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GUIDING PRINCIPLES

The following common, guiding principles should govern any placements across the borders:

DEFINITIONS

'Assessment' - means the assessment carried out by a nurse, employed by the NHS, to establish whether and to what extent an individual requires care by a registered nurse, and as set out in article 1(3)(a) of the National Health Service (Nursing Care in Residential Accommodation) (England) Directions 2001 and article 1(4) of the National Health Service (Nursing Care in Residential Accommodation) (Wales) Directions 2004.

'Self-funder' - means patients, or their representatives, who pay all of the cost of their care from their own resources.

'PCT' - Primary Care Trust  (England only)

'LHB' - Local Health Board  (Wales only)

'LA' - Local Authority

SELF-FUNDERS

ALREADY RESIDENT IN A CARE HOME PROVIDING NURSING CARE AT 1 APRIL 2004

Previously lived in Wales and now in English care home

The English PCT responsible for the care home will carry out the determination and, should the patient have nursing needs, fund the nursing care at the appropriate rate.

Previously lived in England and now in Welsh care home 

The Welsh LHB responsible for the nursing home will carry out the assessment and, should the patient have nursing needs, fund the nursing care at the single rate.

THOSE ENTERING A CARE HOME PROVIDING NURSING CARE AFTER 1 APRIL 2004

Previously lived in Wales and moving into English care home

The English Primary Care Trust (PCT) responsible for the care home should carry out the determination (if possible, normally prior to entry to the care home) and fund the nursing care at the appropriate rate.  If this is not possible, the LHB of origin will undertake an assessment to determine that NHS Funded Nursing Care is required, and inform the destination PCT. The English PCT will need to carry out a determination to identify the appropriate band of care within 28 days of admission.

Previously lived in England and moving into Welsh care home 

The Welsh LHB responsible for the care home should carry out the assessment (if possible normally prior to entry to the home) and fund the nursing care at the single rate.  If this is not possible, the PCT of origin will undertake an assessment to determine that NHS Funded Nursing Care is required, and inform the destination LHB.

LOCAL AUTHORITY FUNDED RESIDENTS

ALREADY RESIDENT IN CARE HOME PROVIDING NURSING CARE AT 1 APRIL 2004

Lives in English care home, funded by Welsh LA.

The English PCT responsible for the care home will carry out the determination and, should the patient have nursing needs, fund the nursing care at the appropriate rate and inform the Welsh LA. The Welsh LA will agree the funding for the accommodation and personal care costs of the placement with the care home concerned.

Lives in Welsh care home, funded by English LA.

The Welsh LHB responsible for the care home will carry out the assessment and, should the patient have nursing needs, fund the nursing care at the single rate, and inform the English LA. The English LA will agree the accommodation and personal care costs of the placement with the care home concerned.

THOSE ENTERING A CARE HOME PROVIDING NURSING CARE ON OR AFTER 1 APRIL 2004

Lives in England and plans to move into Welsh care home

The assessment should be carried out in England (in conjunction with the English LA) by the English PCT. The responsible LHB in Wales where the home is located will be notified confirming that the person requires care from a registered nurse.  The Welsh LHB will fund the NHS Funded Nursing Care at the single rate. The English LA will agree the accommodation and personal care costs of the placement with the care home concerned.

Lives in Wales and plans to move into English care home

The assessment should be carried out in Wales (in conjunction with the Welsh LA), by the Welsh LHB. The responsible English PCT where the care home is located will be notified, confirming that the person requires care from a registered nurse. The English PCT will need to arrange for a further assessment and determination to be undertaken within 28 days of admission, to identify the appropriate band of nursing care. The English PCT will fund the nursing care at the appropriate rate, and inform the Welsh LA, which will agree the accommodation and personal care costs of the placement with the care home concerned.

PAYMENT AND CONTRACTING ARRANGEMENTS

Ideally, payment arrangements should be simplified for providers.  Where there are regular arrangements between LAs and PCTs or LHBs across borders (e.g. in border areas), they may wish to develop partnership arrangements involving lead commissioning and/or pooled budgets, or single payment arrangements.  Possible mechanisms for doing this, including model contracts, are contained within the relevant guidance for England (HSC 2003/006: LAC(2003)7), and the final guidance for Wales (NAFWC 25/2004: WHC(2004)024). Alternatively, and in particular where there are 'one-off' placements between LAs and PCTs/LHBs, payment arrangements for NHS Funded Nursing Care self-funders may be extended to incorporate the cross-border placements. LAs, PCTs and LHBs as appropriate will need to ensure that the total payment is agreed between them and the care homes concerned.