NHS Wales has published a Decision Support Tool (DST) for practitioners deciding Continuing Healthcare (CHC) funding.
This is to support practitioners in the application of the National Framework for the Implementation of NHS Continuing Healthcare in Wales (2021) (2021 Framework).
Guidance accepts that no assessment tool will be perfect and that CHC teams should use professional judgement on whether the totality of an individual’s needs demonstrate the four key characteristics of a primary health need. The tool should support multi-disciplinary teams (MDTs) to demonstrate that they have implemented a rational and consistent approach to their decision-making.
Seven principles underpin the tool:
People first: Individuals who have a primary health need are entitled to CHC funding. They should therefore feel supported throughout the process of determination of eligibility and be confident that they will receive the quality of care required to meet their needs.
Integrity of decision-making: MDT recommendations should never be made by one person acting unilaterally. The final eligibility decision should be independent of budgetary constraints, and finance officers should not be part of the decision making process
No decisions about me without me: Individuals are the experts in their own lives. They must be invited to attend and fully participate in any assessment of their care and support needs.
No delays in meeting an individual’s needs due to funding discussions: The individual must not experience delay in having their needs met because agencies are not working effectively together. Commissioners have a responsibility to resolve concerns/disputes at the earliest opportunity
Understand diagnosis; focus on need: Health and social care providers must work together to gain a holistic understanding of need. Commissioning should maximise the individual’s independence and focus on the preferences of the individual and their carer.
Co-ordinated care & continuity: Every effort must be made to avoid disruption to care arrangements wherever possible, including in transition from direct payments to CHC funding.
Communicate: All professionals involved in an assessment of the needs of people with severe speech and communication difficulties will need to establish the preferred means of communication before starting the assessment. There should be no delays to the individual in receiving their assessment or provision of care.
Information on CHC can be located on the Welsh Government’s webpages.