NHS England has launched The National Advice Line for NHS Continuing Healthcare, we explore the potential conflict of interest that arises from this arrangement
NHS continuing healthcare funding is a complex area which can be a minefield for individuals to have to attempt to navigate on behalf of their relatives. Continuing healthcare funding is available where it can be established that an individual’s need for care is primarily a health need. In such circumstances they are entitled to have the full cost of their care met by the NHS.
Issues can arise in every stage of the process, from attempting to instigate the assessments, to ensuring that the correct scores are awarded based on the individuals needs and the evidence, through to appealing the outcome of an incorrect negative decision.
Issues with the NHS Continuing Healthcare funding process
It would appear that NHS England have correctly acknowledged that there are a number of issues with the process and that there is significant potential for confusion and lack of understanding with what can be an extremely complex process from start to finish. In apparent response to this situation and to counter it they have recently rolled out a National Advice line for all NHS continuing healthcare related queries. The issue this presents is that there is a clear risk of there being a conflict of interest between the advice line and the NHS. The advice line is funded by NHS England and advises individuals in respect of NHS continuing healthcare funding, but it is the NHS who are responsible for meeting the costs of an individual’s care if continuing healthcare funding is awarded. The obvious question would be would the NHS advice line advise an individual to pursue an action against the NHS if appropriate or would this risk biting the hand that feeds it?
This is not a system that is in place in any other aspect of the NHS, for example there is not a national NHS helpline for those who wish to query whether they have an claim for medical negligence against an NHS trust or practitioner, in such circumstances the individual would be expected to seek independent advice from a suitable expert specialising in clinical negligence. And yet in this situation regarding continuing healthcare funding an NHS funded advice line has been created.
Who pays for care?
It should be highlighted that the cost of nursing home care across England and Wales often now exceeds £1000 a week. With annual costs in excess of £50,000 and the average time an individual spends in a nursing home being widely quoted as being around 3 to 4 years, it is obvious that the stakes as to who should have to pay for care are exceptionally high.
The NHS guidance and stance has always been that individuals are free to pursue an application for NHS continuing healthcare without assistance, and a solicitor or equivalent expert is not required. It is difficult however to envisage any situation where the potential liability of tens of thousands of pounds a year is at stake where the advice and assistance of an expert would not be sought. This original NHS stance that expert assistance is not required appears to be wholly at odds with the implementation of an NHS funded National Advice line for continuing healthcare funding. If no assistance is required, why is it necessary for an advice line to be created by the NHS at Public expense?
It is completely correct that an individual can tackle the NHS continuing healthcare funding process without assistance from an expert. It is also correct that an individual could deal with the conveyancing transaction on a house sale without the assistance of a legal expert, or indeed could pursue a high court litigation claim without a barrister or solicitor. The risks of doing so however are clear and obvious.
Risk of a conflict of interest with the National Advice line for NHS Continuing Healthcare
Given that where disputes arise in these situations it is between the individual seeking funding for the cost of their care and the NHS for (potentially) incorrectly denying it, NHS funding of an advice line would appear to present a conflict of interest. The concern is how those providing the advice can be considered to be truly independent and impartial, where they are funded by the NHS. The situation of a conflict of interest describes the risk of a scenario where one party is invested in some way or another and is therefore unable to provide an unbiased opinion.
It is unclear why NHS England has considered it necessary to provide an advice line in relation to NHS continuing healthcare funding and indeed what the cost to the NHS, and therefore the public, has been in doing so. At a time of increased NHS spending it could be considered an unjustified expense and unnecessary. The argument is of course that if the National Framework for continuing healthcare funding were fairly and universally applied in the first instance there would be less disputes raised by patients, and no need for an NHS funded advice line on how to dispute NHS decisions.
Where should I seek advice for continuing healthcare funding issues?
There are a number of specialist experts, both solicitors and ex nursing and local authority practitioners across England and Wales, who offer expert advice to individuals with continuing healthcare funding issues and concerns with a high degree of success. The key point would be that they are independent of the NHS and are thereby able to offer advice without any risk of bias to the NHS or a conflict of interest.
Compass CHC specialise exclusively in the area of continuing healthcare funding and act on a national basis across England and Wales. We have provided, and continue to provide, a free advice line that pre-dated that of the NHS, where an expert in the area of NHS continuing healthcare will explain the full process in as much detail as the individual requires. A detailed analysis of individual situation will be provided and advice offered as to what, if any, action should be taken.
This initial consultation is completely free, confidential and is offered with no obligation. Additionally unlike the advice line provided by the NHS this advice is not limited to a maximum of 90 minutes, but rather the individual has as much time as is required to address their concerns and have their queries answered. Crucially we are completely independent of the NHS.
Should you wish to discuss any aspect of NHS Continuing Healthcare Funding please contact an expert member of our team today on 0121 227 8940 or complete our free assessment here and a member of our team will contact you.
Author: Tim Davies LLB