Welsh government publishes NHS Continuing Healthcare National Framework

Written statement by Eluned Morgan MS, Minister for Health and Social Services

Publication of the NHS Continuing Healthcare (CHC) National Framework 2021 and Decision Support Tool and consideration of the interface between CHC and direct payments.

Following consultation, we are today publishing revised improved guidance for NHS Continuing Healthcare (CHC) in Wales, for implementation in November.

CHC is a package of care and support, funded by the NHS, for people who have complex care needs which are primarily health based, determined by consideration of the four key characteristics of need: nature, intensity, complexity and unpredictability. Existing arrangements for the provision of CHC are set out in the National Framework published in 2014 (‘the 2014 Framework’).

Consultation

As part of a long standing commitment to review arrangements within the 2014 Framework, the Welsh Government consulted in 2019 on a revised national framework and Decision Support Tool (DST), which is used as part of any assessment for eligibility for CHC.

The revised Framework sought to provide greater clarity and an improved layout which mirrors the CHC process from start to finish. This included assessment requirements set out in the Social Services and Well-being (Wales) Act 2014 (the 2014 Act) and the Mental Capacity Act 2005 and arrangements for monitoring and management of care under the 2014 Act. It also set out further information on meeting needs where CHC is provided to individuals in their own home. We also reinforced provisions around the transition from Children’s Continuing Care to adult CHC at the age of 18, aligned with the Children and Young Person’s Continuing Care Guidance 2020.

Revised Framework

The consultation summary report, published in November 2019, set out stakeholders’ views including concerns that further clarity was needed in some areas. It also set out the next steps we would take to consider responses and work collaboratively with partners to further amend the Framework. In particular, we recognised the importance of working together to provide a seamless, person centred health and social care service for individuals, their families and carers. Our intention was to publish the revised Framework and DST in April 2020. That work was suspended due to the impact of the Covid pandemic, but has now been completed.

We have strengthened the wording in the 2021 Framework around person centred health and social care and voice and control of care, particularly in the interface between CHC and direct payments.

We have also clarified the roles and responsibilities of Local Health Boards (LHBs) and local authorities (LAs) and the role of the individual and their representative throughout the assessment process. Individuals are the experts in their own lives, including them and/or their representatives as empowered co-producers in the assessment and care planning process is essential. They must be invited to attend and fully participate in any assessment of their care and support needs. We have also emphasised the importance of ensuring assessment and provision of care is delivered in the individual’s language of choice.

We accepted that the proposed appeals period of 28 days was insufficient. Following discussions with stakeholders we have changed this to 28 days to inform the LHB of an intention to appeal an eligibility decision, and 6 months to submit the written appeal.

Voice and control, CHC and direct payments

Direct payments are monetary amounts made available by local authorities under duties in the Social Services and Well-being (Wales) Act 2014 (the 2014 Act). These are paid to individuals, or their representative, to enable them to meet their eligible needs for care and support, or support needs in the case of a carer. LHBs cannot provide ddirect payments under existing legislation.

Our Programme for Government sets out a commitment to ‘Improve the interface between continuing health care and Direct Payments’. We have strengthened the wording in the 2021 Framework regarding an individual’s right to exercise voice and control to decide how, when and who supports them to meet their eligible care and support needs, especially when transitioning from direct payments to CHC. This includes providing specific examples of actions LHBs can take to support this. We will also develop further guidance in readiness for implementation in November.

However, we acknowledge that there is more to do. We will continue to work with a range of stakeholders, including members of the Disability Equality Forum, to consider suitable long term solutions, including potential changes to primary legislation to allow direct payments for CHC.

Next steps

During the implementation period, we will work with LHBs and partners to ensure the 2021 Framework is fully understood and implemented correctly. We will also review the CHC Performance Framework to ensure effective governance and accountability.

We recognised through the consultation that more was needed to ensure individuals are fully informed about CHC. That is why we are developing a one-stop CHC public information booklet for publication in November, to enable individuals to be fully involved in decisions. We are continuing to work co-productively on this with stakeholders, including individuals who have been through the assessment process. The booklet will set out each step of the process for individuals and include information on further support and advice available. It will be available bilingually and in Easy Read format.

The consultation summary report on the Rebalancing Care and Support White Paper was published 29 June 2021. Findings from the consultation would support a wider review of CHC and FNC policies and the interface with direct payments. We shall work with a range of stakeholders to progress this work.

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Senedd returns I would be happy to do so.