Who should pay?
When an elderly person is no longer able to be safely cared for in their own home oftentimes they will be placed into a residential or nursing home setting. The average cost of this has now risen to £30,000 per annum in the UK and upwards of £40,000 per annum if nursing care is required. With the average life expectancy in the UK increasing, the potential costs of long term care can be significant. Families are routinely wrongly advised that the placement of their relative will need to be funded by the relative themselves if they have the means to pay for their own care. In reality, if a person has intense, complex or unpredictable healthcare needs then they may well be eligible to receive NHS Continuing Healthcare funding, regardless of their assets or income and whether or not they own their own home.
NHS Continuing Healthcare funding is a package of care solely funded by the NHS. Funding should be made available to those people whose needs arise primarily for health as opposed to social care. There is no simple legal definition clearly explaining the difference between a ‘healthcare need’ and a ‘social care need’ and this has created ambiguity and somewhat of a postcode lottery.
Assessments for NHS Continuing Healthcare funding are carried out by Clinical Commissioning Group’s (CCG’s). There are 211 CCG’s nationwide. The CCG responsible for assessing a person’s eligibility for NHS Continuing Healthcare funding will be determined by the GP surgery that the person is registered with. In addition to considering a person’s current needs, CCG’s can also review retrospective eligibility to NHS Healthcare funding if a claimant has never been previously assessed; although retrospective eligibility can now only be backdated to 31st March 2012 and not before. Retrospective reviews can even be requested where the person has died.
There is a National Framework based upon best practice principals where a person’s needs are assessed over twelve different care domains. A copy of the assessment together with the decision and the reasons for arriving at that decision should be made available to the claimant who is the subject of the assessment and/or their legal representative. In the event that the decision is unfavourable then the claimant, or their representative, can appeal the outcome provided that they do so within a 6 month timeframe. Where the claimant is eligible, the NHS is responsible for providing for all of that individual’s assessed needs – including accommodation, if that is part of the overall need.
Once NHS Continuing Healthcare funding is in place it is considered best practice for eligibility to be reviewed at least annually. Funding can be withdrawn upon reassessment if the claimant’s healthcare needs are thought to have reduced or at least stabilised. Again, in this circumstance, the outcome can be appealed within a 6 month time frame. Historically, claimants have not always been advised of their right to appeal an unfavourable decision and the opportunity to do so has then been lost with the passage of time.
The NHS Continuing Healthcare funding process can be both complex and overwhelming. CCG’s appear to experience an unusually high turnover of staff and there is consequently a lack of continuity and experience. It is not uncommon for the wrong decision to be reached at the time an assessment is conducted and several appeals processes might be necessary to achieve the desired outcome. Significant delays at every stage of the process compound the existing difficulties. Claimants unfamiliar with the process might be deterred from continuing and ultimately the elderly person will be left funding their own care, the costs of which could be significant.
So, what can you do if you think a relative should be or should have been entitled to NHS Continuing Healthcare funding during their lifetime? It is advisable to contact a specialist Solicitor who will be able to advise you as to the merits of your case, identify the relevant CCG and guide you through the complicated process of assessment.
Norton Peskett is the only firm of Solicitors in East Anglian with a department dedicated to NHS Continuing Healthcare assessments. The department has been established for a number of years and is able to advise and assist claimants based upon a wealth of knowledge and experience. Should you wish to make an enquiry then please contact Jon Wharry on 01502 533000 or you can email him at firstname.lastname@example.org