What is Funded Nursing Care (FNC)?
It’s a weekly payment made by the NHS to contribute towards nursing care delivered by a Registered Nurse.
FNC is only provided in a care home with nursing, for those that are eligible.
How much will the patient receive?
£165.56 per week. This figure is set annually by the Department of Health.
How is it paid?
FNC is paid directly to care homes as a contribution towards identified nursing care provided to patients.
If your patients are paying for their own care and fees are calculated to include all nursing care, fees should be reduced by the weekly FNC payment.
Payments schedules are sent out on a monthly basis with details of your eligible patients. You are required to validate and return the schedule by the end of the payment schedule month, in order for the next planned payment to be made.
Can I submit a retrospective application?
Any new FNC applications for periods in a previous financial year following the year-end financial close down will not be considered.
During the earlier part of the 2017/18 financial year the CCG’s will only consider retrospective applications for clients for up to a maximum of three months, to allow some flexibility for nursing homes while the Continuing Healthcare and Funded Nursing Care team and processes are being established.
From 1st September 2017 onwards the application is expected within 28 days of an admission to a nursing home and no retrospective applications will be considered. This is due to the responsibility of nursing homes to ensure a timely application is received for consideration of FNC eligibility. There is no requirement within the National Framework for retrospective applications for FNC to be considered by CCGs.
What is the application process?
Once the new FNC service is implemented, you will be required to complete a Funded Nursing Care admission form and consent on behalf of your resident. If a checklist has been undertaken previously, this should be included with the application. This should be emailed to the FNC team within 28 days of the resident’s admission, in order for the relevant assessments to be undertaken.
The NHS Continuing Healthcare (CHC) and Funded Nursing Care (FNC) team will arrange for your resident to be seen by a Nurse Assessor and a CHC checklist will be completed. If a full Decision Support Tool (DST) is required to assess eligibility for CHC, then this will be completed. Eligibility for FNC will then be confirmed. Please be aware that FNC will not be paid until patient has been assessed.
In the meantime, you should continue to submit Nursing Needs Assessment, until advised otherwise.
Who is eligible?
A resident must have identified nursing needs to receive Funded Nursing Care.
If they are funded by the Local Authority they must have been assessed by Adult Social Care to have a nursing care requirement, prior to a request for FNC.
If a person is Self-funding and is found not to have identified Registered Nursing needs at assessment, Funded Nursing Care will cease.
If a resident is self-funding and in a Care Home (with Nursing) but could be supported in Residential Care, they would not be eligible for FNC funding.
Individuals who are in receipt of NHS Continuing Healthcare are NOT eligible for Funded Nursing Care.
Listed below is the information that the NHS FNC Nurse Assessors would expect to see when we come to review Residents.
- Biography, giving background history for the resident, family, friends and if they are regular/ frequent visitors.
- Is there a Registered Lasting Power of attorney for Finance or Welfare (a copy should be in the Care plan file).
- How is this placement funded? If Local Authority which area, Self-funding etc.
- Medical Diagnosis/Past Medical History
- Pre admission assessment & Initial assessment by Care Home
- Current & relevant care plans, showing how an identified need is being met and/or managed.
- If there are wound care plans which are held in a separate folder this needs to be cross referenced in the main care plans with a record of progress.
- Evidence that the care plans are being reviewed monthly and updated/rewritten in a timely manner particularly if there are changes to the identified need.
- Archived care plans should be available if requested; this includes Food & fluid charts, MARS sheets, contact sheets, and any other documentation relevant to the care of the Resident.
- Risk assessments, continence / Nutritional/ Bartel / Waterlow / Braden / Moving & Handling / Cot sides / PEEP's etc should be in clients Care plan folder and should be dated signed and current.
- Daily Records and Nurse records if held separately should be printed off and be in the folder for the assessment (1 month minimum)
- Multidisciplinary & GP visits should be clearly recorded.
- We also need to see and Advanced Care plans and End of Life Care plans.
What are we looking at when we review care plans?
- If assistance is required with Personal Care, how many carers and how much time care takes, if there is resident is non-compliant, or interventions are difficult this would be evidenced in a care plan, and in the daily records evidence of frequency of non-compliance.
- Behavioural issues, explain what these are, how they present, frequency, are there any identified triggers? How are behaviours managed and is the management effective? Has Mental Health team been involved, should this be considered? Have Behavioural charts been kept to establish patterns and as evidence.
- Where a need for 1:1 has been identified, this would be subject to a review 4 weekly and we would expect to see evidence that the 1:1 is with the individual for the hours funded and what they are doing when with the individual.
- If there is cognitive impairment, does the care plan reflect what the individual is able to do, as well as what they cannot, for example making simple choices, responding appropriately, awareness of basic risks such as whether a cup of tea is hot. How is the individual's consent sought for interventions? Has the long term memory as well as Short term memory been assessed?
- Is there evidence of distress, anxiety, depression, fluctuating mood or hallucinations, if so type and frequency, triggers. History of alcohol/drug related issues. If so how are these managed and have they been reviewed by the relevant healthcare professionals?
- Are there Nutritional concerns, these could be weight loss, swallow issues, episodes of choking, feeding problems, has the individual been seen by a Dietician/ Speech & Language if not should this be considered. Are food & fluid charts being completed, are there positional issues around feeding? Does it take longer than half an hour to assist with meals, does the individual require thickened fluids, what Stage. How frequently and how long is it taking to give drinks? Do they require specific equipment such as modified cutlery/plate-guard; do they use a lidded beaker or a straw? There should be a current M.U.S.T score and weight. Are they on a special diet or supplements (this includes any in house milkshakes, fortified diets)
- Wound care plans should be available, there should be wound mapping and wound progress charts to show status of wound(s). Who is involved with the care planning, the community matron or Tissue Viability etc.
- Moving & Handling assessments, which should be personalised to the individual's needs, this could be regarding the individual fears/concerns around moving & handling, if there is an identified Falls risk, is there evidence of falls, are there management strategies in place which prevent falls? The falls risk assessment may indicate a high falls risk but if the individual is not attempting to either get out of bed or stand unaided is there a risk?
- Any issues around elimination, constipation, what is the management plan. If there is a urinary catheter is there a care plan for this.
- Breathing issues identified, management strategies, inhalers etc.
- Medications are they in tablet, liquid form are there compliance issues how are these managed, would the MARS sheets support this? Are there symptoms causing concern or requiring monitoring who has been involved to resolve these? How is the monitoring recorded/achieved? If they are diabetic is this stable what are the Blood sugars. Are there any issues around management of pain?
- Urinary tract infections and Chest infections need to be clearly recorded particularly if the terms frequent or recurrent are used as they would need to be evidenced.
- Epilepsy/TIA, frequency, management plans, any other neurological conditions such as Parkinson's, Motor neurone Disease etc care planned.