An Introduction… to Wales’ CHC Framework and the Decision Support Tool

Related Sector: Health & Social Care

The 2014 CHC Framework and the Decision Support Tool (DST) underwent a review in 2019 and the revised versions were published in July 2021. They were due to take effect in November 2021 but have been delayed until 1 April 2022.

In the run up to the commencement date, Bond Solon Trainers, Sue Inker and Max Duddles provide an analysis of:

• What Continuing Healthcare is?
• What the revised framework aims to address.
• Key issues with the framework (which will be expanded on in training).
• What the revised continuing healthcare framework means for practitioners.

What is Continuing NHS Healthcare?

Continuing NHS Healthcare (CHC) is a package of care and support that is provided to meet all the assessed needs of an individual where it has been assessed that the individual has a “primary health need”. It is a key component of the Local Health Board (LHB) business and is arranged and funded solely by the NHS. Being a health care service, CHC is free at the point of delivery.

What does the revised framework aim to address?

The CHC framework has been revised to address the following:

• Clarification on the concept of, and what is a “primary health need”.
• Extensive criticism of the original 2014 framework.
• Concerns around inconsistency and unfairness of decisions on eligibility.
• A number of complaints to the Public Services Ombudsmen for Wales both around eligibility and administration of the system.
• Concerns that there is a regional approach to CHC around Wales.
• Concerns around the lack of implementation of the 2014 policy and guidance.
• Questions around the extent to which individuals and families are being involved in the assessment process and the gaining and recording of consent and assessing mental capacity are inconsistent.

Key issues with the framework

The revised framework significantly expands upon the 2014 version and correctly reflects the current law.

There are, however, several key concerns that practitioners should be aware of:

• The key aim of the guidance was to clarify the concept of “primary health need” to make it much clearer for practitioners to interpret. This has not been achieved due to the ambiguous wording in the legislation underpinning health services and The Social Services and Wellbeing Act 2014, which defines the concept.
• The guidance makes no attempt to define what it thinks an input being ‘ancillary’ or ‘incidental’ to the provision of a social care service, means in practice. There is currently no case law on this point.
• Assessment timescales and legal responsibility to fund remain vague and open to interpretation.
• The framework does not provide specific guidance on how to assess someone with a learning disability. This means that, unless the assessment takes specific account of a learning disability, there is a danger that the individual will be treated less favourably than other applicants.
• The “draft” framework does not attend to the thorny issue of Direct Payments. This omission and oversight will continue to have a significant impact on many disabled people due to the legal constraints on providing a direct payment for someone eligible for CHC in Wales.

Our training course will explore these issues amongst others, in much more depth.

What does the revised CHC framework mean for practitioners?

The Welsh Government official website recommends that organisations use the months running up to implementation to amend any internal guidance, processes and protocols in line with the new framework. They also mention that they will be making some minor corrections to the 2021 documents but have not provided further information as to what they relate to.

CHC is fundamentally about an entitlement in law to funding from the NHS based on a finding of a “primary health need”. The lawful assessment and process which leads to this entitlement demands a high level of legal literacy from the professional. In addition, as we’ve highlighted above there are several potential issues with the revised framework, which highlight the need for health and social care practitioners to come together in the spirit of partnership, co-operation and joint working and embrace training on the subject to ensure that the framework is understood and implemented for the benefit of the citizen.

It is in the interest of LHBs, Local Authorities and, most importantly, those receiving care, for practitioners to ensure that timely care and support is provided. To that end, Bond Solon will soon be rolling out four core training offers on this topic that have been designed to provide unbiased support and training to health and social care practitioners alike:

• Continuing NHS Healthcare for NQSWs.
• Advanced Continuing NHS Healthcare.
• Continuing NHS Healthcare for Mangers and In-house Legal.
• Capacity and Continuing NHS Healthcare Assessments (2 days).