OPTIONS Norfolk A guide to care and independent living
Leaving hospital What’s next?
Helping you return home safely
NHS
continuing healthcare Who’s eligible?
10 SOCIAL CARE
tips
Free services available for over 50s
Autumn 2023
Contents
Meeting the mental health needs of older people in Norfolk........................................ 4-5 Be at Home - health and social care referrals...................................................................... 6 Getting help........................................................................................................................... 8 Breckland Council - Inspiring Communities........................................................................ 10 Helping you return home safely......................................................................................... 12 Social Care and GP top tips.................................................................................................. 13 NHS continuing healthcare............................................................................................. 14-17 Personal budgets and direct payments.......................................................................... 18-21 Free services available for over 50s..................................................................................... 22 United Against Dementia.................................................................................................... 23
Welcome and introduction
This guide is intended to help you, your carer and your relatives understand how your local health services can help you after discharge from hospital. Also information to help you to live independently or access support and care services in your area.
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To view this guide online as an interactive ebook visit: www.octagon.org.uk/options/norfolk/autumn2023
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Options Norfolk is published by Octagon Design and Marketing Ltd with editorial contributions from Norfolk and Suffolk NHS Foundation Trust, Great Yarmouth Borough Council, Broadland District Council, South Norfolk Council, Breckland Council, Borough Council of King’s Lynn & West Norfolk, Care Community Service, Age UK Norfolk, Alzheimer’s Society, the CQC and the NHS. The editorial contributors have not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor do the editorial contributors endorse any of the products or services.
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Editorial content supplied by: Norfolk and Suffolk NHS Foundation Trust
Meeting the mental health needs of older people in Norfolk Mental health issues, including dementia, can affect anyone at any age. Thankfully, services are available to provide support and guidance. The Intensive Older People’s Service, provided by Norfolk and Suffolk NHS Foundation Trust (NSFT), is just one such service. NSFT provides mental health and learning disability care for people across Norfolk and Suffolk. The Trust is dedicated to providing high-quality care with compassion, delivering many of the NHS services that are provided outside of hospital and in the community. It has clinical teams providing services in inpatient, community and primary care settings.
What is the Intensive Older People’s Service (IOPS)? IOPS Central Norfolk, which is based at the Julian Hospital in Norwich, offers assessments and interventions for adults with age-related needs. This service is not only for people over the age of 75. It is for people living with acute, severe and enduring mental health problems. This includes anxiety, depression, psychosis, confusion, dementia (any age) and related behavioural problems. The service operates seven days a week. It is a multi-disciplinary team, consisting of:
Their aim is to support and treat people in their community settings.
• Clinical team leader / independent nurse prescriber • Nursing staff • Occupational therapist • Assistant practitioners • Specialist doctor Their aim is to support and treat people in their community settings.
Who is the service for? • Service users with dementia of any age, or • Service users over the age of 75 with functional mental health and physical health complexities
What does it offer? • The IOPS team responds to emergency (four hour) and urgent (120 hour) referrals. This team helps people who are either not active to the Trust or are no longer active to community mental health teams • The team provides interventions working with other teams and organisations. The team’s specific role is to provide intensive support to prevent admission to the Trust acute assessment wards • They accept referrals from community mental health teams for patients needing intensive support. They also help patients who meet the criteria referred by the Norfolk and Norwich University Hospital
Editorial content supplied by: Norfolk and Suffolk NHS Foundation Trust
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• Duty workers triage the referral for further information and suitability for the service. The team will then organise a time and date to assess the referred person. • From this assessment, they agree a plan of action with the individual. If the team assesses a referral as not needing intensive support, they signpost them to other relevant services. For those accepted, interventions may include: • Assessment and diagnosis of mental health problems • Risk assessment and risk management • Monitoring of mental health difficulties and agreed treatment plans • Therapeutic treatment including advice around provision of personal care in support of care providers and care homes The team provides intensive support for around six weeks. The team may discharge the person from care. They may also make onward referrals to social services or community mental health teams. They also offer advice, individual support and information for carers.
