Continuing Healthcare in Northern Ireland: Introducing a transparent and fair system

Closes 15 Sep 2017

Opened 19 Jun 2017

Overview

INTRODUCTION

The Department of Health referred to below as “the Department” has undertaken a review of its current continuing healthcare policy in Northern Ireland.   At the outset, it is important to note that this consultation is about the suitability of the continuing healthcare policy in Northern Ireland.  This consultation is not about individual aspects of a person’s care package.

This consultation document aimed at the general public, individuals and their families, clinicians, and other stakeholders, sets out the Department’s policy proposals which have emerged from the review.

What is Continuing Healthcare?

Continuing healthcare, which is for adults, is the term used for the practice of the health service meeting the cost of any social care need which is driven primarily by a health need.   Eligibility for continuing healthcare depends on an individual’s assessed needs and not on a particular disease, diagnosis or condition.  If an individual’s needs change, then their eligibility for continuing healthcare may also change.   So as not to interfere with professional and clinical judgement, the Department has to date, refrained from drafting administrative guidance on a specific continuing healthcare assessment.

Continuing healthcare policy and practice varies across England, Scotland and Wales. For details of continuing healthcare in other countries please refer to the consultation document at the following link: Continuing Healthcare - Consultation Document

Health and Social Care Assessment of Need in Northern Ireland

Northern Ireland benefits from a fully integrated system of health and social care, with the Health and Social Care Board (HSCB) responsible for commissioning health and social care services for the local population and Health and Social Care Trusts (HSC Trusts) delivering services.

HSC Trusts are responsible for ensuring that an assessment of need is carried out for individuals in a timely manner and with appropriate multi-disciplinary professional and clinical input as required.  Assessment of need should focus on maximising opportunities for individuals to live independently at home, or in as near a domestic environment as possible, for as long as they wish to do so and where it is safe and appropriate.

Due to Northern Ireland benefitting from a fully integrated system, the assessment process covers both health and social care needs.  At present, if the outcome of an assessment indicates a primary need for healthcare, then the HSC is responsible for funding the complete package of care in whatever setting.  This is what is known as continuing healthcare in the local context. Alternatively a primary need for social care may be identified and where such a need is met in a residential or nursing home setting, legislation requires the HSC Trusts to levy a means-tested charge.  

If the assessment identifies that nursing home care is appropriate and the individual is responsible for meeting the full costs of their nursing home care, then the relevant HSC Trust is responsible for making a payment of £100 per week to cover the cost of providing the nursing care.  This payment is made directly by the HSC Trust to the nursing home provider.

If it is determined that an individual’s care needs can be met through the provision of a care package in a domiciliary care setting, that is in the person’s own home, then there is no charge to the individual as these services are free in Northern Ireland.

Departmental Circular ECCU 1/2010 Care Management, Provision of Services and Charging Guidance provides further information on:

  1. the care management process including assessment and case management of health and social care needs;
  2. provision of services, including placement of service users in residential care homes and nursing homes and the service user’s right to a choice of accommodation; and
  3. charging for personal social services provided in residential care homes and nursing homes.

Why We Are Consulting

The Need for Change

In 2014, Age NI published a report Age NI Report titled ‘The Denial of NHS Continuing Healthcare in Northern Ireland’  claiming that older people were being denied access to assessments for continuing healthcare, largely due to the lack of clear guidance.  The report contained a total of nine recommendations including one specifically for the Department to consider which stated:

Age NI recommends that the DHSSPS Departments Act (NI) 2016 draft and publish guidance on NHS Continuing Healthcare in NI to provide clarity and to require collation and monitoring of data in a standardised way.

Alongside the report, the Department has continued to receive queries from individuals and their families, MLAs on behalf of their constituents and other stakeholders on the subject of eligibility for continuing healthcare.

In view of this, the Department carried out a comprehensive review to examine the application of continuing healthcare across the HSC Trusts. This involved analysing existing practice across each HSC Trust, reviewing continuing healthcare queries received directly by the Department, engaging with a range of key stakeholders including representatives from the Commissioner for Older People (COPNI) and Age NI, and examining continuing healthcare policy and practice across England, Scotland and Wales.

Outcome of the Departmental Review

The findings of this review are summarised below:

  • There is confusion about continuing healthcare and its applicability in Northern Ireland.  Specifically, there is a lack of understanding that the Checklist Tool and Decision Making Tool  used by authorities in England to assess and determine eligibility for continuing healthcare do not apply here and are not part of our existing assessment process.   
  • It would appear that one of the key drivers for HSC Trusts receiving a request for a continuing healthcare assessment is once an individual needs to, or has, moved into a nursing home.  In such circumstances the individual is required to contribute to the cost of their care according to their financial means, for as long as they are able to do so.
  • There is an apparent variance in the application of Departmental guidance and in continuing healthcare practice across the HSC Trusts.  This leads to regional inconsistency and a potential ‘postcode lottery’ for individuals.
  • HSC Trusts have indicated that they have found it challenging to apply Departmental guidance.
  • Multi disciplinary panels established by the HSC Trusts responsible for making a determination on continuing healthcare applications have found the decision making process extremely difficult; indeed, some HSC Trusts have opted to temporarily suspend the multi disciplinary panels, pending the outcome of the Department’s review.
  • All HSC Trusts confirmed that individuals are assessed using the Single Assessment Tool (NISAT) Northern Ireland Single Assessment Tool (NISAT), which is the standardised, multi-professional assessment tool providing a framework for holistic, person-centred assessment.  HSC Trusts also confirmed that a Nursing Needs Assessment Nursing Needs Assessment Tool (NNAT) (NNAT) is undertaken when required.
  • HSC Trusts informed the Department that there are 43 individuals who have been assessed as eligible for continuing healthcare in Northern Ireland (between the periods April 2011 to September 2016).  The Department acknowledges that this figure is much lower than corresponding numbers qualifying for continuing healthcare in England, Scotland and Wales.  However, it is important to note that the figure here does not include those individuals who may meet continuing healthcare eligibility criteria, but receive a care package in their own home for which there is no charge and therefore there is no requirement for the individual to be assessed for continuing healthcare. 

The Options

The outcome of the review has provided the Department with sufficient evidence that further clarity and revision to the local continuing healthcare policy is now required.   In undertaking any steps to revise the current continuing healthcare policy, the Department is seeking to achieve an outcome which ensures that there is a transparent and fair system in place for all individuals who may or may not have a continuing healthcare need.  It is important that all decisions regarding an individual’s care requirements are based on a clinical assessment of need. The population of older people here is increasing year on year. With advancements in technology and medicine, individuals are now able to live much longer with complex and long-term care needs.  The Department is fully committed to continually improving how the health and social care needs of the people of here are met, but this must be delivered within an environment where there are well documented increasing financial pressures on the wider health and social care system.

The Department has identified four potential options for consideration:

  • Option 1: Do Nothing
  • Option 2: Introduce a Continuing Healthcare Decision Support Tool Model
  • Option 3: Introduce a Single Eligibility Criteria Question
  • Option 4: Develop Standalone Guidance and assessment checklist  specific to the HSC System in Northern Ireland.

More detailed information on the above options are provided in the consultation document at the following link and should be read before completing the on-line survey:  Continuing Healthcare - Consultation Document

Related Links:

Department of Health NI website

Department of Health Consultations

Health and Social Care Board (HSCB)

Age NI Report

Departments Act (NI) 2016

Northern Ireland Single Assessment Tool (NISAT)

Nursing Needs Assessment Tool (NNAT) 

Equality Commission Section 75 for Public Authorities

Section 75 of the NI Act 1998

NI Direct Consultations

 

 

 

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