nursing care practice guide

8/3/2019 Nursing Care Practice Guide

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NHS-Funded Nursing Care

Practice Guide 2007


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NHS-funded Nursing Care Practice Guide

NHS-Funded Nursing Care

Practice Guide 2007

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NHS-Funded Nursing Care Practice Guide 2007

LS2 7UE

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(0113) 254 6468

Andrew Palethorpe

Social Care Policy & Innovation (System Reform)

8E28 Quarry House

Quarry Hill

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Social Care Policy and Innovation (System Reform)

The National Framework for Continuing Healthcareand NHS-funded Nursing

Care

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NHS Funded Nursing Care Practice Guide and Workbook, 2001

01 Oct 2007

PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Directors of Nursing,

Directors of Adult SSs

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

Services Responsibility

This practice guide sets out the process for determing eligibilty for NHS-

funded Nursing Care under the National Framework for NHS ContinuingHealthcare and NHS-funded Nursing Care.

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Crown copyright 2007

First published date

Published to DH website, in electronic PDF format only.

http://www.dh.gov.uk/publications

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Contents

Background................................................................................................................................ 6The National Framework the key principles ............................................................................ 8Who considers the need for NHS-funded Nursing Care?........................................................... 9Determining Eligibility...............................................................................................................10

Making a decision about NHS-funded Nursing Care ............................................................ 11Equipment, continence care and other services....................................................................... 13

Equipment ............................................................................................................................13Continence Services............................................................................................................. 13Chiropody and other therapies ............................................................................................. 14GP Services..........................................................................................................................14

Review and monitoring............................................................................................................. 15Review of Care Needs.......................................................................................................... 15Dispute resolution................................................................................................................. 15Governance .......................................................................................................................... 15

Special circumstances & changes in circumstances................................................................ 16Short periods in residential care, including in emergencies, for respite care and for trialperiods..................................................................................................................................16

The Multiple Sclerosis Society and Vitalise....................................................................... 16Admission to hospital, death of a care home resident and retainers .................................... 17

Hospital Admissions.......................................................................................................... 17Death of a care home resident.......................................................................................... 17Annex A: Transition from 3-bands to a single band.................................................................. 18Annex B: Establishing a responsible commissioner................................................................. 20

General.................................................................................................................................20Residency Rules................................................................................................................... 20Cross-Border Placements..................................................................................................... 20Out-of-Area placements........................................................................................................ 20

Annex C: The roles of the Care Home Co-ordinator and NHS Lead Nurse ............................. 22Annex D: Record of nursing care needs .................................................................................. 23Annex E: MS and Vitalise Care Homes.................................................................................... 25Annex F: Some special cases .................................................................................................. 26

War Pensioners and Ilford Park............................................................................................ 26Charitable and voluntary sector organisations...................................................................... 26Independent hospitals........................................................................................................... 26

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Background1. 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-fundedNursing Care under the National Framework for NHS Continuing Healthcare and NHS-fundedNursing Care (the National Framework)1 to be implemented from 1 October 2007. It replacesthe NHS Funded Nursing Care Practice Guide and Workbookand should be read inconjunction with the other National Framework documents referred to above and included onthe website shown in footnote 1.

2. NHS Continuing Healthcare means a package of continuing care arranged andfunded solely by the health service for a person aged 18 or over to meet physical or mentalhealth needs which have arisen as a result of illness..

3. NHS-funded Nursing Care, introduced in October 2001 is the funding provided by theNHS to homes providing nursing, to support the provision of nursing care by a registered nursefor 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 needfor care from a registered nurse is appropriate and so whether the persons needs would bemost appropriately met in a care home providing nursing care (and, therefore, eligibility forNHS-funded Nursing Care).

6. The registered nurse input is defined in the following terms:

services provided by a registered nurse and involving either the provisionof care or the planning, supervision or delegation of the provision of care,other than any services which, having regard to their nature and thecircumstances in which they are provided, do not need to be provided by aregistered 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 costof accommodation to residents.