What can you expect? The Team provides additional, intensive support for a short period of time, to help people in a mental health crisis stay in their own home with as much autonomy and independence as possible. They will: • Work with service users in their own homes or in nursing / residential homes • Work together with service users and carers • Provide therapeutic interventions, carers support and information • Develop treatment plans for service users with complex needs, working with other agencies, as appropriate
They also offer advice, individual support and information for carers.
• Request admission to hospital, when the service user’s needs can no longer be met in the community setting • Continue to work with the service user to facilitate discharge. Service users who are at risk of harm to self, or others, and awaiting admission, should not be left alone. If a relative / carer feels they are at risk, they should call the police.
Referrals All emergency and urgent referrals come through the Single Point of Access Team. 120 hour urgent referrals can be made to IOPS via Single Point of Access (SPOA) (referrals are usually via the GP). Four-hour emergency referrals can be made via SPOA (the service user must have been seen faceto-face by their GP). Care co-ordinators can refer someone who is already supported by community teams.
Other services for older people NSFT runs a range of community and inpatient mental health services to support older people in Norfolk. You can find out more by visiting the Trust’s website and searching under ‘Our services – Older people’: www.nsft.nhs.uk
Urgent help Service users in crisis can contact the service using the number they were given. Anyone in crisis can call 111 and select the mental health option to speak to our 24-hour mental health crisis line. If you are with someone who has attempted suicide, call 999 and stay with them until the ambulance arrives. If anyone is at serious risk of harm, call 999 and ask for the police. For non-life threatening medical situations, call NHS111 on 111.
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Editorial content supplied by: Great Yarmouth Borough Council
Be at Home - health and social care referrals
Be At Home services are designed to help keep local people living safely in their own homes. The services aim to: • help facilitate early discharge from hospital • prevent falls • prevent hospital admission through undertaking fast track home adaptations and/or providing a temporary Be at Home alarm and key safe
The services are only available to permanent residents in the borough of Great Yarmouth and the Waveney area.
Both services were developed by Great Yarmouth Borough Council, in partnership with the NHS Great Yarmouth and Waveney Clinical Commissioning Group and Norfolk County Council. Suffolk County Council and East Suffolk Council have now joined the partnership, enabling the projects to run until at least March 2024.
Be at Home adaptations This project aims to undertake fast track adaptations to those vulnerable people who are most at risk of falls, imminent hospital admission or readmission. The types of works undertaken include installation of: • grab rails and banisters • half steps • shallow steps and level access doors
Be at Home alarms This is a complimentary short-term package aimed to assist in early hospital discharge or to prevent admission to hospital. The pack consists of a 24/7 Be at Home alarm and a key safe. This helps to boost patient confidence when returning from hospital or following a fall or illness. Access to both of these services is via a Be at Home electronic referral form (opens new window) from health and social care professionals only. The services are only available to permanent residents in the borough of Great Yarmouth and the Waveney area. There must be a clear understanding of how the recommended work helps facilitate early hospital discharge, falls prevention, reduce admissions and/or readmissions. If you have any queries about the schemes, or to request password access to the referral system, please contact the project officer Sue Atkins on 01493 846673 or the project administrator Kerri Drew on 01493 846670 or by email to referrals@great-yarmouth.gov.uk
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Editorial content supplied by: Broadland District Council and South Norfolk Council
Getting help The Help Hub works with partners to get you the right help, whatever the situation. Help in your community
Housing
You may be experiencing loneliness and isolation, have moved into a new area or you may simply want do new things and meet new people. The Help Hub can support you to access a range of support services, groups and activities in your local community. Contact us by completing a Request for Support online or calling 01508 533933/01603 430431.
If your situation changes and you find yourself in need of alternative housing, are made homeless, or require adaptations to enable you to remain within your home, we work with a number of partners who can help facilitate this.
Help and support to combat isolation is available from Better Together Norfolk, local groups and activities can be found on the Norfolk Directory.
Wellbeing and health The Help Hub can support you to access the right services or activities to support your physical and mental health and wellbeing. We work with a range of partners in health services and our communities.
If you are caring for a family member, a friend or a loved one, there is advice and support available through Carers Matters Norfolk as well as from Adult Social Care.
