Future of NHS Continuing Care Funding

What is continuing healthcare funding (CHC)?

NHS continuing healthcare is a package of continuing care provided outside hospital, If you are eligible, you can receive NHS continuing healthcare in any setting, for example:

• In your own home: the NHS will pay for healthcare, such as services from a community nurse or specialist therapist and personal care, such as help with bathing, dressing and laundry
• In a care home: as well as healthcare and personal care, the NHS will pay for your care home fees, including board and accommodation
• NHS continuing healthcare is free, unlike social and community care services provided by local authorities, for which a charge may be made, depending on your income and savings.

 Paying for long term care

Political meltdown following the hacking furore, economies in crisis, the public purse short-changed, access to justice limited, the NHS in turmoil, anxieties over the nation’s care homes and an Adult Social Care system at extreme snapping point. These are difficult times

Let us consider specifically the NHS and long term care:

• If you are assessed as eligible for Continuing Health Care funding (CHC) because of ongoing healthcare needs, then you will receive a package of care arranged and funded by the NHS outside of a hospital setting.
• Eligibility is determined following an assessment by a multidisciplinary team, who complete a Decision Support Tool looking at twelve care domains, including cognition, mobility and continence.
• It follows that the higher you score and the more unpredictable, complex and intense the condition, the stronger the case for CHC funding.
• If in doubt, ask for an assessment, because at worst that assessment will represent a benchmark against which any further decline in health can be measured.
• At best, financially crippling care costs could be avoided, which may result in having to sell your family home, or an escalating charge being placed against it by your Local Authority

Eligibility for longterm care funding
Of course, ascertaining eligibility is difficult and you may not succeed first time. Despite a National Framework and uniform eligibility criteria, a degree of subjectivity employed by some Nurse Assessors renders the whole process open to challenge

More so, given that PCTs are cutting the funding for CHC. A situation perhaps triggered by the PCT review of existing CHC clients and the raising of the eligibility bar to incredibly high levels

But this does not remove the underlying obligation of the NHS to fund a long term healthcare need, of which ‘mere’ fact the Department for Health has to remind the NHS

So, if you find yourself in this situation, my advice is to challenge it! Indeed, a Freedom of Information survey of 49 PCTS (and PCT clusters) has shown a 9% increase in appeals from 2009/2010 to 2010/2011

Accordingly, successful challenges over the same period increased from 33% to 40%.

Moreover, you do not need to be alive to qualify for CHC. Your estate may qualify for a rebate for care home fees hitherto wrongly expended. See www.nhs.uk

Is there a future for CHC funding?

Given that budgetary constraints are the norm, is there a future for CHC funding?

It is somewhat confusing that the (ever-changing) Health and Social Bill is curiously silent on the point, although it was mentioned in the recent Dilnot report

The Bill (at the time of writing) advocates the abolition of PCTs in their entirety and the establishment of GP consortia. This does pose considerable concerns for CHC

Are GPs suitably aware of the financial risks inherent within CHC funding and crucially, will they accept it into their remit? If so, will the guidance on CHC funding remain thus rather being based on a clear set of rules, which is important for the equity of consideration and the provision of care and fairness.? And so it remains that the complexities in the existing funding philosophies greatly emphasises the need for reform in any event

The ineffective use of resources and perverse incentive proffered by way of, for example, bed blocking in acute wards (and an inherent failure to follow proper hospital discharge policies) leads to even greater disarray over what the state is supposed to offer. That aside, perhaps this is not quite the Dickensian nightmare I paint.

To radicalise the NHS would surely by a vote loser, but some there is some hope for CHC, if costs cuts can be made. Andrew Lansley (our Health Secretary) has proposed to extend personal health budgets (which are an amount of funding given to you in order to purchase the services and support to help facilitate independent living) to those receiving CHC funding at a cost saved of some £300 million per annum.

This is impressive, given that the cumulative budget for CHC is £2 billion. Whether those individuals are cognitively aware enough to be able to ‘spend’ those aforementioned Personal Health Budgets is another matter, but what it does again bring to the forefront of our conscious is what happens when we can no longer make our own decisions and this supports the case for good legal advice

Emma Mitcham is a Solicitor in the Community Care Department, specialising in all aspects of community care law, including adult social care, mental health, healthcare, care funding and challenges against the NHS and Local Authorities

Emma has been with the Firm since 2008 and qualified as a solicitor in 2010. She graduated in Law from theUniversity of Exeter in 2002 and pursued a career in Financial Services where she undertook the industry qualifications to a high level. During this time, she also studied Gender, Sexuality and Human Rights law at Keele University before going on to do the Legal Practice Course at BPP Holborn in London

 The Community Care Department at WBW Solicitors provides specialist legal advice for individuals with health, social and community care needs because of sickness, disability or age.

Please  contact  [email protected], or 01626202404 or www.wbw.co.uk