action
By whom
By when
Issue
Framework requirement/good practice
practice.
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Fully
achieved
(Yes/No)
Action required
Action
By whom
By when
Issue
e) Patient involvement
Framework requirement/good practice
Fully
achieved
(Yes/No)
Action required
Action
Individuals are always given the opportunity to
provide their views as part of the assessment and
decision-making process.
Individuals are always given the opportunity to be
supported or represented by a carer or advocate as
part of the completion of the DST.
The views of individuals and their families/carers are
always documented in detail on case files.
Carers’ assessments are always offered and the offer
recorded within case files.
7. Does your health board deal with requests to review a decision in accordance with the CHC Framework?
a) Dealing with a request
for a review
There is a local policy on the process to be followed
when someone wants to dispute an eligibility decision,
including expected timescales for resolving cases.
The local policy on disputes and the independent review
process is made available to all people who are not
deemed eligible for CHC.
Disputes over eligibility are dealt with in a timely manner
and in accordance with the local policy.
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By whom
By when
Issue
b) Independent review
panel
Framework requirement/good practice
The independent review panel has access to
independent clinical advice.
There is adequate administrative support for the
independent review process to ensure the panel’s
deliberations are well recorded, and that policy
timescales are met.
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Fully
achieved
(Yes/No)
Action required
Action
By whom
By when