Adult Social Care Provisions
On 1 April 2015, the Care Act 2014 overhauled the social care system, changing almost every aspect of the provision of care and support to older people and adults with disabilities.
Although many of the new provisions were welcomed, Social Services still lacks resources to meet the increasing demand for social care. As a result, unfortunately, not all care provisions are fair. Further, care services are often charged for when in fact they should be provided free of charge.
If you feel you need to challenge decisions made by health care providers or Social Services on behalf of a loved one or a friend, it is advised that you consult an experienced professional who can investigate the circumstances properly and navigate the legal minefield effectively.
For an indication of the kind of assessment that social services will undertake, you can find more information on the Continuing Healthcare assessment here.
Qualifying for NHS Continuing Healthcare Funding
If you qualify for Continuing Healthcare (CHC) funding, your care fees should be paid in full by the NHS, regardless of your financial circumstances. You qualify if your needs are demonstrably:
- Complex, intense or unpredictable
- Not incidental or ancillary to the accommodation that social services is under a duty to provide
- Not of a nature typically provided for by social services
NHS Continuing Healthcare funding can cover nursing or care home fees, or the cost of your care at home.
Unfortunately, CHC funding decisions are often arbitrary. There remains something of a postcode lottery and sadly, many people do not receive NHS continuing healthcare funding, even when they are eligible.
What is involved when challenging NHS funding decisions?
Understanding the national minimum eligibility criteria for health and social care and support is vital. It helps to ensure eligible individuals receive all the services they are entitled to, and that they don’t pay for any of those services unnecessarily.
Every person’s circumstances are different and so there will be varied requirements for each situation. Areas in which we can support the challenging of a Continuing Healthcare Funding decision include:
- Challenging Local Authority assessments of an individual’s eligible needs
- Understanding when clients should qualify for Local Authority funding
- Accessing all potential sources of health and social care funding to conserve an individual’s assets and income
(NHS Continuing Healthcare; Fast Track Pathway funding; Social Services funding; section 117 Mental Health Act aftercare funding; State Benefits)
- Representing clients at NHS Funding Panels
- Managing allegations or potential allegations of deprivation of capital or income made by the Local Authority or Office of the Public Guardian
- Protecting clients facing financial or health and welfare safeguarding situations
(including about where they live and are cared for; contact with family and friends; financial exploitation by family members or others)
- Understanding the rights of family carers under the Care Act 2014 and whether and how services to carers can be charged for
Challenging NHS Continuing Healthcare funding decisions
There could be a multitude of reasons why NHS continuing healthcare funding decisions may be incorrect. Not least because each individual has different needs that can change over time.
It may be possible to reclaim care home fees through a legal challenge if:
- You have been denied NHS CHC funding and are paying for your own care,
- You believe a relative has been wrongly charged and is now paying for their own care
Contact us today to find out how we can help, using the form at the top of this page, or by calling us on 0161 969 3131.