At present, patients receiving care (such as those in a care home) are required to meet the full cost of their care, unless the value of their estate (including their house) falls below £23,250 in England (£30,000 in Wales). The only exception to this is where an individual’s needs are deemed over-and-above typical social care (such as those with complex needs stemming from dementia). If an individual’s needs are primarily for health, rather than social care, it is the responsibility of the NHS to fully fund the care placement. This is known as NHS Continuing Healthcare (CHC).
Once a patient is found eligible for CHC, periodic reviews will be undertaken to ensure that the patient continues to meet the criteria (i.e. that their care needs have not decreased). The first review will usually take place three months after the initial decision, and annually thereafter. Providing that the patient’s needs have not changed, the funding should remain in place indefinitely.
Since November, we have received an influx of new enquiries seeking assistance as a patient’s CHC has been revoked without reason, despite their care needs remaining the same, or increasing. Alarmingly, this current trend coincides with reports that NHS England aims to make £855m in savings on CHC and NHS-funded nursing care by 2021.
Whilst NHS England claims that it plans to achieve the cuts by reducing administrative assessment costs, among other things, it is difficult to imagine NHS England achieving the savings with these reductions alone. According to a recent report, NHS commissioners spent just £149m on assessment costs in 2015–16. How, then, does the NHS intend to achieve £855m in reductions from these costs alone?
Sadly, the recent Parliamentary report acknowledges that the CHC system is failing patients and that budget cuts are likely to have a further knock-on effect on the provision of CHC funding:
“It is not clear how CCGs can make £855 million in efficiency savings by 2020−21 without restricting access to care, either by increasing eligibility thresholds or by limiting the care packages available.”
Our client, Ms Gill Jarvis, has experienced the impact of CHC cuts first-hand. Ms Jarvis’s mother, Mrs Jean Jarvis, who is currently 92 years old, has resided in a care home in Purley in Surrey for ten years, and Hugh James previously secured CHC to fully fund her care placement in 2011, and also recovered a retrospective reimbursement of fees in excess of £100,000. However, Ms Jarvis contacted us recently to inform us that the funding had been unjustifiably revoked in January 2018, following an unnecessary review assessment.
Alarmingly, Ms Jarvis’s mentally and physically disabled mother was not due for a review, as the last assessment had been completed 4 months prior. She was informed that the review was carried out as the criteria for CHC funding had “changed”.
In reality, Ms Jarvis’s mother was not due an assessment for at least another 8 months - the criteria had not changed. That is, of course, unless the responsible commissioning group had made arbitrary and unlawful changes to the way they assess patients.
Mrs Jarvis also informed us that the nurse assessors undertaking the assessment failed to meet her mother during the review. The decision was made purely on a brief discussion with the care staff, some of which had limited involvement with her mother’s care, and a flick through her care notes, which failed to detail the extent of her mother’s needs. Despite this, a decision was immediately made to remove funding, and Ms Jarvis was given four weeks’ notice to foot a £6000-per-month care bill.
“I didn’t know what the assessors were talking about - why did my mother need a review? I was flummoxed. My mother’s needs haven’t changed - she has severe cognitive impairment, is doubly incontinent, immobile, and displays challenging behaviour. She requires three carers for personal care due to aggression. She has to sit on her own as she will throw objects at other residents.
It was clear from the meeting that the assessors were keen to downgrade my mother’s needs. They didn’t even meet her at the assessment. They just spoke to a few carers and had a brief look at her notes, which were poorly kept. They completely disregarded any input from the family. How can you assess a patient without meeting them?
I feel that my mum has no rights at all. Nobody cares about her - she is just a statistic. If they can get the money back from her, that’s a tick in the box. The care home charges £6000 a month in fees and I’ve been left to foot that bill with four weeks’ notice. No explanation has been given as to why funding was removed.
If you don’t have a solicitor, I don’t think you’d have a chance to secure funding as the NHS just blocks you. I feel really frustrated with the system as it is totally unfair.”
The care home subsequently contacted Ms Jarvis to inform her that, as the NHS was no longer funding the care, they were increasing the fees to almost £8000 per month - a harrowing prospect for any family.
Undoubtedly, far more care and consideration should be given when making such impactful decisions. The new National Framework for CHC, due for implementation in October 2018, acknowledges that there is rarely any need to re-assess an individual’s eligibility for CHC at review appointments. Rather, the reviews should focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. Clearly, where someone is found to meet the criteria (and their condition does not improve), there is no need to re-review the decision regarding eligibility. These resources could be better utilised elsewhere.
The effect of NHS cuts is having a very real and traumatic effect on an increasing number of families. Despite the growing and ageing population, the percentage of people receiving CHC funding dropped from 34% in 2011-2012, to 29% in 2015-2016, according to a report. In addition to this, on average, CHC is now being awarded for progressively shorter periods of time.
Another of our clients, Mrs Carol Rumner, who is a retired nurse with 40-years’ experience, also had a particularly traumatic experience when her husband’s CHC funding was recently revoked without reason. Her husband, Geoffrey (74 years old) who receives full-time care in a care home due to extensive mental and physical disabilities, was fully funded by the NHS from 2009. Mrs Rumner was shocked to find that her husband’s CHC funding was removed last year, despite his condition worsening with age.
“I wasn’t even informed when the CHC was revoked. The NHS sent the outcome letter to my mentally impaired husband. It was only later that I became aware of the letter among my husband’s personal possessions.
I’m elderly myself and will be turning 80 shortly. This experience has been harrowing and has caused great anxiety and stress. It has also had an impact on my husband’s health, as he experienced a severe episode of hypermania two days after the assessment which lasted over eight weeks. I now have the added stress of having to attempt to foot the bill of my husband’s care. The system is so, so wrong.”
Sadly, this trend is likely to increase in line with the NHS’s money-saving ambitions, despite NHS England’s assurances that budget considerations have no impact on the assessment process.
For eligible patients, CHC is a beacon of hope in an otherwise bleak British social-care system. CHC can greatly improve the quality of life for patients and can help mitigate the stress experienced by patients’ families. Unfortunately, NHS England’s money-saving aspirations are putting the integrity of the CHC scheme at risk.
Although parliament has recently acknowledged the need for reform, it is currently unclear how, or when, these much-needed changes will manifest.
Lisa Morgan of Hugh James is also available for interview on 033 0058 5077 or email [email protected]. Case studies are also available.
 2.18: https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/455/45502.htm
 Conclusion – 5: https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/455/45502.htm
 2.19: https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/455/45502.htm