8. Consideration of eligibility for NHS Continuing Healthcare and NHS-funded NursingCare is not an alternative to discussions between providers and commissioners about theappropriate level of fees payable to care homes for accommodation and other non-nursingservices. These discussions will take place locally, taking account of local circumstances andthe general principles set out in Building Capacity and Partnership in Care2, the agreementbetween the statutory and independent social care, health care and housing sectors.

1 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_0762882 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 assessmentbefore 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 inemergencies

10. For self-funders in particular, PCTs should work closely with their local providers sothat they can refer them to the appropriate person to arrange for an assessment of needs forhealth and social to be undertaken. It is vital that the criteria for NHS and social servicessupport on entry to care homes are agreed jointly by local health and social services and localcare 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_40096534 www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Socialcare/Singleassessmentprocess/index.htm

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The National Framework the key

principles12. The National Framework provides a common approach for all Strategic HealthAuthorities (SHAs), Primary Care Trusts (PCTs) and Local Authorities with Social Servicesresponsibilities (LAs) and includes national tools to support decision making, for the NHS inEngland. An assessment of the totality of the relevant needs is necessary to establish whetherthere is a primary health need, and so eligibility for NHS Continuing Healthcare. This decisionwill take account of the lawful limits of LA provision.

13. The National Framework simplifies the interaction between the process for theassessment 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 beforeconsidering the need for NHS-funded Nursing Care. Once the need for such care is agreed thePCTs responsibility to pay a flat rate contribution towards registered nursing care costs istriggered.

14. There will be transitional arrangements in place so that no individual should bedisadvantaged 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, tominimise variation in interpretation of need and to inform consistent decision making whenconsidering 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 experiencein using them5. They are:

The Fast Track Pathway tool for people who have a rapidly deteriorating conditionwhich may be entering a terminal phase, who need an urgent consideration of theireligibility for NHS Continuing Healthcare.

NHS Continuing Healthcare Needs Checklist, to support practitioners in identifyingpeople who are most likely to be eligible for NHS Continuing Healthcare and refer themfor a full consideration of eligibility for NHS Continuing Healthcare. At this stage thethreshold for a full assessment has been set deliberately low, to ensure that all thosewho 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 abearing on persons eligibility are taken into account in making a decision. The result ofcompleting the tool should be an overall picture of the persons needs, which capturestheir nature, and their complexity, intensity and/or unpredictability and thus the qualityand/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 ContinuingHealthcare.

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 theresponsible commissioner is at Annex B.

18. Whether the decision about NHS-funded Nursing Care is made subsequent to a fulldetermination of eligibility for NHS Continuing Healthcare (using the Decision Support Tool) oron the NHS Continuing Healthcare Needs Checklist, a registered nurse employed by the NHSshould 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 ofnursing, have experience relevant to the needs of the individual, and be familiar with the caredomains of the Decision Support Tool. In addition they should be informed about local servicesso they can use their professional judgement to advise the multi-disciplinary team that isresponsible for making recommendations about eligibility for NHS Continuing Healthcare.

20. A registered nurse is personally and professionally accountable for practice. Thismeans that the registered nurse is answerable for their actions and omissions regardless ofadvice or directions from another professional. Professional accountability is fundamentallyconcerned 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 nurseshould be able to account for any decision made.

21. Under the guidance issued when NHS-funded Nursing Care was introduced6, eachPCT was asked to designate a care home co-ordinator responsible for managing the budgetand a lead nurse to monitor the process and outcome of assessments. These two roles couldsometimes be combined in one designated person. These roles remain important, but underthe changes in the National Framework, PCTs may well find it helpful to combine these roleswith 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 Eligibility23. 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, theassessment and care planning process should decide how best to meet those needs. Thestarting point for decisions about NHS Continuing Healthcare and NHS-funded Nursing Carecould 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 needschange, where they are being discharged from hospital, or where they are resident in a carehome and their needs are being reviewed.

24. PCTs should be very clear that the basis of the decision about the need forNHS-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 Healthcareand NHS-funded Nursing Care. The National Framework guidance sets out Core Values andPrinciples, and more detail about the process.

