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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Assessing People for NHS Funding Policy

1. Purpose

The purpose of this policy is to outline how {{org_field_name}} supports the identification, assessment, and application process for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care (FNC) in accordance with the latest guidance from NHS Wales, CIW regulations, and the Regulation and Inspection of Social Care (Wales) Act 2016. This policy ensures that residents who may be eligible for NHS funding are assessed fairly, promptly, and transparently, and that all decisions are documented and communicated in a way that upholds the individual’s rights and dignity.

2. Scope

This policy applies to all residents who may be eligible for NHS Continuing Healthcare or Funded Nursing Care, including those newly admitted, those whose needs change over time, and those undergoing routine care reviews. It applies to all staff involved in the care planning, assessment, and advocacy process, including the Registered Manager, nursing staff, senior care staff, and administrators liaising with health board professionals.

3. Related Policies

This policy should be read in conjunction with the following:
CHW07 – Person-Centred Care Policy
CHW09 – Consent to Care Policy
CHW11 – Safe Care and Treatment Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW18 – Risk Management and Assessment Policy
CHW36 – Initial Assessment and Care Planning Policy
CHW42 – Communication and Engagement with Service Users and Families Policy
CHW41 – Managing Service User Finances Policy

4. Policy Statement and Implementation

A. Overview of NHS Funding Options
There are two primary types of NHS funding available to individuals receiving care in a care home setting:
NHS Continuing Healthcare (CHC): A package of care arranged and fully funded by the NHS for individuals with complex, ongoing health needs.
NHS-funded Nursing Care (FNC): A contribution from the NHS towards the cost of registered nursing care for eligible residents in a care home with nursing.
Eligibility for either is determined by the individual’s assessed health needs, not their diagnosis, location, or financial circumstances. Staff at {{org_field_name}} play a key role in supporting residents through this process.

B. Identification of Potential Eligibility
All new residents undergo a comprehensive assessment on admission (see CHW36), which includes consideration of potential eligibility for NHS funding. Indicators that may trigger a referral include complex physical or mental health needs, rapidly deteriorating conditions, frequent hospital admissions, palliative care requirements, or the need for continuous skilled nursing care. Staff are trained to identify these indicators and escalate them to the Registered Manager for review.

C. Referral and Checklist Completion
If a resident is identified as potentially eligible for CHC or FNC, a CHC Checklist is completed by a trained member of staff in accordance with the Welsh Government Continuing NHS Healthcare Framework. The Checklist is completed in collaboration with the resident (where possible), their family or representative, and relevant professionals. The outcome of the Checklist determines whether a full assessment should be undertaken. A copy of the Checklist is shared with the appropriate health board, and the resident is informed of the next steps.

D. Full Assessment for NHS Continuing Healthcare
If the Checklist outcome supports a full assessment, {{org_field_name}} facilitates the coordination of the multidisciplinary team (MDT) meeting, ensuring relevant documentation is available. The assessment is undertaken using the Decision Support Tool (DST), considering four key indicators: nature, complexity, intensity, and unpredictability of the individual’s health needs. Our nursing and senior care staff provide accurate, up-to-date clinical evidence and care records to support the assessment. The person and their representative are fully involved in the process and supported to express their views. The decision from the assessment is communicated in writing by the health board, and we ensure that individuals understand their right to appeal.

E. NHS Funded Nursing Care (FNC) Assessments
Residents not eligible for full CHC funding may still qualify for FNC. The assessment is usually undertaken alongside the CHC Checklist and considered by the health board. If granted, the FNC contribution is paid directly to {{org_field_name}} to cover the cost of registered nursing care. We ensure that the FNC is applied appropriately and reflected in the individual’s financial records (see CHW41).

F. Recording and Communication
All assessments, decisions, and correspondence regarding CHC or FNC funding are securely recorded in the resident’s care file and digital records. Staff are briefed on any funding decisions that impact care provision. Communication with the resident and their family is clear, respectful, and ongoing throughout the process. We provide written summaries of outcomes and ensure that any changes to funding status are explained fully.

G. Reviews and Reassessments
CHC and FNC eligibility is reviewed annually or sooner if there is a significant change in the individual’s condition. {{org_field_name}} takes the lead in monitoring changes in health status and triggers a reassessment where necessary. All reviews are planned in consultation with the health board and the resident or their advocate. Staff ensure that documentation is accurate and reflects current needs, including daily care logs, incident records, clinical observations, and professional input.

H. Advocacy and Rights
Residents are entitled to independent advocacy throughout the CHC and FNC assessment and review process. {{org_field_name}} provides information about advocacy services and supports residents in accessing these services where appropriate. We are committed to upholding the legal and human rights of all residents during the assessment process, particularly for those lacking mental capacity. Best interest decisions are made in accordance with CHW39 – Mental Capacity and DoLS Policy.

I. Staff Training and Governance
Staff involved in completing CHC Checklists or contributing to DST assessments are trained and competent in NHS funding processes. Ongoing supervision and updates are provided through CHW27 – Staff Supervision, Training, and Development Policy. The Registered Manager monitors all applications, outcomes, and timeframes to ensure compliance with CIW standards and health board expectations. Audit trails are maintained, and any delays or concerns are escalated to the relevant authorities.

J. Financial Transparency and Contracts
Where a resident receives CHC or FNC funding, their funding status is clearly reflected in their service agreement and financial records. We ensure transparency in what is covered by the NHS and what is paid privately, preventing any unlawful top-up fees for NHS-funded care. In line with CHW41, any change in funding is communicated in writing to the resident or their financial representative.

5. Policy Review

This policy will be reviewed annually or earlier if there are changes to NHS Wales funding frameworks, CIW regulations, or following internal audit findings. The Registered Manager is responsible for ensuring the policy remains compliant with current legislation and that staff are aware of any updates.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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