Continuing care and community care
Keeping my head down, I’ve been re-writing St C’s guidance on applying for continuing care, and renewing my acquaintance with the recently-revised practice guidance; it’s a lovely relationship which I shall relinquish with sorrow on my retirement, although the practice framework hasn’t been changed and all of it’s archived: what does that presage? As part of this, I produced a Table comparing community care and continuing care, which constantly confuses my colleagues, and thought readers of the blog might find it useful.
The Table:
Continuing and community care processes compared
| Process | Community care | Continuing care | ||
| Main focus | The patient’s capacity to undertake the everyday tasks of living. | The patient’s ‘primary health need’, that is, healthcare needs are the main reasons for providing care. | ||
| Application | To the local authority (LA) for the ordinary residence of the patient.
People over retirement age: to the older persons team. People under retirement age: to the (younger) disabled persons team. |
To the primary care trust (PCT) contracting with the patient’s general practitioner, usually to the continuing care commissioner.
|
||
| Who applies? | The service user applies, but usually via a referral from a social and health care professional | A health or social care professional applies, and patients cannot make a direct application, but can ask for an assessment. | ||
| Screening | The LA determines the level of need that it will meet under the Fair Access to Care Services criteria. On referral, a care manager decides whether the patient is likely to meet the criteria for a particular level of need defined by FACS that the LA will support. | Screening for continuing care is by completion of a checklist provided in the Continuing Care Practice Guidance. If healthcare professionals involved with the patient’s care judge that a full assessment for continuing care is appropriate, a checklist in not required. | ||
| Assessment | The LA’s care manager makes the assessment, often using an agreed single assessment process adopted by that LA. | A healthcare professional involved in the care of the patient completes a nationally-determined continuing care decision support tool (DST) and/or health needs assessment (HNA) or a fast track tool with care plan. Some PCTs require DSTs and HNAs to be completed by their own staff. | ||
| Urgent assessments | Reasons for urgency and evidence to support them should be explained to the care manager. | A fast-track tool is used where urgent provision of a care package is required. | ||
| Carers assessments | The LA is required by law to complete, separately from the assessment of the patient, an assessment of the needs of any informal carer regularly involved in the care of the patient. | The PCT or any other health and social care professional may refer carers of its patient to the LA for assessment. | ||
| Care planning | The care manager agrees a care plan with service users, setting out the needs identified, the services proposed and the charge for provision. | The assessor, or the continuing care unit of the PCT plans the package of care (procedures vary). | ||
| Panels | Plans may be submitted to a joint panel of experienced social and health care professionals set up by the LA and the PCT for consultation, coordination and advice, so that decisions are consistent and coherent. | |||
| Direct payments | The LA| must offer the opportunity for patients (or their carers) to receive a direct payment or independent budget, which they can use to plan and manage their own care. | Direct payments are not used in the NHS, but experiments on notional budgets are in progress and may spread. | ||
| Commissioning | The care manager or a brokerage unit of the LA commissions and organises services. | The PCT’s manager for continuing care allocates funding. Packages of services may be implemented by PCT staff or other health and social care professionals as agreed when clear funding approval has been given. | ||
| Monitoring of the efficiency of the implementation of the plan | Social and health care professionals involved with the care of the patient monitor how the package of care is working. | |||
| Review of the effectiveness of the implemented plan in meeting the needs identified in the assessment | The multiprofessional team working with the patient reviews the assessment and care plan at agreed intervals. This may lead to revised decisions about commissioning. | |||
| Review periods | Community care is a provision for long-term conditions, so reviews are often six-monthly or annually. | Reviews in continuing care for palliative care patients are often monthly or three-monthly. | ||
The Practice Guidance:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_115477.pdf