We are often asked about the difference between healthcare and social care and how it impacts on funding.
To receive NHS continuing healthcare funding – which covers the cost of an individual’s care in its entirety – the need for funding must be established primarily as a healthcare NOT a social care need.
However, we have heard from countless individuals, and witnessed first-hand, how NHS continuing healthcare assessors consistently try to downplay and down score obvious health needs and recategorize them as social care needs.
Clients inform us that they have spent many frustrating and upsetting hours in continuing healthcare assessment meetings disputing the difference between health and social care needs with assessors determined to withhold funding. Many clients ultimately receive the news that their relative doesn’t qualify for funding as their need for care isn’t health based despite clear evidence in the form of medical records and care charts to the contrary.
This desire to withhold funding shouldn’t come as a surprise as it allows the NHS to pass responsibility for funding the individuals care to the Local Authority where the person will be means tested and then, more often than not, told they must fund social care themselves. But, by its very essence, medical services provided by the NHS are free to residents in the UK so if there is a clear healthcare need, care should be provided for free.
What the National Framework for NHS Continuing Healthcare says:
2.1 Whilst there is not a legal definition of a healthcare need (in the context of NHS continuing healthcare), in general terms it can be said that such a need is one related to the treatment, control or prevention of a disease, illness, injury or disability, and the care or aftercare of a person with these needs (whether or not the tasks involved have to be carried out by a health professional).
2.2 In general terms (not a legal definition) it can be said that a social care need is one that is focused on providing assistance with activities of daily living, maintaining independence, social interaction, enabling the individual to play a fuller part in society, protecting them in vulnerable situations, helping them to manage complex relationships and (in some circumstances) accessing a care home or other supported accommodation.
Despite what appears to be clear guidance in the National Framework – the Framework establishes that where the primary need for care is a health need, the responsibility for providing funding lies with the NHS – there are several grey areas. These grey areas are the main source of conflict between patients and the NHS with many people having to argue with the NHS assessors regarding how their treatment should be defined.
How can Compass CHC help?
We specialise in helping to ensure healthcare funding is in place from day one meaning no fees are paid from the outset.
The Compass CHC team of continuing healthcare experts, comprising lawyers (non-practising) and clinicians (including nurses, tissue viability specialists and pharmacists), review and consider the evidence from a clinical perspective before drafting reasoned arguments which identify an individual’s entitlement to the funding by cross-referring the medical evidence to the National Framework for continuing healthcare criteria.
Compass CHC does not undertake work in any other area which means we have accumulated vast experience attending assessments and appeal hearings at local and NHS England level and we are not distracted by work of other nature.
Author: Tim Davies LLB