The cost of care – who pays?

The NHS celebrated its 70th birthday in July 2018. Since its creation it has sought to make good healthcare accessible to us all, regardless of our financial means. A way in which care is extended to adults who are in need, even when they haven’t necessarily crossed the threshold of an NHS-run hospital or surgery, is through the provision of NHS continuing healthcare.

Either the NHS or social services, or both, may have a responsibility to look after someone who needs care. Care which is provided by the NHS is free, but that which is funded by social services is means tested. Under the current rules for social care funding the general position is that anyone who has capital in excess of £23,250 is responsible for meeting the full cost of their care. It is important to establish where the responsibility for care lies as the financial impact for the individual can be great: care comes at a substantial price and we are evermore aware of our ageing population which is living longer, but often not in the best of health.

If someone’s needs are severe and complex, they may be eligible to receive NHS continuing healthcare – NHS funding to meet the full cost of their care. A person’s needs must be considered by the local Clinical Commissioning Group to determine eligibility. A national framework is applied to support decision-making for eligibility. It is important that the criteria be applied fairly and the different factors at play can be puzzling at the best of times.

If it is clear that someone’s principal need is for care to meet their physical or mental health needs arising out of illness, disability or injury, they could be considered to have a primary healthcare need and eligible for NHS continuing care. This contrasts with a social care need, such as the need to be supported with accommodation or social interaction. A particular illness or disability does not automatically lead to eligibility.  Rather, it is someone’s needs and how they impact upon one another which must be considered, and these can be unique in each case.

To establish whether someone is eligible for NHS continuing care, a checklist will usually be completed. If this indicates that a primary healthcare need may exist, a full needs assessment will follow. The assessor will consider 12 health domains including, amongst others, behaviour, cognition, communication, mobility and nutrition, and the level of need which applies to each will be measured. If someone’s needs are intense, complex and unpredictable, it is more likely they will be found eligible.

This funding can provide great relief by shouldering the financial burden for care. If you or a relative would like advice in taking forward a claim for NHS continuing care, or appealing a decision on eligibility, please contact Louise Mathias-Williams who is an accredited member of Solicitors for the Elderly at Thomson Snell & Passmore, to discuss.