Discharge planning, review or other trigger.

Establish primary health

need: qualify for NHS CHC

No eligibility

NHS-funded Nursing Care:

NHS contribution to servicesof a registered nurse

Care Planning, including determination ofrequirement for registered nursing care

Written rationale for decision communicated to individuals,families and carers

Care Package provided and funded

Screening: consider possible eligibility for NHS CHC

Possible eligibility

Full consideration forNHS CHC

Review

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

Other NHS-

funded services

Other care packageNHS and Local

Authority contributionsCare planning

yes

Fast track

Figure 1

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26. Alternative ways of providing care and support, other than admission to a care homeproviding nursing, should always be considered as part of the care planning process. Thesetypes 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 facilitatedischarge 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 aresidential home)

Social Services Care Package. The individual has no nursing needs but may howeverrequire social care services. These will be provided on the basis of an assessment oftheir social care needs in line with the LAs Fair access to care criteria. The PCTwill still be responsible for providing healthcare services as necessary as for anyoneeligible for NHS services (e.g. access to a GP and community health services).

27. Whatever the outcome of the consideration for NHS Continuing Healthcare, thepersons needs will need to be met. Where the decision is that the person is not eligible forNHS 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 nursingis the best option.

Making a decision about NHS-funded Nursing Care

28. This decision should take into account all the individuals nursing needs based onwhat is known about the persons condition and their usual behaviour over the course of aweek, or a number of weeks. They should also consider the potential outcomes if support werenot to be provided, or was provided in different ways. In making their evaluation, the registerednurse should also focus on the impact of any decisions on the persons independence, andrisks involved for the person, their family and others close to them.

29. This assessment of registered nursing needs should help the individual, their carerand/or representative understand the extent and nature of the nursing care needed to meettheir 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 theprovision of care or the planning, supervision or delegation of the provision of careby aregistered nurse. This therefore includes not only direct input from a registered nurse, but alsotime spent in the planning, supervising and monitoring of care delivered by someone else, whomay or may not be a registered nurse.

31. From 1 October 2007, the need for registered nursing care needs may be recorded inthe form of a care plan using the same comprehensive care domains as those used in theDecision Support tool and the NHS Continuing Healthcare Needs Checklist. The suggesteddocumentation is contained in Annex D.

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32. If the decision about registered nursing care is being reached subsequent to a fullconsideration of eligibility for NHS Continuing Healthcare, there is a space in the DecisionSupport 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 registerednurse should record the level and quantity of nursing need and any specific risk factors againsteach care domain. The summary box should be used to make a recommendation on the typeof care needed and the rationale for that recommendation.

34. Only the needs of the individual should be recorded, and this should not be influencedby the restrictions placed on the delivery of care by the hospital or care home environment. Forexample, an individual who is competent to self medicate will, in a hospital or care homeenvironment, 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 registerednursing care.

35. The registered nurse involved in this decision should help answer the followingquestions

Does the person have registered nursing needs at a level where theyrequire a care home providing nursing care environment?

Do they want to/need to be in residential setting or is another option moreappropriate?

36. Once it has been agreed with the individual and/or their carer or representative that acare home providing nursing offers the best environment in which their needs can be met, thenext phase is to set goals for the care plan. This process should usually be completed beforeapermanent admission to a care home takes place. Where a LA is involved the relevantprofessionals should be working closely together to identify the care required which in turn, willinform the selection of a care homes able to meet those needs. In all cases the individual theircarer and/or representative is responsible for making the choice of care home providingnursing care. The guidance issued in 2004 on the National Assistance Act (Choice ofAccommodation) Directions7 will be relevant where a LA is involved. Arrangements for movingto 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 registerednursing care. In such cases, the PCT needs to identify the necessary services and arrangeprovision and funding of those services.

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

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Equipment, continence care and

other services38. Care plans for individuals entering care homes providing nursing care should set outthe services to be provided within the LAs standard rate and by the NHS. Individuals shouldnot have to pay for any NHS services included in the care plan, although they may need tocontribute towards social services as part of an assessment made by a LA under the NationalAssistance (Assessment of Resources) Regulations for other services they need.