There are lots of resources online that can help you to improve your wellbeing and health. You can find selfhelp guides and the self-referral form on the Norfolk and Suffolk Wellbeing Service website. The NHS provide lots of advice around healthy living which includes mental health, help to stop smoking and eating well; this can be accessed on the NHS pages. We offer a number of programmes, including Broadly Active as well as a range of leisure and fitness services. Advice specifically for young people can be found on the Young Minds website. Just One Norfolk has lots of information and guidance for children and parents. Kooth is free and confidential chat service for young people to access support; they have a wealth of information that is available to access any time.
Carers support If you are caring for a family member, a friend or a loved one, there is advice and support available through Carers Matters Norfolk as well as from Adult Social Care. Don’t forget that there are lots of support networks for specific conditions, for example Dementia UK and Arthritis Action, try searching online for a wealth of information.
Advice around housing and homelessness is available on the main housing webpages. If your home needs some adaptations to ensure that is it safe then you might be able to receive support through our Disabled Facilities Grant. Rented properties should be up to standard - if you’re concerned that the property you rent is not a safe environment or in good condition you can get advice from our Housing Standards Team.
Handyperson service Simple adaptions to the home can make a huge difference to the health and wellbeing of our older and most vulnerable residents. Our handyperson service helps people to stay living independently in their homes for longer. We can help with hand rails, key safes, smoke alarms, works to prevent slips and falls and small home improvements which can improve people’s quality of life. For our South Norfolk residents, please complete our online handyperson request form to make an enquiry. For our Broadland residents, please call our Housing Standards Team on 01603 430518 or email handyperson@southnorfolkandbroadland.gov.uk. If your work is more urgent, or if you require more extensive home adaptations and improvements, then a variety of traders can be found through the Norfolk County Council’s Trusted Trader Scheme.
Get help To get help with any of these issues, or with any other problems visit: www.southnorfolkandbroadland.gov.uk
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Editorial content supplied by: Breckland Council
Breckland Council - Inspiring Communities Breckland Council is an organisation that cares. We are working for everyone in our area – but especially those who are most in need. In March 2020 we launched Inspiring Communities, investing £1 million to develop an approach to the prevention of vulnerability. Through this programme of work, we have been able to tackle key issues that affect people living in Breckland, such as loneliness and isolation.
Our services Social Prescribing Our ‘Community Connectors’ spend time getting to know patients and what matters to them most. The team make sound judgments on how to ensure patients get the most out of the service and feel empowered to work through their issues. Reasons for referral may include: • Debt / Finance • Social Isolation & Loneliness • Low-Medium Mental Health issues
Our ‘Community Connectors’ spend time getting to know patients and what matters to them most.
• Benefits / Welfare Rights (supporting applications for benefits and assessing entitlements) Welfare Welfare Officers provide a holistic needs assessment to residents referred to them. They signpost to appropriate services to help, including debt advice and financial support as well as mental health services. Community Health Workers Targeting households in in Watton, Community Health Workers visit registered patients to discuss their health and wellbeing, with a focus on early intervention/ preventative offers, such as vaccinations and screening, smoking cessation, and wellbeing.
Breckland Arts for Health (previously Silver Social) An ambitious programme of daytime events aimed at people who may be isolated or lonely, in community venues across Breckland. The Project uses a range of art forms, delivered by professional practitioners, to promote participation and independent living in our communities, with the specific aim of improved wellbeing for people in Breckland who are experiencing early stages of poor mental and physical health.
The services mentioned in this article are not exhaustive of the help available from Breckland Council. If you would like to know more, please visit our website www.breckland.gov.uk/community, email communitysupport@breckland.gov.uk or call 01362 656870
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S OPTION Norfolk A guide to care and independent living
Leaving hospital
Autumn 2023
What’s next? Helping you return home safely
NHS
continuing healthcare
CARE AT HOME FOR ALL OF LIFE IN NORWICH
Who’s eligible?
