What Our Nursing Expert Lynn Hannon Learnt At Bond Solon NHS Continuing Healthcare Training

I attended this one-day training course run by trainers Sue Inker, lawyer, and Max Duddles, solicitor, on the 8th of November 2019. The course was designed for health and social care professionals experienced in undertaking NHS continuing healthcare assessments.

The overall aim of the training was to increase knowledge of the law, evidence and procedure necessary to work within the legal framework, and to enable professionals to carry out the role effectively and in line with best practice.

The key learning outcomes for the day were:

• Understand relevant legislation, guidance, case law and procedures.

• Recognise the importance of evidence in the screening, assessment, review and appeal process.

• Identify and consider the potential pitfalls in the decision-making process.

• Understand the screening and assessment process.

• Understanding the purpose of the review panel and the appeals process.

NHS continuing healthcare (CHC) is a package of care provided to an individual aged 18 years and over with an assessed ‘primary health care need’ and is fully funded by the NHS. It is a statutory obligation, currently outlined in the NHS Act 2006, and may include both health and social care elements. The current National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care was published in March 2018 and implemented from October 2018.

The morning session was focused on the history of CHC, and noted that, prior to 2007, each health authority had its own criteria for CHC, which led to “a postcode lottery”. Although the boundaries be-tween health and social care have shifted over many years, legally, there has been no material change in the scope of NHS CHC responsibilities. Numerous reports have set out guidance, however, changes to policy and funding arrangements (national and local), and variation in interpretation of the guidance, have impacted on eligibility, meaning some people are awarded CHC and others (with apparently similar needs) are not.

There are often disputes over where the line is drawn between the health and social aspects of care. There is no legal lower limit to what the NHS can provide, but there is a clear ceiling to the type of care that the local authority can lawfully provide. The key difference is one of degree, (quality or quantity) of nursing care. ‘Nursing’ relates to the level of ‘care’ an individual requires in relation to their health needs, and the guidance does not state this is only in relation to registered nursing care. The local authority can provide nursing that is “incidental or ancillary” to the provision of accommodation or social care, but beyond this, it becomes more likely that there is a primary health need.

In the afternoon we explored the assessment and review process in more detail. Certain characteristics are taken into account in establishing a primary health need, including the nature, intensity, complexity and unpredictability of the care needs. A standard checklist and Decision Support Tool (DST) are used to collate the evidence, covering 12 care domains. The way that the evidence is obtained, and the thoroughness of the process, ultimately affects the decisions made, and disputes often arise on this basis.

The importance of good evidence within the process cannot be stressed highly enough, as this is what the decision will be based upon. Some key cases were discussed (including Coughlin (1999), Pointon (2003), Grogan (2006) and Pearce (2007) and the learning points from these.

It was interesting to note that the assessed level of need in one of the key case law examples, (Coughlin), (which is often cited in relation to eligibility for CHC funding) had a much lower need threshold than is typically seen when CHC is awarded nowadays.

Lynn Hannon is a Somek nurse expert witness and is also very experienced in continuing healthcare assessments. For more information on Lynn’s profile or if you want to instruct Lynn please click here.