39. Care home residents should have access to the full range of specialist NHS supportthat is available in other care settings and to people receiving care at home. In addition toequipment that is provided or secured by the care home in accordance with the minimumstandards, 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 equipmentservices, including pressure redistributing equipment, aids to mobility, and communication aidsetc. that are available in other settings.

Equipment40. Care homes providing nursing care are expected to be fit for purpose, which, in themain, means they will have in place basic handling, mobility, and lifting equipment andadaptations. There may be some situations where they will need to draw on the resources ofthe local community equipment service.

41. Where the NHS has determined that an individual requires a particular piece ofequipment, it should ensure either that the care home provides it; or provide it on a temporarybasis until the care home is able to provide it; or provide it to the individual for as long as theyneed it. It would be unreasonable to expect care homes to provide items of equipment that, bythe nature of the design, size, and weight requirements, need to be specifically tailored to meetthe individuals needs and would not be capable of being utilised by other care home residents.Further information on community equipment is available8.

Continence Services42. Residents of care homes, including those providing nursing care, should have access

to professional advice about the promotion of continence. See Good Practice in ContinenceServices.9

43. As well as prevention and advice services, this should also include the provision ofcontinence products, subject to a full assessment of an individuals needs. Continenceproducts should be made available by the NHS to residents of care homes who are alsoreceiving NHS-funded Nursing Care, if required.

8 www.icesdoh.org/doc_cat.asp?ID=169 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005851

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Chiropody and other therapies44. Chiropody services and other therapies such as physiotherapy, occupationaltherapy, speech and language therapy and podiatry should be made available to residents ofcare 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 individualschoose 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 Services45. Residents of care homes are as entitled to be registered with a local GP as anyoneelse 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 theiradmission 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 Needs47. Following an initial decision about NHS Continuing Healthcare and NHS-fundedNursing Care, a review of eligibility for NHS Continuing Healthcare and NHS-funded NursingCare should be undertaken within 3 months and then on an annual basis or more frequently ifthere is a significant change in the health needs of the individual . If the person is receivingNHS-funded Nursing Care, the persons potential eligibility for NHS Continuing Healthcareshould always be checked as part of the review, using the NHS Continuing HealthcareChecklist.

48. The same principles and process apply to the review process as for someone enteringthe National Framework process for the first time.

49. The review plays a critical role in ensuring the nursing needs of the individual arebeing appropriately met and provides an opportunity to review the goals set in the care plan. Itmay be pertinent to consider whether the individuals level of independence has improved tothe point where permanent admission to a care home providing nursing is no longerappropriate and if so, whether other forms of care should be considered.

Dispute resolution50. 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 theNational Framework. Challenges to decisions about eligibility for NHS-funded Nursing Care willbe dealt with by the PCT according to their local disputes process in the first instance. Theindividuals rights under the existing NHS Complaints procedure remain unaltered.

Governance51. In addition to the section on Governance in the National Framework, which refersmainly to NHS Continuing Healthcare eligibility considerations, the PCT will find it helpful tocarry out routine analysis of the award of NHS-funded Nursing Care. This should enable thePCT 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

circumstancesShort periods in residential care, including in emergencies, for respite care and

for trial periods52. There may be occasions where individuals need to go into a care home for shortperiods of time

in an emergency or crisis, or where for example a carer is suddenly taken ill and isunable to look after the individual

those placed in a care home who are awaiting the completion of a nursingdetermination 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 homeswho wanted to find another home

for respite care.

53. Short periods in a care home providing nursing care of less than 6 weeks qualify forNHS funding, though there is no need to carry out an assessment if it is known at the outsetthat the stay will be less than 6 weeks and the person has already been assessed as requiringnursing 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. Ifsomeone 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 personis already receiving NHS Continuing Healthcare, in which case the NHS will be responsible forall the costs of care.

