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Continuing Care and Continuing Healthcare

This page contains information on Continuing Care and Continuing Healthcare.

Children's Continuing Care

An NHS continuing care package may be offered when a child or young person under 18 years of age has needs arising from disability, accident or illness that cannot be met by existing mainstream/universal, targeted or specialist services alone but requires regular and planned complex intervention.  

The aim of the care package is to support the child/young person’s parents or carers to manage their child/young person’s care at home and/or in other settings and often requires joint working between the NHS, Social Care and Education.

Please be aware that a diagnosis of a particular disease or condition is not in itself a determinant of a need for Continuing Care; not everyone with a disability or long-term condition will be eligible.

Children and Young People are assessed using the National Framework for Children and Young People’s Continuing Care (Department of Health 2016). This framework is designed to support Clinical Commissioning Groups (CCGs) in determining if a child’s needs are such that they can only be met through a package of continuing care.

Referrals will usually be made by health or social care professionals. If you are unsure who to ask, please discuss with your GP.  Once received all referrals are pre-assessed to consider whether full assessment is required. 

Referrals for Children and Young Persons Continuing Care should be submitted electronically to continuing.care@dorsetccg.nhs.uk .

When submitting a referral please make sure you include appropriate consent, a fully completed pre-assessment form as well as all relevant supporting evidence.

Where a pre-assessment indicates that a child/young person may be eligible, a multi-disciplinary team meeting is held. At this meeting the Decision Support Tool document is completed using supporting evidence (from health, education and social care) to consider whether or not the child or young person has a continuing care need.  The Decision Support Tool is then submitted to the Children’s Continuing Care panel to be ratified. A decision about eligibility will usually be made within 6 weeks of a multi-disciplinary meeting being carried out. 

If Continuing Care eligible, a bespoke care package may then be arranged. This is called a Continuing Care package. Some of the care may be provided through existing services and some may need to be specially arranged; care can be commissioned on your behalf or you can request a Personal Health Budget to meet assessed health and well-being needs. The health care package is designed to complement existing services offered by Social Care and Education. Children who are eligible for continuing care have complex needs and developing the right package of support in a safe way, can take time and a Multi-Disciplinary approach!

What happens if my child is found not to be eligible for Children and Young Persons Continuing Care?

If following consideration of your application by the Childrens Continuing Care Panel your child is not found eligible for Children and Young Person’s Continuing Care we will write to you to advise you of the reasons for this decision.

If you disagree with the outcome you have the right to request that the CCG review its decision (Appeal). In order to request a review of an eligibility decision in respect of Children and Young Persons Continuing Care you will need to write to the CCG to provide a detailed rationale as to why you disagree.

Requests for a review can be submitted by post to:

Personal Health Commissioning, Vespasian House, Barrack Rd, Dorchester, DT1 1TG

Or emailed to continuing.care@dorsetccg.nhs.uk and marked for the attention of the Operational Manager of Central Services.

You can find more information in the National Framework for Children and Young People’s Continuing Care (2016) or by visiting the CCG website.

What should I do if I am unhappy with the Continuing Care process?

If you have any concerns regarding the process followed by the CCG in respect of your application for Children and Young Person’s Continuing Care you should discuss these with your allocated worker in the first instance.

For Complaints and Enquiries relating to Dorset CCG, you can write, telephone or email the Customer Care Officer:

NHS Dorset Clinical Commissioning Group
Vespasian House, Barrack Road, Dorchester DT1 1TG
Telephone: 01305 368926
Email: customer.careteam@dorsetccg.nhs.uk

Feedback relating to the any of the services we commission is welcome, please write or telephone the Customer Care Officer as above or email feedback@dorsetccg.nhs.uk

Should you decide to contact the Chief Officer with concerns regarding the organisation, this will be passed to the complaints team who will acknowledge your concerns and determine the best way forward.

Transition and Continuing Healthcare (CHC)

Young people in receipt of Continuing Care and their families/carers will be supported in the transition to adult services from the age of 14. Assessment for NHS Continuing Healthcare should take place after their 17th birthday. 

This assessment will determine a decision in principle so that, where applicable, effective packages of care can be commissioned in time for the young person’s 18th birthday.

What is Continuing Healthcare and why is it different to Children's Continuing Care?

NHS Continuing Healthcare is a package of ongoing (care provided to an individual aged 18 years plus.

The package of care is required to support complex health care needs that have arisen as a result of disability, accident, or illness (not based on diagnosis).

To be eligible for Continuing Healthcare funding, the individual will have been deemed to have a ‘primary health need’ as determined by The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2018).  Where an individual is identified as having a primary health need, the NHS becomes responsible for meeting all of the individual’s assessed health and social care needs.

Care that is free at the point of delivery can include support in the home, respite care, supported living and residential/nursing home care; this can be commissioned by the Continuing and Complex Care Team or you can choose a Personal Health Budget to meet your assessed needs.

Please speak to your GP, District Nurse or Social worker who will be able to discuss the referral process with you.

Continuing Healthcare assessment process

The decision-making process, as set out in The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2012), is used to determine eligibility for Continuing Healthcare funding in adulthood (18 years plus).

This process involves gathering information, such as assessments and care plans, to evidence the young person’s health care needs.  A multi-disciplinary Team Meeting (MDT) is then held to complete the Decision Support Tool (DST) – a document that records healthcare needs and the level of need in 12 different domains.

The young person is encouraged to attend the MDT (unless this is not appropriate) alongside family/carers/ representatives and health and social care professionals involved in the young person’s care. At the end of the meeting, professionals will make a recommendation regarding eligibility.  This recommendation is then submitted to the CCG for ratification and the young person/parents/carers are notified of the outcome within two weeks.

If a young person is deemed to have a ‘primary health need’, as determined by The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (2018), all the young person’s Health and Social Care needs will be met by NHS Continuing Healthcare funding; this will be free at the point of delivery. If the MDT recommendation cannot be accepted by the CCG, in the first instance the application will be returned to the MDT for further work or to obtain additional supporting evidence, following which the application will be resubmitted to the CCG.  

If a child or young person is found eligible for NHS funded Continuing Healthcare, the CCG will write to you to confirm eligibility and advise of the date on which NHS funded Continuing Healthcare will commence.

If a child or young person is found not eligible for NHS funded Continuing Care we will write to you to explain the reasons for this decision and provide you with information regarding your right to requests a review of the eligibility decision (Appeal).

What if I’m not eligible for Continuing Healthcare funding?

If a young person is ineligible for Continuing Healthcare funding, appropriate planning will take place to support the transition to adult services; which may be provided by Adult Social Care or universal or specialist health care services. 

Sometimes it may be appropriate for care to be jointly funded between health and Social Care even though a young person does not have a primary health need. 

If this is the case following a not eligible decision your Local Authority will need to submit a joint funding proposal to the CCG for consideration.