Government Publishes National
Framework for NHS Continuing Healthcare and NHS Funded Nursing Care
Recognising the “postcode lottery” that exists regarding fully funded
Continuing NHS Care the government has (26 June 2007) issued fresh guidance on
how the NHS bodies should approach the question of eligibility for continuing
care under the NHS.
People who receive hospital treatment have always been statutorily entitled to
receive that free under the NHS. Not only the treatment is free but, of course,
so is any incidental personal care and accommodation required.
law requires that, in given circumstances, these services must be provided free
wherever they are delivered, whether a private nursing home or otherwise.
leading cases (Coughlan and Grogan) highlighted the fact that not all people
eligible were being provided with this entitlement and it transpired that
thousands of families were effectively being stripped of inheritances
In deciding who should be entitled to “free nursing care” or to give it its
correct description Continuing NHS Care, NHS bodies had been encouraged by the
Department of Health to develop their own policies and guidelines intended to
reflect the legal position espoused in Coughlan and Grogan.
the guidelines developed and their application were not co-ordinated between the
various bodies and the outcome of the eligibility assessments has therefore been
inconsistant resulting in a great many people being denied their legal rights
simply because of the area in which they live.
The government, having consulted widely, has now sought to standardise NHS
bodies’ approach to eligibility by issuing new Framework and guidance centred
around the “primary need approach”.
principal tenet of Coughlan followed by Grogan was that where a person’s
primary or lead need for care is a health need then the entire care package
should be free at the point of delivery just as though the patient were in
new guidance seeks to standardise NHS practice in deciding who should be
eligible. It comes into force in October 2007.
National Framework document summarises itself thus:
guidance sets out the principles and process of the National Framework for NHS
Continuing Healthcare and NHS funded Nursing Care. It concentrates mainly on the
process for establishing eligibility for NHS Continuing Healthcare and
principles of care planning and dispute resolution relevant to that process,
rather than specifying every aspect of planning NHS Continuing Healthcare.
Directions under the National Health Service Act 2006 and the Local Authority
Social Services Act 1970 in relation to the National Framework will be issued in
October 2007. Until that time, this guidance and associated tools can be
regarded as good practice and used to prepare for implementation. In this
interim period, we would encourage the efforts of Strategic Health Authorities (SHA’s).
Local Authorities (LA’s), Primary Care Trusts (PCT’s) and NHS Trusts to move
towards practice that more closely reflects the processes set out here”.
Framework paper goes on to tell Primary Care Trusts (PCT’s) etc. what action
they must take as a result as follows:
PCT’s should consider how the principles and process in this guidance relate
to what is currently in place and prepare to align their processes with this
SHA’s should help facilitate this process. The obligations of SHA’s to
operate review panels (directions 4 to 8 of the Continuing Care (National
Health Service Responsibilities) Directions 2004 as modified by the Continuing
Care (National Health Service Responsibilities) Modification Directions2006)
NHS Trusts will wish to consider those sections of this guidance, which are
relevant with a view to reviewing current review and discharge processes.
LA’s should read this guidance and consider how their current practice fits
with the responsibilities outlined below.
NHS Bodies and LA’s are encouraged to work together in a partnership
approach when reviewing existing processes.
The government have issued a separate document telling us, and particularly NHS
bodies, what is going on and what they should be doing in preparation for
The new framework is a significant piece of work and one that will give NHS
bodies pause for thought on this issue. Of the hundreds of preliminary
assessments we have carried out for clients over 80% have resulted in a finding
that the primary need has been a health need, contrary to the Trust’s own
remains to be seen whether the new guidance achieves its desired objective as
this will depend upon the benchmarks used by the Trusts in implementing it..
Robert Campbell & Company
||This article was sponsored by HDS Personal Care
The home delivery service for top quality products for people with
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