Revisions to the Continuing NHS Healthcare (adults) Framework

The Welsh Government has published for consultation changes it proposes to make to the Continuing NHS Healthcare Framework (for adults) and its accompanying  Decision Support Tool.  The consultation document and drafts of the revised Framework and the Decision Support Tool can be accessed by clicking here.

The consultation document states that there ‘is no intention for policy changes made through this process to impact on the eligibility threshold for CHC, which is well-established and based on the consideration of a ‘primary health need’’.

The Welsh Government states that the proposed changes are designed to provide ‘greater clarity and presentational style’ – and that the proposals retain the core principles of the existing Framework which it states as being to:

put people first, involve and engage with them and their representatives throughout the process and ensure decisions affecting them are informed by evidence. There is a continued emphasis on care and support that is focused on need and that is co-ordinated and avoids any unnecessary upheaval to an individual’s way of life.


In relation to the Decision Support Tool, the consultation document states that the changes include an emphasis on the Tool not being used as a ‘scoring mechanism’.  It additionally states that the Tool is broadly unchanged, with a ‘few minor amendments’ (although on cursory inspection this is debatable – eg see the cognition change proposed) – the changes being:

  • Behaviour – add reference to self-harm as an example.
  • Mobility – revise notes. For example, replacing the reference to the 2001 National Service Framework for Older People with a more general emphasis on assessment.
  • Nutrition – revise wording and examples in the low, moderate, high and severe categories.
  • Psychological and Emotional Needs – clarify wording around the individual’s engagement in the care process.
  • Cognition – replace the previous highest level of identified need of ‘severe’ with ‘high’.
  • Drug Therapies or Medication – replace references to ‘non-concordance’ with ‘refusal or misuse of medication’.
  • Other Significant Care Needs – remove the levels of need in order to better reflect its purpose to capture areas for wider consideration.

The consultation closes on the 21 August 2019.


Photograph of ‘Lyn Padarn’ by Richard Jones -@lluniaurich



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