Sorry it is so long - hope this helps (Taken from Liverpool PCT site) Phew!!!
1. CONTINUING CARE
NHS continuing healthcare is free care outside of hospital that is arranged and funded by the NHS. It is only available for people who need ongoing healthcare and meet the eligibility criteria described below. NHS continuing healthcare is sometimes called fully funded NHS care. The information on this page relates to NHS continuing healthcare for adults. Children and young people under 18 can be eligible for a similar type of care, but there are differences in the way this is organized.
Where is care provided?
NHS continuing healthcare can be provided in any setting, including a care home, hospice or the home of the person you look after. If someone in a care home gets NHS continuing healthcare, it will cover their care home fees, including the cost of accommodation, personal care and healthcare costs. If NHS continuing healthcare is provided in the home of the person you look after, it will cover personal care and healthcare costs. It may also include support for you as a carer.
Eligibility
To be eligible for NHS continuing healthcare, the person you look after must be assessed as having a "primary health need" and have a complex medical condition and substantial and ongoing care needs. Not everyone with a disability or long-term condition will be eligible. The assessment process is outlined below.
Guidance says that the assessment for NHS continuing healthcare should be "person centred". This means that the person being assessed should be fully involved in the assessment process. They should be kept informed, and have their views about their own needs and support taken into account. As a carer, you should also be consulted where appropriate. It’s a good idea to make it clear that you would like to participate fully in the assessment process.
A decision about eligibility should usually be made within 28 days of an assessment being carried out.
If they are ineligible
If the person you care for doesn’t qualify for NHS continuing healthcare, their local authority will be responsible for assessing their care needs and providing services if they are eligible.
However, if they don’t qualify for NHS continuing healthcare but are assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For someone who lives in their own home, this could be provided as part of a joint package of care, where some services come from the NHS and some from social services. If the person you care for moves into a nursing home, the NHS may contribute towards their nursing care costs (see NHS-funded nursing care, below). Care services from the local authority are usually means-tested, so if the person you look after is eligible for local authority care, their finances will be assessed. Depending on their income and savings, they may need to pay towards their care costs.
What is Continuing Care?
Continuing care means care provided by health and social care professionals over an extended period of time, to meet adults’ physical or mental health needs caused by disability, accident or illness.
If you need continuing care, your care needs are likely to be complex, substantial and ongoing, caused by a disability or chronic illness, or following hospital treatment.
Who provides continuing care?
If you need continuing care, your care needs may include:
•healthcare services provided by the NHS, for example, from your GP or in hospital
•social and community care services from your local authority
Social and community care services provided by local authorities include:
•personal care at home, for example, help with bathing, dressing, getting up and going to bed
•delivery of hot or frozen meals
•day centre facilities
•care provided in a care home
Local authorities include town, city, borough, metropolitan and county councils.
Who pays for continuing care?
The funding of continuing care can be complicated.
If you are eligible for NHS continuing healthcare, your continuing care will be paid for by the NHS (also sometimes known as fully funded NHS care). If you are not eligible for NHS continuing healthcare, you may receive continuing care as part of a package funded jointly by the NHS and your local authority (sometimes known as a joint package of care). This may include NHS-funded nursing care.
There is no charge for the NHS part of a joint package of care.
Local authorities are allowed to charge for the services they provide, and most of them do so. If your local authority is part-funding your care package, you may have to pay towards the cost of their part of the care, depending on your income and savings.
NHS-funded nursing care is care provided by a registered nurse, paid for by the NHS, for people who live in a care home. Your needs will be assessed to decide if you're eligible for NHS-funded nursing care.
2. CONTINUING CARE – NHS FUNDED NURSING CARE (FNC)
Who is eligible for NHS-funded nursing care?
You should receive NHS-funded nursing care if:
•you live in a care home registered to provide nursing care, and
•you don’t qualify for NHS continuing healthcare but have been assessed as needing care from a registered nurse
The NHS will make a payment directly to the care home to fund care from registered nurses who are usually employed by the care home.
How will my needs be assessed?
If you’ve already had an assessment to see whether you’re eligible for NHS continuing healthcare, you probably won’t need another one. The assessment you’ve already had should include enough information to assess your eligibility for NHS-funded nursing care.
However, if you do need an assessment or you haven’t already had one, your primary care trust (PCT) will arrange an assessment for you.
Outcome of the assessment
If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care in a care home that’s registered to provide it. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.
If you’re not eligible for NHS-funded nursing care and you don’t agree with the decision about your eligibility, you can ask your PCT to review the decision.
What is the rate of payment for NHS-funded nursing care?
NHS-funded nursing care is paid at the same rate across England. For 2011/12, the rate is £108.70 a week (standard rate).
Before 1 October 2007, there were three different levels or bands of payment for NHS-funded nursing care: low, medium and high.
If you moved into a care home before 1 October 2007, and you were on the low or medium bands, you would have been transferred to the standard rate from that date.
If you moved into a care home before 1 October 2007, and you were on the high band, NHS funded nursing care is paid at a higher rate. For 2011/12, the higher rate is £149.60 a week. You’re entitled to continue on this rate until:
•you no longer have nursing needs
•you no longer live in a care home that provides nursing
•your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £108.70 a week, or
•you’re entitled to NHS continuing healthcare instead
3. CONTINUING CARE - NHS CONTINUING HEALTHCARE (CHC)
For most people, the first step is to have their care needs assessed by a health or social care professional using a screening tool called the Checklist Tool.
If this screening suggests that you may be eligible for NHS continuing healthcare, a full up-to-date assessment of your needs will be arranged, using a tool called the Decision Support Tool. You will be fully involved in the assessment and decision-making process. Your views about your needs for care and support will be taken into account. If you feel that you need help to explain your views, you may want to ask a friend or relative for support.
Initial screening with the Checklist Tool
The Checklist Tool is used to decide whether you should be referred for a full assessment. It helps health and social care professionals to work out whether your care needs may be of a level or type that could entitle you to NHS continuing healthcare.
The Checklist Tool is usually completed when a nurse, doctor, other qualified healthcare professional or social worker is assessing or reviewing your health or social care needs. For example:
•a nurse or doctor could carry out the initial screening before you leave hospital
•your GP or a nurse could do the screening in your own home
•a social worker could do the screening when carrying out a community care assessment
After the initial screening, your primary care trust (PCT) will write to you to confirm whether or not you will be referred for a full assessment for NHS continuing healthcare.
Full assessment with the Decision Support Tool
If the Checklist Tool shows that you may be eligible for NHS continuing healthcare, the person who completed it will contact your PCT to arrange a full up-to-date assessment of all your care needs.
The full assessment will be carried out by a multidisciplinary team. With your permission, the assessment will include contributions from all the health and social care professionals involved in your care, to build an overall picture of your needs. In some cases, more detailed specialist assessments may be required from these professionals.
The information from your assessment will be used to complete the Decision Support Tool.
This Tool is used to decide whether your main or primary care needs relate to your health, by looking at several types of care need, such as:
Behaviour, Cognition, Psychological Needs, Communication, Mobility, Nutrition (Food & Drink), Continence, Skin (Inc Tissue Viability), Breathing, Drug Therapies & Medication, Altered States of Consciousness.
For individuals who need an urgent package of care because their condition is deteriorating rapidly, the Fast Track Tool may be used instead. This enables the PCT to arrange for care to be provided as quickly as possible.
What happens after the assessment?
The multidisciplinary team will make a recommendation to the PCT about your eligibility for NHS continuing healthcare.
