One of the central principles of the new NHS in 1948 was to be free at the point of need. Aside from some notable exceptions such as prescription & dental charges, this continues to be the case in the NHS in England. This principle has been questioned and challenged over the years; more recently by a suggestion that people could be charged a monthly ‘subscription’ fee. Fortunately, so far, this isn’t formal Government, opposition or NHS policy.
Although NHS services are free to all at the point of need; who ‘qualifies’ as being in need doesn’t always equate to everyone, all the time. There are many issues of geographical difference of services, often referred to as the ‘post-code lottery. I may write a blog on that subject in the future, but this one is focussed on another element, namely continuing healthcare. This is when it is established that a person has complex and ongoing healthcare needs that should be met outside of hospital. People are assessed as to whether they qualify for NHS for this. This assessment of need is done through a formal process; initially using a screening tool called a Checklist, which is used to identify whether a person requires a more in-depth assessment. If so, then a multidisciplinary assessment is undertaken supported by a Decision Support Tool.
If a person, following assessment through the Decision Support Tool is identified as meeting the criteria for NHS funding, a ‘package’ of care is then commissioned to ensure that these assessed needs are met on a continuing basis. The assessment is multidisciplinary, including health and social care staff. There are e-learning tools available, aimed at both NHS and Local Authority staff involved in the process. Each stage of the process is open for appeal and if someone has a more urgent need to get service in place quickly, i.e. for someone near end of life, there is a Fast Track process to ensure this happens without delay.
I attended an NHS England Roadshow this week for CCG Directors of Quality & Nursing and people from the NHS & Local Authorities responsible for commissioning Continuing Healthcare. The focus of the event was a new Quality Assurance Framework, which is yet to be formally published. The framework is intended to assess both the quality of the assessment process and the quality of service received through a series of prompts. This is intended to form part of and not to replace local quality assurance systems. The prompts have two distinct features:
- Firstly, they are set out as a series of statements starting “I...”, as quality should be assessed from the perspective of the person receiving the assessment and the continuing healthcare itself; or their family/carer(s). For example: “I felt the assessment focused on me as an individual and helped me live the best life I can” and “I am supported to have choice and control wherever possible over my care and support”.
- Secondly, the framework is built around the ‘Six Cs’, i.e. the prompts are separated into six category headings: Competence, Courage, Commitment, Care, Compassion, Communication.
As a group of Directors of Quality & Nursing from our local area (Hertfordshire & South Midlands), we agreed at the Roadshow that we needed to do more work locally to ensure that we consistently embed this assurance framework into our quality assurance systems. We committed to doing this collectively.
Finally, but very significantly, since 1 April 2014, all recipients of continuing healthcare are entitled to request a Personal Health Budget(PHB). This allows individuals to directly ‘commission’ their own NHS-funded package of care, personally selecting the agencies and sometimes individuals who will meet their needs. NHS England’s vision for personal health budgets is “to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive”. PHBs were originally piloted and have been evaluated. The website for the evaluation project and the final report contain a lot of detail on what was found. In summary, the pilots showed that people had: more control, greater choice, better care-related quality of live and significantly lower cost.