Independent Review of NHS Continuing Healthcare

CEL 6 (2008) and Assessment Eligibility for NHS CHC

The Panel recommend that CEL 6 (2008) is completely revised and the term NHS CHC should be replaced with the term "Hospital Based Complex Clinical Care" (HBCCC). The choice of this term emphasises the recommendation that HBCCC should be a form of care that is only provided in facilities wholly funded and managed by the NHS.

Eligibility and Provision

Eligibility for HBCCC should continue to be decided by specialist clinicians in partnership with a professional multidisciplinary team. No specific list of eligibility criteria, or scoring system, based on a description of an individual's current or predicted future condition, prognosis or care needs, should form part of the guidance. For the future the primary eligibility question should simply be "Can this individual's care needs be properly met in any setting other than a hospital?"

The current annual census should be replaced. Consequently, all individuals in NHS hospital care at a point three months after admission should be considered for HBCCC unless they are a delayed discharge. . At this point and every three months thereafter as necessary, a clinician and another member of the multidisciplinary team responsible for the care of the individual should assess and affirm this need on specifically designed documentation.

Health Boards and Local Authorities should determine the number of HBCCC beds that will require to be provided in their area. The Scottish Government should monitor progress towards more equitable provision than currently exists.

Monitoring

The Scottish Government should, via the new census recommended in this report, monitor the shift of long term care venues from NHS to more homely care settings in all Health Boards.

Information for Individuals, Relatives and Staff

An easy to read document containing information on HBCCC should be made widely available to patients, carers and all health care professionals. The document should be reviewed at a minimum every three years and revised at that time if thought necessary. The document should be available in printed form, in appropriate languages and formats.

Disputes and Appeals

When there is a dispute between an individual, their family and a multidisciplinary team about the most appropriate venue of care the decision should continue to be reviewed on an internal basis by a clinician from the same Health Board.

Specific Groups

The principles and recommendations outlined in this report should apply equally to individuals of all ages.

Other Issues

It would be unfair and unjust if those who are currently in receipt of NHS CHC are disadvantaged by the proposals and the current financial arrangements should remain for these individuals without detriment.