A new National Framework for Continuing Health Care (CHC) and other NHS funding for health and social care services came into effect on 1 October 2018.

Although the new framework does not solve all of the difficulties providers face when seeking to recover payment for the services they are providing to the NHS at a sustainable cost, there are some important changes that providers should be aware of and which can be used to influence the outcomes of the discussion for themselves and for their customers.

The changes arise from a restatement of the National Framework for NHS Continuing Healthcare and Funded Nursing Care (FNC) made in March 2018 and which, by 1 October 2018, Clinical Commissioning Groups (CCGs) and NHS Trusts should have implemented.

The fundamental changes effected by the revisions are based on making some of the key principles of the Care Act 2014 far more prominent when health bodies are looking at their obligations to arrange and fund health and care services. This change in emphasis is not so fundamental that it creates a new way of judging eligibility for CHC or FNC, but the new framework does spell out areas where health bodies will not be able to ignore some important principles arising from the Care Act, such as:

  • putting the individual at the heart of the process;
  • not discriminating where services are provided in a person’s own home rather than in a residential care setting; and
  • directing assessments and reassessments towards the outcomes to be achieved for individuals rather than a process to question their continuing eligibility for services.

There are some detailed amendments covering such things as “top-ups” in the context of health-funded services, the identification of the split between services which are obliged to be funded free by the NHS and those which are not, particularly in the context of health services provided in residential care and other settings. There is also some improvement in identifying who is the responsible commissioner, particularly in circumstances where there are joint packages of care between local authorities and CCGs.

This note is primarily aimed at providers who are often left powerless to deal with NHS bodies funding services (or failing to do so) and acting in ways which are both high-handed and irresponsible; with regards to setting fees or planning / removing individuals from services. The following specific scenarios are covered:

  • when care needs increase but funding for additional care services does not;
  • the local authority and the CCG refuse to agree how funding is to be split and one or both fail to fund their obligations;
  • private payers wishing to purchase additional or higher-quality services; and
  • the obligations of NHS bodies to pay proper rates for the services commissioned.

A document discussing the changes in detail brought about by the new framework can be found here.

For more information

Please contact John Wearing or Emma Watt.