Healthcare can be full of unfamiliar terms and complicated jargon.

Key terms.pngIf you or a loved one are receiving a package of care, healthcare professionals will do their best to explain things in the most straightforward way possible. Sometimes, healthcare professionals may need to use a term unfamiliar to you, so we have provided explanations for those key terms.

Key terms

The National Framework for Children and Young People’s Continuing Care (0-18 years) provides guidance when assessing the complex health needs of children and young people.

The framework provides a process for assessing, deciding and agreeing continuing care for children with complex health needs.

A continuing care package will be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone.

There is no legal definition of what constitutes a ‘primary health need’. However, a key court judgement, the Coughlan case, set a precedent for when someone’s healthcare needs are beyond the responsibilities of local authorities and should be paid for by the NHS.

An individual has a primary health need if, having taken account of all their needs (following completion of the Decision Support Tool), it can be said that the main aspects or majority part of the care they require is focused on addressing and/or preventing health needs. Having a primary health need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day-to-day care needs taken in their totality ‘ (National Framework 2022, Paragraph 56)

If someone is assessed as eligible for CHC, NHS Birmingham and Solihull funds the full package of health and social care. For example, if a patient is eligible for CHC in their own home, NHS Birmingham and Solihull will pay for health care costs (such as services from a community nurse or specialist therapist) and associated social care costs (such as personal care and help with bathing). In a care home, NHS Birmingham and Solihull also pays for people’s care home fees, including board and accommodation.

The decision support tool (DST) is not an assessment of needs in itself. Rather, it is a way of bringing together and applying evidence in a single practical format, to facilitate consistent, evidence-based assessment regarding recommendations for NHS Continuing Healthcare eligibility. The evidence and rationale for the recommendation should be accurately and fully recorded.

The purpose of the DST is to help identify eligibility for NHS Continuing Healthcare. It is designed to collate and present the information from the assessments of need in a way that assists consistent decision-making regarding NHS Continuing Healthcare eligibility. The DST is a national tool and should not be altered.

The DST is designed to ensure that the full range of factors that have a bearing on an individual’s eligibility are taken into account in reaching the decision, irrespective of client group or diagnosis. The tool provides practitioners with a method of bringing together and recording the various needs in 12 ‘care domains’, or generic areas of need. Each domain is broken down into a number of levels. The levels represent a hierarchy from the lowest to the highest possible level of need (and support required) such that, whatever the extent of the need within a given domain, it should be possible to locate this within the descriptors provided.

Completion of the tool should result in a comprehensive picture of the individual’s needs that captures their nature, and their complexity, intensity and/or unpredictability – and thus the quality and/or quantity (including continuity) of care required to meet the individual’s needs. The overall picture, and the descriptors within the domains themselves, also relate to the nature of needs.

If you have a rapidly deteriorating condition that may be entering a terminal phase, the National Framework has a ‘fast-track tool’. This can be completed by an ‘appropriate clinician’ as defined by the National Framework, who may recommend you move quickly onto NHS Continuing Healthcare. This recommendation should be acted on immediately by NHS Birmingham and Solihull, ideally within 48 hours.

Due to the nature of your care needs it may not always be possible to accommodate your first choice of care home.

For people in a nursing home who do not meet the funding criteria, they may be eligible for NHS-funded nursing care (FNC). This is because the nursing fee includes an additional cost for the employment of registered nurses. The decision on whether you are eligible will be provided at the same time that a decision is made regarding your eligibility for NHS continuing healthcare.

FNC is a weekly payment made by the NHS to cover nursing care provided by a Registered Nurse. FNC is only provided if you need nursing care within a care home setting.

The nursing care contribution is paid directly to the care home by the NHS. If you pay your own care fees, this amount should be deducted from your bill. If you are funded by the local authority, this amount will be deducted from the fees paid to the care home.