55. PCTs that arrange care for their residents out of their area should pay the care homeor LA direct. They will need to inform the PCT where the care home is located of the period ofcare to avoid duplicate payment.

56. Someone who chooses to pay privately for nursing care at home may qualify forNHS-funded Nursing Care for any periods of care in a care home providing nursing care.

The Multiple Sclerosis Society and Vitalise57. 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. Nursingcare for periods of short-term respite care in the care homes below will be funded by the PCTwhere the care home is located rather than the PCT where the client or service user isregistered.

58. To ease administrative burdens, allocations to the host PCTs were increased to reflectthe additional administrative burden placed on them for making payments and for monitoringcare on behalf of other PCTs and, where partnership arrangements are in place, localauthorities

59. The care homes and the relevant PCTs are listed in Annex E.

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

Hospital Admissions60. When a care home resident is admitted to hospital, payments for their care by aregistered nurse should not be duplicated for the duration of their stay but should resume ontheir return to the care home. These terms, and any variations to them, should be reflected inlocal NHS contracts with care homes. LAs and individuals will need to agree separately withcare homes the level of fees necessary to secure the place in the care home providing nursingcare in the event of such temporary absences. It is clear that in these circumstances the NHSshould 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 toavoid people being asked to pay any shortfall for the time they are in hospital, PCTs will wantto 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 aSocial Services contract, it has been custom and practice for LAs to continue to pay carehomes the full fee for a set period (usually 6 weeks), followed by a reduced payment after afurther period.

62. In these circumstances, the NHS will need to pay a sum equal to the amount that wasbeing 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 selffunders) should also provide for retainer to be paid on admission to hospital in order tosafeguard 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 theircontracts with providers, LAs often pay a full fee for a certain period following death inrecognition that rooms need to be prepared for new residents. PCTs will need to agree asimilar payment in these circumstances to cover the period after death in line with anyagreements reached with providers and LAs.

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Annex A: Transition from 3-bands to

a single bandUntil 30 September 2007, there are two stages to a decision about the assessment of needsufficient 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 threebands high, medium and low and is paid by PCTs, based on the level of an individualsneed, not their income.

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care will beimplemented from 1 October 2007, from when there will be one single band for NHS-fundedNursing Care.

When NHS-funded nursing care was introduced in October 2001 we made a commitment toregularly reassess the payment attached to the banding, in line with the increases in nursespay. That commitment will remain, and a further update will be published in time for contractswith 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 moveimmediately onto the standard weekly payment.

Any resident currently receiving high band funding should continue to receive this higher levelof 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 theywould have been granted the high band payment, payment should continue at thehigh rate

has needs that would have been medium or low, they move on to the new, flat-ratepayment

is eligible for NHS Continuing Healthcare then NHS-funded Nursing Care paymentscease.

The same procedure should be followed at all subsequent reviews.

The legal basis for these arrangements are set out in The National Health Service (NursingCare 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 Workbook200112 will remain available, to enable this decision to be reached. Other guidance, publishedin HSC2001/17 / LAC2001(18), and HSC2003/006 / LAC(2003)7 will also remain available onthe Departments website for reference purposes.

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Annex B: Establishing a responsible

commissioner

GeneralMany care home placements are made at some distance away from the individuals place ofresidence. The PCT where the individual lives prior to entering a care home should carry outthe assessment and should notify the PCT responsible for the care home so that the receivingPCT can fund and plan nursing care services in its area effectively. There should be no needfor the receiving PCT to repeat the assessment, although it would need to arrange a reviewwithin 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 forthe decision to place away from their previous place of residence, the 3 month review will alsoprovide an opportunity to review with the person and their representatives whether alternativeservices are available locally that more fully meet their needs.

Residency RulesThe residence rules for NHS Continuing Healthcare and NHS-funded Nursing care areincluded 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 ordinaryresidence set out in LAC (93) 7 and relevant case-law.

