Funding Continuing Care

It was interesting to hear Stephen Dorrell, the chairman of the House of Commons Health Committee raise the issue of ‘continuing care’ on Radio 4 this morning which were picked up on the BBC website.

Continuing Care is health-funded care which can be provided in a hospital setting, nursing home setting or in the community but it tends to involve jumping through many hoops and having very high dependency needs in order to ‘qualify’ for the ‘free’ care. It is a thorny subject as a lot of money can be at stake.

Basically, he explains that we, as a nation, have been failing a group of people whose care has shifted from ‘health care’ and NHS funding which is free at the point of delivery to all, to social care which is means-tested. The barrier to accessing ‘continuing care’ funding is set very high. Higher than it might have been in the past and it is this moving of the barrier that he is referring to.

This is a development which has not been fast in coming. In a way, it is surprising it has slipped under the notice of the general public who do not have wider understanding of the details unless they are personally involved.

It is easy to see this as an injustice, especially as care costs, which are means tested can be exorbitant and lead to the ‘selling of the family home’ type protests and distress that make for an anxious government.

The systems to make a claim for continuing care are very complex and wrought in obfuscation.

However, the comparison that Dorrell makes to the ‘old geriatic hospitals’ where care used to be delivered free is a little disingenuous. I don’t think anyone would want to see a return to those types of systems, indeed, it is impossible because currently even acute wards are closing, let alone long-stay wards.

The political motivation has, for decades been – quite rightly, in my opinion – moving towards a ‘care at home’ agenda. Partially because it would be in someone’s best interests and partially because it is cheaper.

The difficulty is that the funding that was free in hospital did not follow this client group home. At home they became subject to the vagaries of the so-called ‘postcode lottery’ funding systems.

It is an issue that absolutely needs to be resolved with much more clarity.

The difficulty is that with budgets being so preciously protected at the moment, it can only lead to an increase or tightening in the qualifying criteria in the future. That is why legislative clarification would be so welcome.

It will cost though – and it will cost a lot. If the money isn’t to come from means-testing, it will have to be taken elsewhere. Personally, I would be happy to pay higher taxes to live in a society that is able to care for people with dignity but I might not be in the majority there – anyway, with impending rounds of job cuts, it may be that there are fewer tax payers as a whole to contribute!

Part of the complication of the ‘continuing care’ criteria are the differences between the way the health budgets and social care budgets are sourced and granted. Local authorities face a freeze or reduction in their incomes. They would be delighted to move care costs to the NHS if they could because regardless of means-testing, they still accrue costs by delivering services. The NHS through central funding is being squeezed in so many directions that picking up more care costs could potentially be crippling.

That doesn’t mean it won’t or shouldn’t happen – it is just that more routes for money coming in will have to be established first. Whether this issue is included in the comprehensive care funding review is to be seen,  but it really does need to be.

It’s very easy for politicians to say that this shouldn’t be happening. A solution which involves a method of actually paying for the funding needs to be tightly connected and it’s a question of deciding who pays and if/how that can ever be equitable.

4 thoughts on “Funding Continuing Care

  1. I’ve always seen the various criteria, protocols and assessments for Continuing Care as being designed to construct a byzantine maze through which professionals struggle to find their way, let alone patients or families.

    Is it not disingenuous for politicians to be bemoaning the difficulty in accessing free health care? if he is chair of the Public Health Committee then presumably he has some idea of why those with complex health needs aren’t accessing it?

  2. Have you had any experience working with the relationship between Sec 117 aftercare and NHS Continuing Health Care. Where I am currently the PCT says if you are subject to Sec 117 then you are excluded from CHC despite need etc. As you can imagine many high cost placements for people with very high needs are met by Sec 117. Whilst both are ‘free’ to service users the LA budget is somewhat streched. Any thoughts? Hope all is well..

  3. TT – come to think of it, I’ve personally not come across any situations where someone needing or potentially needing CHC has been on s117. It can’t be that uncommon though.. especially as (quite rightly) rules and guidance have changed regarding discharging people from s117.

    I would think though that the PCT is playing a bit hard and loose with the law.. although I’m no legal expert, it seems certainly to be counter to the spirit of the law to provide adequate and appropriate aftercare.
    I presume that the costs of either continuing care and/or s117 funding come out of different ‘pots’. It cannot be morally right that someone is denied CHC despite need because they are subject to s117 which is supposed to be about benefiting them and ensuring they get the most appropriate aftercare.
    I imagine a lawyer might have a little fun with your PCT..
    I’ll actually ask around in the office next week (on a theoretical basis!) and ask if anyone knows what might happen in our area…

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