With an ageing population and the increase in care cost, future care is a real concern for thousands of people. Recently, the healthcare analysts LaingBuisson confirmed the cost of care in the UK had risen by almost 10 per cent in the past year to £41,600 per annum for a residential care placement and £56,056 for a nursing home placement. The increase in the cost of care means many people in care will run out of funds, resulting in family members being asked to pay a top-up payment for loved ones ongoing care costs.
However, what many are unaware of is the availability of full financial support. The NHS must pay the full cost of care fees for those who have significant ongoing healthcare needs. If a patient's needs primarily fall under health, rather than social care, they are entitled to a free package of care paid for by the NHS called NHS Continuing Healthcare (CHC). Funding is not related to an individual's wealth.
CHC is a vital source of funding for many individuals receiving long-term care as the NHS will pay the full cost of care, even if it is provided in a private nursing home. However, a lack of awareness of the funding scheme coupled with guidelines which are often forgotten or applied too restrictively, means more people could be eligible. Despite an ageing population, NHS England figures show the number of people eligible for funding has dropped by 18% in the last 5 years.
It is very important to check that an individual has been properly assessed for NHS CHC by way of a multi-disciplinary team assessment. Every person needing long term care because they are ill should be assessed by their Integrated Care Board (ICBs) in England or Health Board in Wales.
If a person is not the responsibility of the NHS, they are the responsibility of the local authority. However, unlike the NHS, the local authority is able to assess the individuals' ability to pay. Currently in England, if a person has capital over £23,250 (£50,000 in Wales), they will have to meet the full cost of care.
The full NHS funding is not based on a diagnosis of an illness, or the fact an individual is being well cared for. It is based on the type and amount of care someone requires to meet their needs. Retrospective claims for unassessed periods of care can also be made back to April 2012 if a person has been in care for some time or has since died with over £400m being paid out by the NHS in redress for past periods of care.
Unfortunately, it is often the case that individuals are wrongly assessed. 30% of those who should be eligible for fully funded nursing care are turned away. The process of assessment is also very subjective which is leading to a postcode lottery across England when it comes to individuals receiving CHC, as illustrated by the quarterly statistics published by NHS England. For example, the number of people receiving NHS CHC in NHS Bury is 230 per 50,000 population as opposed to 19 in NHS Berkshire West. The Department of Health statistics also show that 28% are eligible following an assessment for CHC in the North West and 23% in the North East and Yorkshire, compared to 17% in the South East and 18% in the South West.
If families are unhappy with a decision, it can be challenged through the NHS appeals process, which is a two-stage process, culminating in an Independent Review Panel. Although challenging wrong assessments can be a time-consuming process, statistics from the Department of Health highlight that 22% of challenges are successful at Integrated Care Board (ICB) level, and a further 30% on a national level.
The future of long-term care is in crisis, yet the Government continues to disappoint on this front. The social care cap – designed to place an £86,000 cap on the cost of a person's social care fees, beyond which the Government would subsidise the funding – was delayed by the Government, dealing yet another blow to the crisis of funding the care needs of an ageing population.
It is therefore more important than ever that the very thin line between healthcare and social care is understood and assessed correctly, as the impact for the individual is the difference between free care and care which is means tested. It is extremely important for individuals to be aware of their legal rights regarding NHS CHC, which can remove a hefty financial burden of healthcare costs.
Lisa Morgan is a Partner and Head of the Nursing Care Fee Recovery Team at Hugh James Solicitors