On 1 July 2022 an updated version of the National Framework for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care (FNC) came into use.

In this article we summarise the updates and explain their impact. We also highlight where we believe changes will make a positive or negative impact on the individuals and their loved ones navigating CHC, and what areas are unclear.

Read our longer form article giving a more detailed study of these changes.

Background

The latest updates are the fourth revision to the Framework, which was first published in 2007. The reasons behind the latest revision are primarily:

• To incorporate the legislative changes brought about by the Health and Care Act 2022, which transfers statutory responsibility for CHC from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs).

• To strengthen guidance around the relationship between CHC and the Discharge to Assess model, incorporating recent best practice and aligning with new policy.

• To clarify when consent and participation should be sought throughout the CHC journey.

In addition to revisions to address these points, other minor updates have also been made.

The new Framework and its tools were implemented on 1 July 2022 but should not be retrospectively applied. In other words, assessments that were carried out before 1 July should have used the version of the National Framework and tools that were in place at the time. Any appeal of such an assessment after 1 July 2022 should also use the tools that were in place at the time of the assessment, but the way those appeals are managed should adhere to policy and guidance from the new July 2022 Framework.

As the recognised independent expert in CHC in England, Beacon were invited to be involved in the scrutiny of the text and to provide feedback to the Department of Health and Social Care on the proposed changes.

However not all of our views and suggestions have been incorporated.

Summary of the updates

At-a-glance, the updates are as follows:

• References to Clinical Commissioning Groups (CCGs) have been changed to Integrated Care Boards (ICBs) in most cases.
• Sections on consent / capacity / best interest have been updated to bring them in line with various legislation (which also impacts on other areas such as advocacy).
• Discharge to Assess (D2A) and CHC Checklist sections are updated to improve flow, avoid repetition and reflect best practice.
• Virtual assessments are mentioned with a strengthening of expectations for ICBs to involve individuals and care professionals, although there is no policy change.
• Inter-agency dispute guidance is updated in line with new NHS structure (ICBs).
• Fast Track reviews receive a minor update in line with Standing Rules (law).
• Deprivation of Liberty Safeguards (DOLS) section contains a paragraph looking ahead to the pending introduction of their replacement: Liberty Protection Safeguards.
• The section on carers rights has been strengthened.
• Very minor updates and tweaks to the text, links, glossary etc.

The National Framework is accompanied by three tools which are the Checklist tool, the Decision Support Tool (DST) and the Fast Track Pathway tool. All three have been updated in line with the changes to the Framework:

Checklist

Consent section is aligned to National Framework, there are minor clarifications and an updated equality monitoring form.

DST

Strengthened wording around person-centred approach, consent and virtual assessment sections are aligned to National Framework, language is aligned to Standing Rules and an updated equality monitoring form.

Fast-Track Pathway

Language is updated to align to DST, National Framework and Standing Rules, consent is aligned to the National Framework, and there is an updated equality monitoring form.

In addition to these three tools, there are minor updates to NHS FNC Practice Guidance and the Patient Information Letter, in line with the changes set out above.

How Beacon can help

Our expert advisers can answer your questions on any aspect of NHS Continuing Healthcare in England. We have helped thousands of people to understand the eligibility criteria, navigate the assessment process, understand the Decision Support Tool and your assessment, review a decision, or begin an appeal. We can also talk to you about funding policies and issues in your area.

Contact us by visiting our Talk to Us page and completing the contact form, or call 0345 548 0300 during office hours.