10 SOCIAL CARE
tips
DESIGN PRINT SUPPORT
Free services available for over 50s
OUR HOME CARE SERVICES INCLUDE Considerate companionship Respite care End of life and cancer care
OCTAGON DESIG N & M ARK ET ING LT D
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Contact us today to discuss your care needs
01603 298742
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Editorial content supplied by: Borough Council of King’s Lynn & West Norfolk
Helping you return home safely Careline Community Service, part of the Borough Council of King’s Lynn & West Norfolk, are working in partnership with the Queen Elizabeth Hospital in King’s Lynn, Norfolk, to assist West Norfolk patients who are being discharged to return home safely. Hospital staff working in the Rapid Assessment and Frailty Team can refer patients to the ‘I’m Going Home’ service. This means a ‘Go’ mobile alarm unit is provided, free of charge, for six weeks while the patient gets settled back at home. The ‘Go’ is a mobile version of our careline alarm which enables patients to call for help just by pressing the button. A call will be placed to our monitoring centre via the internal roaming sim and our call handlers will assess the situation and call for assistance or the emergency services if required. The device also has a GPS function which will provide the patients location so assistance can be sent to them directly.
Careline Community Service will contact the patient at the end of the six week period to discuss next steps.
Patients are assessed before being referred to this service, but once referred, set up is quick and easy, with no need for a landline. This enables patients to return home speedily where their recovery is likely to be quicker. Careline Community Service will contact the patient once they are discharged to make sure they are confident and know how to use the ‘Go’ device. We will stay in touch during the six weeks to make sure everything is okay and to see if there are any additional requirements. Careline Community Service will contact the patient at the end of the six week period to discuss next steps. If the patient chooses to keep the ‘Go’ we will explain the cost and send out a service agreement. We can discuss alternative products if the ‘Go’ isn’t suitable or we cancel the service and arrange for the equipment to be returned if it is no longer required.
Contact us For more information on how Careline Community Service can help you to live safely and independently at home, please contact us on 01553 616200 (option 1) or visit our website www.careline-cs.org.uk
The Care Quality Commission is here to make sure health and adult social care services including hospitals, home and residential care as well as GPs in England provide people with safe, effective, high-quality care. We publish independent inspection reports and ratings about services – information you can use when you’re choosing care for yourself, or a loved one. You can use our website to search for services you might be interested in by geographical area, or by specialism. For example, a care home that might offer specialist care for someone who has dementia. We also welcome your feedback on the care you have received – good or bad. We use this information to help inform our inspections and can alert authorities including local social services, if there are safeguarding concerns about care being provided. You can visit our website at www.cqc.org.uk to find our inspection reports, or share an experience of care. You can also call us to share an experience of care on 03000 61 61 61. Here are some tips to help you choose your care.
Social care Top tips 1
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The Care Quality Commission (CQC) registers all care homes and home care agencies. You can find out which ones support specific groups of people, such as people with a learning disability or those living with dementia. CQC’s Chief Inspector for Adult Social Care, Andrea Sutcliffe always uses ‘The Mum Test’: is a care home safe, caring, effective, responsive to people’s needs and well-led? In other words, is it good enough for my Mum (or anyone else I love and care for)? Look for care homes and home care agencies where the staff involve people who use services and their families and carers, and treat individuals with compassion, kindness, dignity and respect.
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Whether you are being cared for in your own home or in a residential setting, the staff looking after you need to be skilled, kind and supportive. They should also be capable and confident in dealing with your particular needs. You should always feel that their support is helping you to live the life you want to. A care home will be a home for you or your loved one. Residents should be treated as individuals with their likes and dislikes taken into account. Think about whether a home is close enough to family, friends, and community facilities. Look at how well-led and managed a home is. What does it have in place to ensure that it delivers high quality care? Does it promote meaningful activity and connect the home with the community?
If you or a loved one needs help with day-today care, you can contact your local council’s social services department. They will ‘make an assessment of your needs’ and depending on circumstances, may be able to help you access financial help. For more advice visit Age UK’s website www.ageuk.org.uk /home-and-care.
If you would like to organise your care yourself, you can find a care worker or personal assistant through an agency. Your local social services department should be able to provide details of approved agencies.
