Yesterday’s announcement from Baroness Louise Casey that the public will be involved in deciding what adult social care should provide and who should pay for it marks another significant moment in the debate about the future of care in England.
It has long been reported that the current care system in England is not fit for purpose and too complex for those who need to rely on it and their families. Born in the wake of the government’s scrapping of a cap on social care costs, the two-phase commission into adult social care in England will instead undertake a review of funding.
As Chair of the Independent Commission on Adult Social Care, Baroness Casey has been tasked with recommending reforms that will lay the foundations for a National Care Service. A key part of that work is engaging with the public to understand what they believe the social care system should provide, who should receive support, and ultimately how it should be funded.
Whilst these discussions are undoubtedly important, they also raise an equally important question for families who are currently navigating the care system and, in particular, the NHS Continuing Healthcare assessment and/or appeals process.
Essentially, it is most important to remember that social care and NHS Continuing Healthcare are not the same. One of the greatest sources of confusion for families is the distinction between social care and NHS Continuing Healthcare (CHC). Social care is generally means-tested. Depending on a person’s assets and income, they may be required to contribute towards the cost of their care (whether in a care home or at home). CHC is fundamentally different. It is a complete package of care funded by the NHS for individuals whose needs are primarily health needs. Where someone is found eligible for CHC, the NHS is responsible for meeting the full cost of their assessed care package, regardless of their financial circumstances.
Although yesterday’s announcement focuses on social care funding, the Commission’s has been tasked to also consider the interface between the NHS and adult social care and how funding currently operates across that boundary. For many families, that boundary is where disputes arise. Questions about whether care needs are “health” needs or “social” needs determine whether responsibility falls to the NHS through CHC or to the local authority through the social care system. Those distinctions can have life-changing financial consequences.
Whether the Commission ultimately recommends changes to that boundary remains to be seen. At present, no changes have been proposed to the legal framework governing NHS Continuing Healthcare. It is therefore important to remember that nothing changes today. The National Framework for NHS Continuing Healthcare remains in force, and Integrated Care Boards must continue to assess eligibility in accordance with the existing legal test of whether an individual has a primary health need.
Families should not delay seeking an assessment, requesting a review, or pursuing an appeal because of the Commission’s work. Any future recommendations will take time to develop and would require Government consideration before resulting in legislative or policy change. The Commission’s first recommendations are expected later this year, with longer-term reforms due by 2028.
At Hugh James, we will continue to monitor developments arising from the Casey Commission and explain what they mean for individuals and families seeking NHS Continuing Healthcare funding.