Cross-Border PlacementsA protocol governing placements between English and Welsh NHS bodies and LAs either sideof 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 placementsThere may be partnership arrangements in place between the area in which the person isplaced and their local PCT which provide for the delegation of the nursing care function to theLA, either under a pooled budget or a lead commissioner arrangement. These partnershiparrangements may also be used where the LA is providing residential care for persons placedby another LA. The LA in which the home is situated would contract with the care home for theprovision of social care services with the consent and agreement of the placing authority. It isalso able to contract for the provision of nursing care because this function has been delegatedto it under the partnership arrangements. Thus, it is possible to have one set of contractualarrangements for the provision of the total care package. The function of conducting theassessment 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 makearrangements under section 21 of the National Assistance Act to place a person in a

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residential care home situated within the area of a different LA. It may be that some LAs haveregular 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 carehomes 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 NurseA care home co-ordinator (the budget manager) to:

Manage, on behalf of the NHS, the budget for NHS funded nursing care, includingresponsibility for agreement that the NHS funded nursing care budget will fundindividuals registered nursing care, and day-to-day budget management

Monitor spending on nursing care against the allocated budget to ensure that spendstays within budget

Liaise closely with nurses carrying out determinations of care by a registered nurse forexisting 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 (inthe SHA, Councils with Social Services Responsibilities, Ombudsman, etc) asnecessary.

A lead nurse for NHS-funded Nursing Care to:

Provide professional nursing advice to care homes, LAs and the care home co-ordinatorabout the carrying out of determinations and use of NHS-funded Nursing Care

Monitor the quality and consistency determinations carried out by registered nurseswithin the PCT

Ensure that a sufficient number of nurses receive appropriate training.

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Annex D: Record of nursing care

needsTemplate for local adaptationNameHome Address

DOBID No

Current Location

Date CompletedName & Address ofcare home Placement

Registration Categoryof homeRelevant dates Placement First review Subsequent

Reviews

Name of Assessor(Printed) & Signature

Contact Details ofAssessor(s)

Other relevant information such as carer or representative

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Care Domains Registered Nursing Care Needs Date

Behaviour

Cognition

Psychological andEmotional Needs

Communication

Mobility

Nutrition food &Drink

Continence

Skin

Breathing

Drug therapies &Medication

Altered States ofConsciousness

Summary of Needs & Recommendation

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Annex E: MS and Vitalise

Care HomesMultiple Sclerosis Society Care Homes

Brambles, Horley East Surrey PCT (managed in association with Elmbridgeand Mid Surrey PCT)

Helen Ley, Leamington Spa South Warwickshire PCTWoodlands, York Selby and York PCT

Vitalise Care Homes/Centres

Sandpipers, Southport Southport and Formby PCTSkylarks, Nottingham Gedling PCTNetley, Eastleigh Eastleigh and Test Valley South PCTJubilee Lodge, Epping Epping PCT

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Annex F: Some special cases

War Pensioners and Ilford ParkA very small number of residents of care homes receive nursing care and the whole of theircare costs, including care from a registered nurse, funded by the State either by the VeteransAgency (including the Ilford Park Polish Home).

Although not self-funders, they continue to receive funding for their care from the Agency andso are not eligible for NHS-funded Nursing Care. The NHS will however be involved inensuring 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 forNHS-funded Nursing Care would be unaffected by whether or not they qualify for any supportfrom a LA.

Charitable and voluntary sector organisationsThe policies of a number of charities has been for them to subsidise all the costs of care by aregistered nurse for the residents of their homes. In the majority of cases, those charitable andvoluntary sector bodies are also the providers of care. The individual is usually asked to pay forall the other costs of their care, other than nursing care. In these circumstances, they are likelyto 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 carefrom a registered nurse. With the agreement of the individual, the charity may retain the NHSfunding in full. Alternatively, the charitable and voluntary sector bodies could amend their rulesso that the care from a registered nurse is no longer subsidised and it receives and retains theNHS funding. Whatever option is chosen, individual residents or their representatives, wouldneed to be informed and the position explained to them, in particular if and how this is likely toaffect the level of fee they will be expected to pay to the care home in fees.

Independent hospitalsSome 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 haveopted 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 NHSContinuing Healthcare.

nursing care practice guide

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