This may help.
Invaluable booklet incidentally
http://www.sfe.legal/assets/media/NHS_CONTINUING_HEALTHCARE_BOOK_MARCH_2014.pdf
From Solicitors for the Elderly
Page 45
7. WHAT HAPPENS IF THE PERSON IS ELIGIBLE?
The CCG should inform the person in writing, giving clear reasons and the basis on
which the decision was made
167
. A copy of the completed DST should also be
available. The CCG must provide a care package that it thinks is appropriate to meet
the person’s need based on supporting outcomes identified in the care plan.
168
It is normally the CCG responsible for the individual’s GP who will be responsible
for funding the care.
169
Care can be provided in a variety of settings including:
A care home registered to provide personal or nursing care– the
person should be given a choice about the location of care home,
taking into account their needs and circumstances, however they
have no right to choose.
In a hospital – if the person is
in the final stages of a terminal
illness
In their own home – depending on the type and level of care
needed and whether their home is suitable or can be adapted,
which should be offered, wherever appropriate
170
.
The CCG is responsible for care planning, commissioning services and for care
management
171
.
The CCG is also responsible for monitoring quality, access and patience experience
within the context of provider performance.
172
7.1 Choice of care provision
There will normally be a range of options available for support. The starting point
for agreeing the package should be the individual’s preference. However, the
package of care provided will be what the CCG assess is appropriate for the
individual’s needs.
173
The National Framework states:
‘When deciding on how their needs are met, the individual’s wishes
and expectations
of how and where the care is delivered should be
documented and taken into account, along with the risks of different
167
The National Health Service Commissioning Board Groups
(Responsibilities and Standing Rules) Regulations 2012
168
Part 2 Paragraph 78.1 The National Framework for NHS Continuing Healthcare and NHS funded Nursing are 2012
169
Regulation 3(7) of the National Health Se
rvice (Functions of Strategic Health
Authorities and Primary Care Trusts and
Administration Arrangements) (England) Regulations 2002 (S.I. 2002/2375) as amended by S.I. 2002/2548, 2003/1497,
2006/359 and 2007/559 (“the Functions Regulations”)
170
Paragraph 56 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
171
Paragraph 108 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
172
Paragraph 109 The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care 2012
173
Paragraph 167 The National Framework for NHS Continuing Healthcare and NHS funded nursing care 2012
50
types of provision and fairness of access to resources.’
174
If the person is living in a care home when the decision to grant NHS continuing
healthcare is made the person will need to discuss with the CCG, whether they can
continue to stay there. This is particularly relevant where the care home is much
more expensive than the CCG would normally pay to meet their needs. However,
the risks and benefits of moving the person, including the effect on their physical
and mental health would need to be assessed before a decision is made to move
them.
The individual should be advised of all the options and the benefits and risks
associated with each one. The model of support preferred by the individual may be
more expensive than other options. CCGs can take comparative costs and value for
money into account when considering the support to be provided but should consider
the following factors: -
The cost comparison has to be made on the basis of the genuine costs of
alternative models. A comparison with the costs of supporting a person in a
care home should be based on the actual costs that would be incurred in
supporting a person with specific needs in the case and not on an assumed
standard care home cost.
Where a person prefers to be supported in their own home, the actual costs of
doing this should be identified on the basis of the individual’s assessed needs
and desired outcomes. The willingness of family members to supplement
support should also be taken into account, although no pressure should be put
on them to offer such support.
Cost has to be balanced against other factors in the individual case, such as
the individual’s desire to continue to live in a family environment.