CQC’s ratings will identify services as:
Outstanding H Good ● Requires improvement ● Inadequate ● For up-to-date information about planning, choosing and paying for care, visit NHS Choices. https://www.nhs.uk/conditions/social-careand-support-guide/
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Safeguarding adults who receive social care is everybody’s business. If you are concerned about the safety of a loved one receiving care, contact the service provider in the first instance. You can also contact social services at your local council. If you feel a crime has been committed, contact the police. You can share your safeguarding concerns with us on our website or contact our National Customer Services on 03000 616161.
The Care Quality Commission has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does the Care Quality Commission endorse any of the products or services.
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Editorial content supplied by: the NHS
NHS continuing healthcare Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare. Where can NHS continuing healthcare be provided? NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
Am I eligible for NHS continuing healthcare? NHS continuing healthcare is for adults. Children and young people may receive a “continuing care package” if they have needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone. Find out more about the children and young people’s continuing care national framework on GOV.UK
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition.
You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate. A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment. If you are not eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them. If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to: • what help you need • how complex your needs are • how intense your needs can be • how unpredictable they are, including any risks to your health if the right care is not provided at the right time Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
Information and advice The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS continuing healthcare. Visit the Beacon website or call the free helpline on 0345 548 0300.
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Editorial content supplied by: the NHS
NHS continuing healthcare assessments Integrated care boards, known as ICBs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it. For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently – for example, if you’re terminally ill – your assessment may be fast-tracked.
For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment.
Initial assessment for NHS continuing healthcare The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed, and what the assessment involves. Depending on the outcome of the checklist, you’ll either be told that you do not meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility.
Being referred for a full assessment does not necessarily mean you’ll be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment. The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. You should be given a copy of the completed checklist. You can download a blank copy of the NHS continuing healthcare checklist from GOV.UK
Full assessment for NHS continuing healthcare Full assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care. You should be informed who is co-ordinating the NHS continuing healthcare assessment.
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Editorial content supplied by: the NHS
The team’s assessment will consider your needs under the following headings: • breathing • nutrition (food and drink) • continence • skin (including wounds and ulcers) • mobility • communication • psychological and emotional needs • cognition (understanding) • behaviour • drug therapies and medicine
If you’re eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs.
• altered states of consciousness • other significant care needs These needs are given a weighting marked “priority”, “severe”, “high”, “moderate”, “low” or “no needs”. If you have at least 1 priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare. You may also be eligible if you have a severe need in 1 area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability. In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision. You can download a blank copy of the NHS continuing healthcare decision support tool from GOV.UK
Fast-track assessment for NHS continuing healthcare If your health is deteriorating quickly and you’re nearing the end of your life, you should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
Care and support planning If you’re eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs. Depending on your situation, different options could be suitable, including support in your own home and the option of a personal health budget. If it’s agreed that a care home is the best option for you, there could be more than 1 local care home that’s suitable. Your ICB should work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, they can also take other factors into account, such as the cost and value for money of different options.
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Editorial content supplied by: the NHS
NHS continuing healthcare reviews
If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.
If you’re eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.
Refunds for delays in NHS continuing healthcare funding
they should refund any care costs from the 29th day until the date of their decision.
If you’re not eligible for NHS continuing healthcare If you’re not eligible for NHS continuing healthcare, but you’re assessed as requiring nursing care in a care home (in other words, a care home that’s registered to provide nursing care) you’ll be eligible for NHS-funded nursing care.
ICBs will normally make a decision about eligibility for NHS continuing healthcare within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.
This means that the NHS will pay a contribution towards the cost of your registered nursing care. NHS-funded nursing care is available irrespective of who is funding the rest of the care home fees.
If the ICB decides you’re eligible, but takes longer than 28 days to decide this and the delay is unjustifiable,
Find out more about NHS continuing healthcare from NHS England.
Frequently asked questions about
NHS continuing healthcare
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I have a local authority support package that works well. I’m now eligible for NHS continuing healthcare – will my support package change? If you’re concerned about changes to your care package because of a move to NHS continuing healthcare, your ICB should talk to you about ways that it can give you as much choice and control as possible. This could include the use of a personal health budget, with 1 option being a “direct payment for healthcare”.
