Free at the Point of Delivery?
Tuesday, 23rd September 2014
In the last couple of features we have looked at how you can access support for 'social' care needs and how a means test is applied before the Local Authority will fund your care.
This month we look at how you can access support from the NHS via 'Continuing Health Care' funding. This is a form of funding that can support care provided in your own home or in a care/nursing home setting.
One of the founding principles of the NHS is that medical care should be provided at the point of need without the question being raised as to whether or not you can pay.
This expectation can cause confusion when it comes to long term care. As we saw last month, if you have needs that are classed as 'social', care is provided by the Local Authority but is subject to a means test.
However if your needs arise from a 'Primary Health Need' then support (including 'bed and board') is provided by the NHS and your personal income/wealth is not considered.
In the case of conditions which get progressively worse you might start with 'social' needs but as your illness progresses the support required may be seen as resulting from 'primary health needs'.
Any sensible person might think that a need that arises form a diagnosed illness such as Alzheimer's or Parkinson's is automatically a 'health' need. Sadly that is not the case. To qualify for NHS care funding you need to go through an assessment process to determine whether your particular needs qualify for NHS funding.
The process is summarised below with some tips that may help you if you request an assessment.
The process usually starts with a brief paper-based assessment completed by a health or social worker. It looks at your needs to determine whether they appear serious enough to warrant a more complete assessment. This is designed to 'filter out' applications that are unlikely to succeed.
If the short process identifies serious needs then a full assessment will be completed using a 'Decision Support Tool'. This is a weighty document that considers 12 different domains (types) of care need and rates them according to their seriousness. The assessment is performed by a Multi-Disciplinary Team made up of professionals involved in your care. The process should also actively involve you and any friends or relatives involved in caring for you that you want to be included.
Once the assessment is complete a recommendation is made to the local Clinical Commissioning Group (CCG) either to provide or refuse funding. The Clinical Commissioning Group is the body within the NHS who hold and manage budgets for the area.
The CCG don't have to accept the recommendation, but whatever their decision they should write to you to let you know the outcome and provide reasons for their decision. If they refuse funding they will usually direct you towards the Local Authority for a 'social' care needs assessment.
If you are not awarded funding you can appeal against the decision. Initially the CCG will explain how they reached their decision, but if you are still unhappy you can ask for an independent review. The CCG may not inform you of this right so make sure you raise it yourself if you are unhappy. You may also find that the CCG impose deadlines for you to provide information but you should call them and get these changed if you need more time.
If funding is awarded it is not forever - even if you have a degenerative condition. We have heard of cases where funding has been removed because a person's health has stabilised. This can be a bit of a perverse decision if the only reason the person's situation has improved is because of the care they are receiving. It's a bit like taking a pacemaker away from a patient because their heartbeat is no longer irregular.
Ashfords has the following top tips if you do apply for Continuing Health Care funding:
a) If you have a medical condition that has given rise to care needs, ask for an assessment to be performed. They don't cost anything, and in the case of degenerative illnesses they will let you understand how close you are to NHS funding.
b) If you are discharged from hospital but have on-going care needs an assessment should be performed automatically. Make sure you get a copy of that document and address any inaccuracies or missing information.
c) If you decide to request an assessment you can seek it via your GP, Somerset Adult Social Care (firstname.lastname@example.org) or Somerset Clinical Commissioning Group (Wynford House, Lufton Way, Lufton, Yeovil, Somerset, BA22 8HR). Why not try all three!
d) When you request an assessment make it in writing and keep a copy of the request. If funding is awarded you should ask for it to be backdated at least to the date of that request.
e) If you have an urgent need for support, make sure you ask for the 'Fast Track Tool' to be used. This should result in a decision being made in days or weeks rather than months.
f) Ask for copies of all documents prepared as part of the assessment. Make sure that you correct any errors or omissions.
g) Be persistent in making your request and do not be shy about asking to be involved, or for explanations of terms used and/or conclusions reached.
If you feel overwhelmed by the process, or if you feel you are not being treated fairly (rare, but it does happen), seek advice.