Continuing Care is a package of care provided by the NHS to a child or young person who has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone. The NHS will fully fund all services required by a child to meet their health needs. How do I apply for Continuing Care? There is a two stage process where a referral is firstly made to the Integrated Care Board (“ICB”) who will then carry out an assessment. The second stage is the decision making process, where the package of care is then developed. Assessments are split into two parts. Firstly, a checklist is completed by a health assessor. This will inform whether a full assessment is required. ICBs are advised that they should make such decisions quickly and in a transparent manner so that the family are fully aware of the process. This pre-assessment should not take more than two days. A full assessment involves the completion of a decision support tool. This must be completed by a multi-disciplinary team comprising of the child, if they are old enough to be involved, their parents, medical professionals, their nurse and, if possible, a social worker. The team will record the child’s needs in the following domains: Challenging behaviour Communication Mobility Nutrition Continence Skin tissue viability Breathing Drug therapy and medication Psychological and emotional needs Seizures How is the Continuing Care eligibility decision made? The health assessor completing the decision support tool will then make a recommendation to the local ICB regarding eligibility. There will then be a multi-agency meeting of senior health and social care professionals to make an eligibility decision. If the child is eligible for NHS funded care, then their family will be informed in writing and contacted to discuss the next stage of the process. The decision should be made within six weeks of the referral. Is there an appeal process if my child is ineligible for Continuing Care? There are two pathways that can be taken following an ineligible decision. Firstly, one can complain about the process in which the assessment took place. However, this is unlikely to change the eligibility decision. Alternatively, you can formally appeal the decision. The appeal route consists of a local resolution meeting followed by an independent review panel if necessary. If a DST has been completed and a decision has been made that your child is ineligible for Continuing Care funding, we can advise you on the prospects of a successful appeal and help you to prepare, and/or represent you throughout the process. My child is eligible for Continuing Care, what happens next? A Care Plan will be drawn up for the child and should be shared with the family for review. The wishes of the child and family should always be at the core of this process. It is expected that the Local Authority will work with the ICB since it is responsible for the social care elements of the package. The legal position is that Childrens Services cannot provide social care funding to meet the child’s health or medical needs. There is an interface with Education Health and Care Plans, as there are common elements in both processes, so the EHC Plan and Continuing Care plan should be brought together to create a single set of needs and outcomes. The ICB and Local Authority should work together to make the plans work and have joint arrangements to ensure Continuing Care fits within the process. The same information and professionals may be involved so there should be an agreed process and sharing of resources rather than duplication. We can provide advice on the care planning process and help you to prepare for your discussions with the ICB to ensure that your care plan meets your child’s needs. If you are unhappy with a decision made by the ICB in respect of the level of support that your child requires, we can advise you on your options to challenge this. What happens when my child turns 18, will they lose their Continuing Care funding? Continuing Care funding is only available to children and young people until they reach their 18th birthday. Once a young person turns 18, the adult NHS Continuing Healthcare (“NHS CHC”) arrangements apply. The ICB should assess all those eligible for Continuing Care when they are aged 16-17 to check if they are likely to be eligible for NHS CHC when they turn 18. The eligibility criteria are different and not all those eligible for Continuing Care are also eligible for NHS CHC. The ICB should provide transitioning services so that an NHS CHC package of care is already in place and agreed with the family prior to the young person’s 18th birthday. If a young person is found ineligible for NHS CHC, they may be eligible for social care support and funding instead. We can provide advice on how to prepare for your child’s transition to adult services within the NHS and Social Services and assist you in securing the appropriate assessments to ensure their care needs are met. Continuing Care and legal advice To find out more about how Boyes Turner's specialist Community Care team can help you please contact us or call 0808 168 0814.