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FAQ’s
Can I refuse an assessment for NHS continuing healthcare? If I refuse, will I be able to get services from my local authority? Consent is not needed for completion of assessments (CHC Checklists, Decision Support Tools (inclusive of FNC by default) and Fast Track), or collation and sharing of information with: • Care Teams • Health and Social Care Staff But consent is needed to share personal information collected for, and as part of, assessments (Checklist, Decision Support Tool (inclusive of FNC by default) and Fast Track) with third parties, such as family, friends or representatives, at the beginning of the process. There is a legal limit to the types of services that a Local Authority can provide. If you have any concerns about being assessed for NHS continuing healthcare, the ICB should explore your reasons for this, and try to address your concerns.
If someone lacks the mental capacity to consent to sharing of information with third parties (other than Care Teams or Health and Social Care Staff), the principles of the Mental Capacity Act will apply and a best interests decision may be needed.
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My relative is in a care home and has become eligible for NHS continuing healthcare. The ICB says the fees charged by this care home are more than they would usually pay, and has proposed a move to a different care home. I think a move will have a negative effect on my relative. What can we do? If there’s evidence that a move is likely to have a detrimental effect on your relative’s health or wellbeing, discuss this with the ICB. It will take your concerns into account when considering the most appropriate arrangements. If the ICB decides to arrange an alternative placement, they should provide a reasonable choice of homes.
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Is it possible to pay top-up fees for NHS continuing healthcare? No, it is not possible to top up NHS continuing healthcare packages, like you can with local authority care packages. The only way that NHS continuing healthcare packages can be topped up privately is if you pay for additional private services on top of the services you’re assessed as needing from the NHS. These private services should be provided by different staff and preferably in a different setting.
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Editorial content supplied by: the NHS
Personal budgets and direct payments You’ll be given a personal budget to spend if your local council decide you’re eligible for help with any social care and support you need. You can request an assessment from the council to establish your needs. The money in your personal budget can be paid to you, to help you make more decisions about how it’s spent. This is known as a direct payment.
What is a personal budget? Your personal budget is the amount of money your local council will pay towards any social care and support you need. The amount of money in your personal budget is decided by your local council after a needs assessment to work out: • what kind of care and support you need • how much it will cost • how much you’re able to afford yourself
If you’re a carer, you may be entitled to receive a personal budget after having a carer’s assessment to see what might help make your life easier.
Carers and personal budgets If you’re a carer, you may be entitled to receive a personal budget after having a carer’s assessment to see what might help make your life easier. A carer’s assessment is free and anyone over 18 can ask for one.
Choosing how to receive your personal budget
You can also choose a combination of these options. For example, the council could arrange some of your care but send you the rest of the money. This is often called a mixed package or “mix and match”. If the council manages your money The money in your personal budget will be spent for you by the council. They will arrange all your care and support based on your agreed care plan. They still need to check you’re happy with the care they’re arranging for you. If your money is paid to another organisation The organisation you choose, such as your care provider, will speak to the council and arrange the payments. Sometimes other organisations charge you extra money to arrange payments from the council.
The benefits of direct payments Direct payments give you more flexibility over how your care and support is arranged and provided. For example, you could choose to hire care workers or personal assistants who:
You can ask the council to either:
• are always the same people and available when you need them
• manage your personal budget for you
• speak the same language as you
• pay the money to another organisation – such as a care provider
• have experience working with your care needs
• pay the money directly to you or someone you choose – this is known as a direct payment
• are a specific person that has been recommended to you • can help you get to shops or social events
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Editorial content supplied by: the NHS
There are many ways you could choose to use the money. It’s your choice as long as you’re spending your personal budget on things that meet your agreed care plan. Most councils will ask for evidence of how you’ve spent your money every 3 months. When to consider other options You may decide direct payments are not helpful if:
You could also consider having someone else manage your direct payments, for example a friend or family member.
• you’re worried about managing money or the people you employ • you spend a lot of time in hospital • you would rather the council arranged your care If you’re not confident about keeping records or managing the people who care for you, your local council should be able to provide support. You could also consider having someone else manage your direct payments, for example a friend or family member. You’ll need to set up a trust for payments that are managed by someone else. The Money Advice Service has information about setting up a trust.
