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7 November 2014 | Comment | Article by Michelle Evans

New National Framework for Continuing Healthcare in Wales

Caitlin discusses the revised Continuing NHS Healthcare Framework which, it is hoped, will assist those suffering with dementia to qualify for NHS funded care in Wales.

Following the deadline imposed for registering continuing NHS healthcare claims on 31 July 2014, the Welsh Government has now released a revised National Framework for Continuing Healthcare which replaces the previous arrangements set out in the 2010 National Framework. The effective date for implementation of this framework is 1 October 2014.

The revised framework is seen to bring Wales in line with England and follow their lead. The decision support tool currently used in Wales will also be replaced with that which is used in England.

The previous decision support tool has been widely criticised and challenged by the public. The particular criticism relates to the levels of need that can be awarded within the Cognition domain. There are domains for a number of categories such as cognition, behaviour, continence, breathing, skin integrity etc. and the provision of continuing healthcare is dependent upon the level awarded in one or more of the domains. Only a ‘high’ level of need could be awarded within the previous framework, but in England a severe level could be awarded for cognition.

The new decision support tool provides a ‘severe’ level of need in cognition which hopefully will assist dementia sufferers to qualify for funding in Wales. There is hope that by adopting the same practice, the postcode lottery will be removed and assessments for continuing healthcare will be consistent across the board, regardless of whether a patient resides in care in England or in Wales.

An investigation by the BBC previously considered the discrepancies and found that the number of people eligible dropped in Wales, which was also highlighted by the Audit Report in 2011 and discussed by the Welsh Government Public Accounts Committee.

Whilst the framework has adopted the English decision support tool it is disappointing to note no checklist has been published. Currently in England, as part of the assessment process, an NHS Continuing Healthcare Checklist is used. This acts as a screening tool for a full assessment and helps decide if a full assessment of health needs is necessary. However, despite the National Framework following suit, there will be no such checklist undertaken in Wales. This tool will only be used in Wales in specific circumstances and is not mandated within this new framework despite specific requests from the Wales Audit Office.

The lack of a ‘trigger tool’ prior to an assessment for eligibility can be seen as both detrimental and beneficial to those undergoing the process.

By having no checklist, a thorough investigation of health needs can take place from the outset, removing the need for this apparent tick box exercise. Individuals can be satisfied that a robust, transparent assessment has been carried out as opposed to a mere screening tool.

However, by removing this tool, many patients will be the subject of a full assessment when it is clear that their health needs are not at a level indicative of continuing health care eligibility. The use of a screening tool in England can ‘filter out’ those with social, as opposed to health, needs and eliminate the need for a full assessment. This can be seen as beneficial in terms of both public spending and time spent undertaking full assessments on those that pass the threshold.

Therefore, whilst the revised National Framework should facilitate improved cross-border working and provide a more user friendly approach like that adopted in England, there is still a key difference outstanding between the nations.

Author bio

Michelle is a Senior Associate in the niche area of continuing healthcare, and has represented many clients, in both England and Wales, in challenging current and retrospective decisions to refuse NHS funded continuing healthcare to long-term nursing home residents.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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