There are several means by which an individual in Sheffield may have their health needs assessed to determine whether they are eligible for funding:
When an individual living in the community is identified as having a significant change in need, typically when the individual needs to go into a home with nursing care or have some level of care at home. The first point of access for an assessment would be through their GP or District Nursing Service.
Intermediate care forms part of the overall range of services available to provide care to individuals at various points along the acute and rehabilitation pathways. The Assessment and Integrated Care Scheme (AICS) supports early discharge and admission avoidance. If it was clear that someone was not able to go home without considerable support, or had deteriorated and required long-term care, then eligibility for CHC needs to be considered at this point. A member of the nursing staff within the team can carry out the first assessment.
Mental Health Services cover both bed based inpatient services and services in the community. This covers a wide range of settings, ages and illness. However, the overall process still remains the same, in that the person needs to be considered either using the Checklist Tool and if indicated the Decision Support Tool. Usually for inpatient services there is a Multi Disciplinary Team (MDT) who can do this, however in the community it may be more difficult to gather together a MDT. The person who is responsible for the patient, i.e. Care Coordinator, should ensure that the individual has access to being considered and assessed.
The statutory learning disabilities services in Sheffield are integrated between health and social care, therefore, the process of considering someone is usually done on a joint agency basis. The social worker is involved with the community nurse or residential support staff in completing the Checklist Tool and if indicated the Decision Support Tool.
The National Framework has established a new Fast Track process to assist professionals in securing End Of Life (EOL) services in a very short space of time. In order to satisfy the criteria the professional must ensure the following:
The professional filling in the Fastrack Tool must be a senior clinician. This doesn't necessarily have to be a doctor as long as the person has a confirmed diagnosis from a doctor. Often it is a nurse in a senior position or a GP. The National Framework passed over the responsibility for procurement of end of life care from the local authority to the NHS to arrange. The CHC/FNC department will authorise the procurement of a package of care, i.e. nursing home placement or home care package, and will assist other health organisations and professionals with this process. Social care professionals will support health to carry out this function.
St Lukes Hospice Charity (www.stlukeshospice.org.uk) also has a substantial role in identifying individuals for end of life care. The Hospice identifies a person for Fast Track and set in motion the process to apply for funding whether that is home care or care in a nursing home.
A multi disciplinary team is a group of professionals from different disciplines, who have a role in contributing to an assessment of an individuals needs. This should include two health professionals, i.e. nurse, clinician or therapist, as well as a representative from social care services, i.e. a social worker.
Once the Decision Support Tool is received and is adequate, any clear judgements that can be taken outside of panel will be made to ensure the care package can be put into place quickly. When the decision support tool indicates a borderline decision, or there is any complexity surrounding the case, it will go to panel for discussion and endorsement.
It is the role of the Eligibility Panel to listen to the cases, to be satisfied that enough evidence is produced to make a judgement and to endorse recommendations made by the multi disciplinary team of an appropriate care package. The panel considers eligibility only, financial decisions and procurement are done separately. NHS Sheffield retains the right to make the decision on eligibility.
Please note: the Appeals Procedure and Dispute Resolution Procedure are currently being revised.
For disputes between individuals applying for Continuing Health Care (CHC) and the NHS, in line with the appeals procedure, the first step for the claimant (eg: relative, carer, advocate) is to seek a review of the decision by the original decision making body. This can be done in the form of a written appeal to the CHC/ FNC Manager. Further evidence to support an individual's case can be gathered and the case submitted again for the Panel to review. Thereafter, if an appellant remains dissatisfied with the decision, they are entitled to seek independent review by Yorkshire & The Humber Strategic Health Authority.
There is a Dispute Resolution Procedure (211kb pdf, opens in a new window) available.