How to apply for direct payments You should be offered direct payments as an option after your needs assessment. You can also ask your local council’s social services department about direct payments.
How direct payments work If you choose direct payments, the council will send you the money in your personal budget by either: • paying it directly into a bank, Post Office, building society or National Savings and Investments account • sending you a pre-paid card You can then choose how you spend the money on your own care and support, as long as it matches the care plan you’ve agreed with the council. Signing a direct payment agreement The council might ask you to sign a document called a direct payment agreement. This says: • how the council want you to record your spending – for example, keeping receipts
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Editorial content supplied by: the NHS
• your responsibilities as an employer - if you’re paying for a care worker If you spend direct payments on something that isn’t agreed in your care plan, the council could take the money back or end the direct payments. If you’re struggling to manage your money Ask your local council for advice or call the Money Advice Service on 0800 138 7777. If you want someone else to receive the direct payment You could speak to the council and agree for the money to be sent to someone who will spend it for you. For example: • a carer
When choosing an agency, decide what sort of service you’re looking for and the tasks you need help with.
• a friend or family member • someone else who speaks up for you (an advocate) You may need to write down how they will spend the money and which decisions they can make for you. This is known as a decision-making agreement.
Employing your own carer or personal assistant If you decide to hire a carer or personal assistant yourself, it’s important to know the responsibilities you’ll have as an employer. Although support from the council should be available, you may need to arrange:
• background checks or references • tax • National Insurance • pension contributions Read more about employing someone to work in your home on GOV.UK. Disability Rights UK also have more information on getting a personal assistant. If you don’t want to become an employer You could choose to hire care workers through an agency instead. This removes the legal obligations of being an employer, but could: • cost you more money • remove some of the benefits - such as having the same person provide your care
How to research a care agency When choosing an agency, decide what sort of service you’re looking for and the tasks you need help with. It’s a good idea to contact more than one agency, as they may offer different types of services. You can find out about local home care agencies by: • speaking to your local council’s social services department • contacting the UK Homecare Association
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Editorial content supplied by: the NHS
There are also organisations that inspect care agencies to see how well they are doing. The Care Quality Commission (CQC) regulates all health and adult social care in England. You might see a CQC inspection rating when you search online for care home agencies. Their 4 ratings are: • Outstanding • Good • Requires improvement • Inadequate You could also search for care home agencies on the CQC website to see their full reports.
Telephone helplines
It’s worth speaking to your council’s social services before making an official complaint to see if they can help. You still have to the right to complain if you: • have been told you’re not eligible to receive money towards your care and support • don’t agree with the amount of money in your personal budget You could either: • speak to your social worker about being re-assessed • call your local council social services and request a complaints form Your council should also have a formal complaints procedure on its website.
If you would like support to help you manage your personal budget or direct payments, speak to your council or call:
If you’re not happy with the council’s response
• the Disability Rights UK personal budgets helpline on 0330 995 0404
• Age UK have a detailed fact sheet on personal budgets and direct payments in social care
• the Age UK advice line on 0800 055 6112 (for older people)
• The Money Advice Service has a guide to direct payments
NHS-funded nursing care NHS-funded nursing care is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.
If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided by registered nurses employed by the care home.
How to complain about personal budgets
Contact your Local Government Ombudsman. They investigate all adult social care complaints.
by registered nurses employed by the care home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care.
Who is eligible for NHS-funded nursing care?
If you’re not eligible for NHS-funded nursing care and you don’t agree with the decision about your eligibility, ask your ICB to review the decision.
You may be eligible for NHS-funded nursing care if:
The cost of NHS-funded nursing care
• you’re not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse
NHS-funded nursing care is paid at the same rate across England. In May 2022, the rate was set at £209.19 a week (standard rate) and will be backdated to 1 April 2022.
• you live in a nursing home
How will my needs be assessed? You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care. Most people don’t need a separate assessment for NHS-funded nursing care. However, if you do need an assessment or you haven’t already had one, your integrated care board (ICB) can arrange an assessment for you.
