Background
Recent issues have been raised by providers who have experienced significant delays in assessment of their residents. Some assessments are straightforward
(usually Checklist or Screening tool assessments) and can be arranged relatively quickly. However, where a resident is identified as requiring a full assessment for
CHC (Decision Support Tool or DST) the Multi Disciplinary Team (MDT) completing the DST in order to make recommendation regarding a person’s eligibility for CHC, and Social Services are funding their placement at the home, a Social Services representative must be part of the MDT. Surrey County Council have had two reorganisations of their Social Services teams in the past 18 months or so and they are currently experiencing a shortage of resources in terms of Social Care
Practitioners being available to attend the assessments and therefore, we are not always able to complete these assessments as quickly as we would like to.
The issues this document aims to address are as follows: -

Perceived inconsistencies for start date for resident's eligibility for NHS
Continuing Healthcare (CHC)

NHS Surrey's Reimbursement Policy leading to providers not receiving rate commensurate with agreed CHC contracted rate.

NHS Surrey have their own concerns relating to timely referrals for new admissions to nursing homes. Despite regular requests to providers to alert the team to new admissions by submitting admission forms and Health Needs
Assessments, there are still some homes who are referring people who have been resident for many months and in some cases years. This causes problems for the team who try to prioritise those residents who have been in a home for the longest period of time as well as for the Finance Department who have not been able to accrue any monies for these residents in previous years' budgets which are now closed.
The CHC team leads have discussed these issues with the Finance Manager for
CHC and agreed a way forward which should address these concerns.
Providers must be aware of their own responsibilities with regard to the issues they have raised insofar as, having assessed a potential new resident and ascertained that CHC funding has not been considered at this point, they must accept the financial consequences when they then agree to admit a person at a rate agreed and

contracted with either the patient (or their representative) themselves (self funders) or at the rate set and contracted by a Local Authority (either Surrey or out of area) plus FNC - if patient is found to be eligible - plus third party top up if negotiated with the patient or their representative. Providers should not make an assumption that a resident will be eligible for FNC or CHC from admission.
The process that follows lays out the expectations of NHS Surrey in relation to submitting a referral for a resident to be considered for FNC or CHC funding and confirms what you as a provider can expect from NHS Surrey with regard to the issues raised: -
1) Patient is assessed by Nursing Home (NH) prior to admission. NH agrees admission, and agrees a contract with the funder, taking needs of patient into account.
2) Patient admitted to NH
3) NH to notify admission to NHS Surrey Continuing Care Team within 7 days of admission, using admission form which must be fully completed.
4) Fully completed Health Needs Assessment (HNA) to be submitted by NH to
NHS Surrey Continuing Care Team within 28 days of admission.
5) Patient to be assessed by Continuing Care Team in accordance with the
Department of Health National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. This may take the form of either a checklist
(screening tool) assessment or a Decision Support Tool (DST) and sometimes both
6) If patient is found to be eligible for CHC , NHS Surrey will accept responsibility for funding no later than day 29 after admission, provided the
NH has met steps 3) & 4) above and the evidence supports backdating to day
29.
7) For those residents who are already in receipt of FNC and whose needs change and may therefore be eligible for CHC the NH must submit an amendment form and up to date HNA to request a review. If the resident is found to be eligible for CHC, NHS Surrey will accept responsibility for funding no later than day 29 after the review request with HNA is received provided the evidence supports this.

8) Payment for CHC . It is appreciated that where a patient is accepted as
CHC, funding should be at the CHC rate. Therefore, where a patient is funded by Surrey County Council (SCC), and the client is found to be eligible for a backdated period of time (this may be from day 29 after admission or day 29 after a review request with HNA is received or from a date identified by the MDT completing the DST), the NHS Surrey reimbursement process will be put in place. NHS Surrey is happy to pay the difference provided steps 3) and 4) have been met. The NH should submit an invoice to NHS Surrey for the NHS contract rate for the backdated period covered by the reimbursement process, less the sum charged to Surrey CC for that period and less any FNC that has already been paid to the NH. NHS Surrey will pay the difference provided steps 3) and 4) have been met. Please note that invoices should not be submitted to NHS Surrey prior to the start of the month to which they relate.
9) If a patient is FNC, NHS Surrey will accept responsibility for funding from the date of admission (or date of review request if patient was previously no band) provided the NH has met steps 3) & 4). If a NH fails to notify NHS Surrey of admission within 7 days, or fails to provide NHS Surrey the HNA within 28 days of admission, it is not reasonable to expect NHS Surrey to backdate
FNC payments. In these circumstances, the PCT will not normally accept
FNC funding responsibility prior to the date the completed HNA is received.
Summary: if outcome is CHC

-NH advises of admission within 7 days, and supplies complete HNA within 28 days

NHS Surrey assesses resident and agrees eligible for NHS Continuing
Healthcare

-NHS Surrey accept responsibility and pay from day 29 (or possibly earlier) or date agreed by MDT completing DST

-If NH have invoiced others at a lower rate, NHS Surrey will pay the additional sum from day 29 (or earlier if agreed) until the date at which invoices are sent directly to NHS Surrey.


Where notification to NHS Surrey is late, no responsibility for funding will be accepted prior to date completed HNA is received by NHS
Surrey.
Please note that these arrangements will apply to all referrals – i.e. new admissions or review requests, submitted after 1 st November 2012.
If you are experiencing problems in completing Health Needs
Assessments for any reason you must notify the team as soon as possible.
Vicky Clark
Business Manager - Care Homes