The founding principle of the NHS is that health care should be free at the point of need.
When we visit a GP or Hospital we would not expect to undergo a financial assessment procedure to establish whether we should pay for our treatment. Unfortunately the situation is not so simple when it involves an older person who also has social care needs, especially if they need 24 hour care within a care home setting.
Whilst NHS healthcare is provided free of charge, social care provided by a Local Authority is subject to a means test. When an individual has both health and social care needs this creates a dilemma as to which body should meet the cost of their care.
The answer is a common sense one. If the individual needs care primarily to address issues relating to poor health then the NHS should arrange and fund this care, including their accommodation costs if poor health requires residential care. This type of funding is called NHS Continuing Healthcare funding.
If the person needs care primarily to assist with their activities of daily living (eating, dressing, safety etc.) then this would be deemed social care, which the Local Authority will arrange and charge for based upon a means test.
Who is eligible to receive NHS Continuing Healthcare funding?
The method of deciding whether a person has a primary health need is set out in ‘The National Framework for NHS Continuing Healthcare’. It involves a screening tool, called a Checklist, and an assessment tool called a Decision Support Tool. If the person is in the final stages of a rapidly declining condition, then the Fast Track Pathway Tool would need to be completed.
The National Framework sets out clear guidance as to how assessments should be conducted, the process which should be followed and the rationale which should be used when making decisions about eligibility for funding. Unfortunately decisions regarding eligibility can be unreliable, leading to huge financial detriment to the individual involved.
How can SAS Daniels help with NHS Continuing Healthcare funding?
Our team are experienced in providing support and advocacy to ensure that an assessment is fair and follows the correct procedure. We have also recovered substantial sums of money for people who have historically paid privately for care which should have been funded by the NHS.
As well as helping you through the assessment process, our specialist team can help you challenge decisions if you have been refused NHS Continuing Healthcare funding and think that you or your relative should be entitled to it.
If you would like further advice in relation to a loved one who is going through the assessment process, or would like to challenge a decision and look into recovering historic care home fees paid by someone who should have received NHS funding, please contact our team.