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 Page 2 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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. Page 3 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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. Does your health board have the governance arrangements in place as outlined in the CHC Framework? a) Policies and protocols b) Training and development 2. Does your health board assess and decide upon cases as outlined in the CHC Framework? a) Assessment b) Decision making 3. 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 4. Does your health board undertake reviews as prescribed in the CHC Framework? a) Review process b) Review outcomes 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 b) Disputes between the health board and local authority partners 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 b) Advocacy c) Consent d) Mental capacity e) Patient involvement 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 b) Independent review panel Page 4 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
Part 2 Self-assessment tool Is your health board meeting the requirements of the CHC Framework? Issue Framework requirement/good practice Fully 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. Page 5 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
b) Training and development All relevant health and social care staff have attended the initial one-day CHC training course. (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.) Page 6 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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 7 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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. Page 8 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
b) Transition from children to adult services 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 9 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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. Page 10 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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 11 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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 made available 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. Page 12 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
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 practice. Page 13 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
e) Patient involvement 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. Page 14 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool
b) Independent review panel 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. Page 15 of 16 - Framework for Continuing NHS Healthcare - Self-Assessment Tool