NHS Continuing Healthcare Services East Midlands Pcts - Phase 3

Document 10

NHS Continuing Healthcare Services – East Midlands PCTs - ‘Phase 3’

Pricing Model ‘Guidance Notes’

These notes should be read in conjunction with Document 7 ‘Pricing Model’ – ITT Document Pack

Guidance Notes on ‘Pricing Model’ - NHS Derbyshire County

The basic rate (Band A) of £560 per week covers patients not qualifying for Bands B to D as set out below. Band A is therefore the default weekly rate.

Band B at £600 per week covers patients determined as Fast Track (terminally ill) who are newly admitted and therefore, not existing residents of the Residential Home. Existing residents will maintain their existing banding.

Band C at £760 per week covers patients with at least two or more severe scores on the Decision Support Tool used to assess eligibility for NHS Fully Funded Continuing Care.

Band D covers patients with complex and specialist needs requiring additional resources over and above that capable of being provided at the Band C rate of £760 per week. The fee rates will be individually negotiated, reflecting the specific needs of these patients.

Guidance Notes on ‘Pricing Model’ - NHS Derby City

The basic rate (Band A) of £560 per week covers patients not qualifying for Bands B to D as set out below. Band A is therefore the default weekly rate.

Band C at £725 per week covers patients with at least two or more severe scores on the Decision Support Tool used to assess eligibility for NHS Fully Funded Continuing Care.

Band D covers patients with complex and specialist needs requiring additional resources over and above that capable of being provided at the Band C rate of £725 per week. The fee rates will be individually negotiated, reflecting the specific needs of these patients.

Guidance Notes on ‘Pricing Model’ – NHS Lincolnshire

NHS Lincolnshire have applied the following Band Prices for NHS CHC;-

Band A = £578 per week (prime health need price includes all hotel and nursing care costs and up to 2hours 1;1 per day)

Cat. / Description / Criteria
DST Minimum / Price per week and per day / Pricing components
A / Mainstream / Patient has a minimum of 3 domains scoring High
And has identified prime health needs and agreed by NHSL CHC team as eligible for Fully Funded Continuing Health Care. / £578 per week
(82.57 per day) / Includes :-

all costs
including up to 2 hours 1:1 care per day
FNC
and equipment costs

Band B = £588 per week for Fast Track applications

B / Fast-Track / Patient is within four weeks of end of life as agreed by NHSL CHC team
agreed by NHSL CHC team as eligible for meeting fast-track criteria in accordance with the National Framework for Continuing Healthcare and NHS Funded Nursing Care (Oct 2009) / £588 per week
i.e. £84/day / Includes :-

all costs for a period of up to 4 weeks i.e. 28 days.
Payment will be made for up to 3 days following death.

Band C = £578 per week, plus additional 1:1 support @ £10 per hour (over 2 hours per day)

C / Complex / Patient has a minimum of 2 domains scoring severe
And has more than 2 hours per day 1:1 care as agreed by NHSL CHC team
And has identified prime health needs and agreed by NHSL CHC team as eligible for Fully Funded Continuing Health Care. / £578 per week i.e. £82.57/day
plus hourly rate £10 per hour for additional 1:1 care above 2 hours 1:1 care/day / Includes :-

all category A components
and in addition the NHS Lincolnshire CHC team will approve additional needs of more than 2 hours 1:1 care per day. Pay additional hourly rate for 1:1 care above 2 hours at rate of £10/hour.

Band D = £578 per week plus any additional bespoke/complex care required as evidenced and requested by the Complex Case Manager NHSL additional care and its cost is negotiated and agreed in accordance with need.

D / Highly complex & exceptional / Patient has a minimum of 1 domain scoring Priority
And has identified prime health needs and agreed by NHSL CHC team as eligible for Fully Funded Continuing Health Care. / £578 per week i.e. £82.57/day and bespoke negotiated additional payment to meet the healthcare needs of the patient as agreed by NHSL CHC team. / If bespoke healthcare equipment is required then this may be part of the negotiated package subject to agreement by NHSL CHC team.

Notes for applying the price band:-

Fast Track – Band B
Applied £588 for a person meeting this criteria to put an immediate package of care in place, this tool is not used to switch funding for an already existing package of care.

BAND A – fully funded CHC
Applied £578 for person with prime health need, when this is a new eligibility, the individual will be awarded band A, in the first instance, and at 12 week review, the evidence and evaluation from each care plan is taken into account to award the Band thereafter, which may continue as Band A, or indicate Band C/D, as Advised by the PCT staff.

Exceptional arrangement to Band A in the first instance
Where a person has been managed in a specialist rehabilitation unit or equivalent, for highly complex needs band C/D may be awarded from the outset. This will be advised by the PCT CHC coordinator.
At 12 week review, the PCT will then advise what ongoing care band is appropriate.

Existing Patient receiving NHS CHC within a preferred provider venue
Where an existing care package is due annual review, the evidence and care plan evaluations are considered and providing that eligibility still exists for prime health need, the appropriate price band is awarded to adequately meet need. this could be Band A/C/or D

Guidance Notes on ‘Pricing Model’– NHS Nottingham City and NHS Nottinghamshire County

Both NHS Nottinghamshire County & NHS Nottingham City have agreed to use a banding system based on Local Authority quality rates. This works as follows:

Band Athis is the PCT weekly CHC base price (County £615.00 – City £597.00). It is the price linked to the Laing & Buisson Report and is matched to the LA quality Band 2 Price for Older Peoples Nursing. Any homes which are quality rated 3-5 will include an additional Local Authority quality premium. In NottinghamshireCounty, where relevant, there is also an additional payment for dementia in line with Nottinghamshire County Council. The weekly rate for care homes with a 0 or 1 quality rating will be reduced in line with the Local Authority quality differential. LA annual price changes will apply to these rates

Band Bthis is the Band A rate as described above plus a payment of £73.29 per week

Band Cthis is the Band A rate as described above plus a payment of £219.87 per week

Band Drates will be individually negotiated for people with highly complex, specialist needs and would apply to specialist placements for example, brain injury, learning disability and mental health (excluding dementia).

The weekly rates are indicated in the tables below.

Nottingham City Care Home Prices for NHS Continuing Healthcare 2011-12

Local Authority Band / NHS Band A
Up to 4 highs & 1 severe / NHS Band B
5 highs or more & 1 severe
and Fast Track / NHS Band C
2 severe levels or more / NHS Band D
Learning Disability
Mental Health
Brain Injury
Specialist cases
0 / £523 / £596.29 / £742.87 / Placement to be individually negotiated
1 / £579 / £652.29 / £798.87
2 / £597 / £670.29 / £816.87
3 / £615 / £688.29 / £834.87
4 / £632 / £705.29 / £851.87
5 / £649 / £722.29 / £868.87

Nottinghamshire County Care Home Prices for NHS Continuing Healthcare 2011-12

Local Authority Band / NHS Band A
Up to 4 highs & 1 severe / NHS Band B
5 highs or more & 1 severe
and Fast Track / NHS Band C
2 severe levels or more / NHS Band D
Learning Disability
Mental Health
Brain Injury
Specialist cases
Nursing / Dementia / Nursing / Dementia / Nursing / Dementia / Placement to be individually negotiated
1 / £560 / £570 / £633.29 / £643.29 / £779.87 / £789.87
2 / £615 / £652 / £688.29 / £725.29 / £834.87 / £871.87
3 / £638 / £675 / £711.29 / £748.29 / £857.87 / £894.87
4 / £660 / £698 / £733.29 / £771.29 / £879.87 / £917.87
5 / £682 / £720 / £755.29 / £793.29 / £901.87 / £939.87