An Introduction to the English revised National Framework for NHS Continuing Healthcare

Related Sector: Health & Social Care

The 2018 National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care and the associated Practice Guidance and Tools have undergone a collaborative review and update by the Department of Health, NHS England, and Local Authorities. The revised National Framework takes account of the legislative changes brought about by the Health and Care Act 2022, which establishes the Integrated Care Boards (ICBs) as the statutory bodies with responsibility for NHS Continuing Healthcare. The new Framework was implemented on the 1^st July 2022.

In response to the review, Bond Solon trainer and subject matter expert, Sue Inker provides an analysis of:

• What is Continuing Healthcare?
• What the revised framework aims to address.
• Key issues with the framework (which will be expanded on in training).
• What the revised continuing healthcare framework means for practitioners.

What is Continuing NHS Healthcare?

NHS Continuing Healthcare (CHC) is a package of ongoing care that is arranged and funded solely by the NHS, where an individual has been assessed and found to have a ‘primary health need’ as set out in the National Framework. Such care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen as a result of disability, accident or illness.

What does the revised framework aim to address?

The National Framework has been revised and updated as follows:

• Legislative changes brought about by the Health and Care Act 2022 to include the revocation of the procedural requirements in Schedule 3 of the Care Act 2014 around discharge from hospital.
• Confirmation of Section 22 of the Care Act 2014, which preserves the existing boundary and limits of the local authority responsibility in relation to the provision of nursing and/or healthcare.
• To strengthen existing guidance and align NHS CHC with the current hospital discharge policy to reflect best practice around the “Discharge to Assess” Model.
• Clarification on the concept of, and what is a “primary health need”.
• Guidance around a person-centred approach, consent, capacity and best interest decision making.

Key issues with the framework

The revised framework significantly expands upon the 2018 version and correctly reflects the current law.

There are, however, several key concerns that practitioners should be aware of:

• The key aim of the guidance was to clarify the concept of “primary health need” to make it much clearer for practitioners to interpret. This has in part been achieved as there is clear reference to Section 22 of the Care Act 2022, which correctly reflects the principles from case law in Coughlan that sets the ceiling/boundary or limits of the local authority responsibility in relation to the provision of nursing and/or healthcare.  Unfortunately, the wording  in paragraph 44: ‘’ …..places a limit on the care and support that can lawfully be provided to individuals by local authorities”, could do with further clarification. We suggest that it should be amended as follows: “…..places a limit on the provision of nursing and/or healthcare that can lawfully be provided to individuals by local authorities” to avoid any ambiguity in interpretation. 
• The guidance makes no attempt to define what it thinks an input being "ancillary" or "incidental" to the provision of a social care service, means in practice, nor does it attempt to define “of a nature beyond”, which it states a local authority could be expected to provide. There is currently no case law on this point. It does helpfully though link this concept to “quality” and “quantity” of care required and the characteristics of nature, intensity, complexity, and unpredictability.
• The framework does set out the importance of the Mental Capacity Act 2005 (MCA) capacity and best interests fairly early on. But it is concerning to note that it isn’t until page 101 where there is any reference to the relevance of the Deprivation of Liberty Safeguards, which therefore reads as an afterthought, rather than it being integrated into care management.  Given the fact we only have around 18 months to prepare for the implementation of the LPS, which creates ICBs' responsible bodies, it is so important to embed the basis for the LPS on the principles of human rights and the MCA building the concept of deprivation of liberty much earlier into care management thinking. It is a shame this is only referenced in passing at paragraph 347.
• The framework does attempt to explain how NHS Continuing Healthcare interacts with hospital discharge and the “Discharge to Assess” model but fails to make reference in sufficient detail to the revocation of Schedule 3 of the Care Act 2014 and its relevance.

Our training course will explore these issues amongst others, in much more depth.

What does the revised National Framework for NHS  CHC framework mean for practitioners?

The introduction of the new revised framework has a slightly amended structure, which does reduce repetition and is helpfully designed with the framework at the front and practice guidance at the rear. The tools also come with very handy user notes which professionals should familiarise themselves.

NHS CHC is fundamentally about an entitlement in law to funding from the NHS based on a finding of a “primary health need”. The lawful assessment and process which leads to this entitlement demands a high level of legal literacy from the professional. In addition, as we’ve highlighted above, there are several potential issues with the revised framework, which highlight the need for health and social care practitioners to come together in the spirit of partnership, co-operation and joint working and embrace training on the subject to ensure that the framework is understood and implemented for the benefit of the citizen.

It is in the interest of ICBs, Local Authorities and, most importantly, those receiving care, for practitioners to ensure that timely care and support is provided. To that end, Bond Solon are delivering four core training offers on this topic that have been designed to provide unbiased support and training to health and social care practitioners alike:

• NHS Continuing Healthcare for NQSWs.
• Advanced NHS Continuing Healthcare.
• NHS Continuing Healthcare for Mangers and In-house Legal.
• Capacity and NHS Continuing Healthcare Assessments (2 days).

If you would like to enquire about booking on one of these courses or would like more information, please contact a member of the team at info@bondsolon.com or on +44 (0)20 7549 2549.#

Author: Sue Inker

Date first published: 06 July 2022