NHS Continuing Healthcare is a name given to a package of care which is funded by the Clinical Commissioning Group for individuals over the age of 18 who have ongoing care needs outside of hospital; to ascertain individuals who are eligible for NHS Continuing Healthcare we must follow a complex process which is focussed on the individual and the intensity, complexity and Unpredictability of their care needs and who presents with a primary health need.
NHS Continuing Healthcare is a needs led process and is not diagnosis led therefore it is not dependent on a particular illness or disease, diagnosis, condition or on who provides the care or where it is provided; if you are found eligible the CCG will pay for healthcare and associated social care needs which are clinically required.
The NHS Funded Care Team and local authorities work to the guidance of The National Framework for NHS Continuing Healthcare; although the CCG is the lead organisation for implementing the NHS Continuing Healthcare Process there is an expectation that partner agencies and authorities work in partnership to promote openness and transparency during the assessment and decision making process.
To be eligible for NHS continuing healthcare, the person you look after must be assessed as having a "primary health need" and have a complex medical condition and substantial and ongoing care needs; not everyone with a disability or long-term condition will be eligible.
Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four characteristics:
Nature – this describes the characteristics and type of the individual’s needs and the overall effect these needs have on the individual, including the type of interventions required to manage those needs
Intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/ongoing care
Complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/or manage the care.
Unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided
A decision about eligibility should usually be made within 28 days of an assessment being carried out.
The NHS Funded Care Team are a multi-disciplinary team of Nurses (both RGN and RMN), Occupational Therapist and administration staff, the team accept referrals from health professionals, nursing and residential homes and local authority colleagues.
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