If you moved into a care home before 1 October 2007, and you were on the previous high band, NHS-funded nursing care is paid at a higher rate. In May 2022, the higher rate was set at £287.78 a week and will be backdated to 1 April 2022. You’re entitled to continue on this rate unless: • you no longer have nursing needs • you no longer live in a care home that provides nursing
Outcome of the assessment
• your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £209.19 a week, or
If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided
• you become entitled to NHS continuing healthcare instead
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Editorial content supplied by: Age UK Norfolk
Free services available for over 50s Age UK Norfolk is a local charity with over 75 years’ experience of delivering crucial services for older people in Norfolk.
Our dedicated team can assist you with a number of services including:
Information and Advice Our Information and Advice Help Line is open Monday-Friday 10am to 4pm and our trained advisors can offer guidance on a variety of issues including care assessments, cost of living, lasting power of attorney and local services in your area.
Welfare Benefits We offer people aged 65+ companionship by phone with a friendly chatty call from a dedicated befriender.
We provide free benefit checks to determine any entitlement to welfare benefits and further practical assistance with applying for benefits.
Advocacy We support and enable people over 50 to have their voice heard; we can help you with making phone calls and writing letters to help ensure you do not experience any inequality or discrimination.
Money Matters We offer one to one support from a dedicated volunteer to assist and empower over 65s to remain independent when handling the day-to-day management of household finances and paperwork.
Befriending We offer people aged 65+ companionship by phone with a friendly chatty call from a dedicated befriender.
Let’s Get Digital Our Digital Inclusion Champions can assist anyone aged 50+ in learning how to use your digital device, for example, setting up WhatsApp and answering video calls from family and friends to more advanced support like online shopping.
Travel Companions We match lonely and isolated older people with a trained Travelling Companion who can accompany you on journeys you need to make in order to help build your confidence so that you can regain your independence and make journeys alone. For more information or to access any of our services, please call our team on 0300 500 1217, email advice@ageuknorfolk.org.uk MondayFriday 10am to 4pm, or visit our website www.ageuknorfolk.org.uk
United Against Dementia Alzheimer’s Society wants everyone affected by dementia to know that whoever you are, whatever you are going through, you can turn to them for support, help and advice. Dementia Connect Dementia Connect, from Alzheimer’s Society, is a personalised support service for anyone with dementia, their carers, families and friends. We understand that dementia affects everyone differently. So whether you, a loved one, a friend or neighbour needs dementia support, we’re here for you. We’ll connect you to a whole range of dementia support, by phone, online and face to face. Our highlytrained dementia advisers can help people come to terms with their diagnosis and navigate the complicated maze of health and social care services. It’s free, easy to access, and offers you the support you need. Whether it’s advice on legal documents, help understanding dementia or someone to talk to when things get tough, we’re here to help. We can keep in touch with you to make sure you keep getting the support you need. And because we know it’s never easy to tell your story, you’ll only ever need to tell it to us once.
Phone support Our dementia advisers are available to talk to on the phone seven days a week. They will listen and give you the support and advice you need, including connecting you to help in your local area and online. We can offer you the option of regular calls so we can keep in touch, to find out how you are and help when things change.
Support line opening hours* Monday – Wednesday: 9:00am – 8:00pm Thursday – Friday: 9:00am – 5.00pm Saturday – Sunday: 10:00am – 4:00pm
*Calls charged at standard local rate.
Online support Dementia Connect online support is available round the clock through our website. Answer a few simple questions about yourself, or someone you know, to get personalised, relevant information and advice. From guides on dementia to advice on making your home dementia friendly, get the information about the things that matter to you.
‘The Dementia Adviser was lovely and full of information. Without Alzheimer’s Society and the Dementia Adviser we’d have nothing. She is a major networker and knows everything and everyone local. I feel in charge and empowered.’ Katherine, living with dementia
If you need further support, you can request a call from our dementia advisers, who should be in touch with you within a week. Our online support includes Talking Point, our online community where you can connect with others in a similar situation, and our Dementia Directory where you can search for local services.
Face to face support Where possible, our local dementia support workers can meet you in person to offer further support, advice and information. They will also connect you to other face to face services in your area, including local support groups. Notes: Dementia Connect phone and online support is available wherever you live. As the service is new, some parts of the service may not be available in your area just yet.
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