Many people receiving NHS Continuing Healthcare funding for care find that their funding is taken away after a review.
If this has happened to you, you’ve probably been told to start paying care fees and that you can launch an appeal in the meantime. But should you pay care fees if Continuing Healthcare is removed? Continuing Care assessors seem to be targeting people who have previously been awarded full Continuing Care funding – and systematically taking the funding away. This is happening to people whose care needs have actually increased and whose health is deteriorating, and to people who need round-the-clock nursing care at the end of their lives. There can be only one motive: assessors wanting to protect budgets. And yet the National Framework – the very guidelines assessors are supposed to follow – states in black and white that budgetary considerations should never play a part in any Continuing Healthcare funding decision.
Should you pay care fees if Continuing Healthcare is removed?
If you’ve had funding withdrawn, and yet you know that health needs have increased and/or the assessment/review process was flawed and mistakes have been made, you can appeal. The NHS and local authority will say that you have to start paying care fees, and they will argue that it is only when there is a dispute between the NHS and the local authority themselves that the NHS has to continue to pay in the interim. This is outlined in the revised 2012 version of the National Framework. However, this gives the NHS free rein to simply remove all funding, regardless of need, and make people start paying for care – while also forcing them to fight to get the funding back.
Healthcare and nursing care – free at the point of need
This approach would suggest that NHS assessors can act with impunity throughout, falsely declare someone ineligible for NHS funding, force them to pay, force the family to enter an exhausting appeal process – all in order to wash their hands of the person’s care provision. What the NHS wants you to overlook in all of this is that healthcare and nursing care are free of charge in the UK (in law). It is only if it is clearly and reliably shown that a person is not entitled to NHS care (no matter what their age or circumstances) that NHS care should be refused. If you genuinely believe Continuing Care funding has been incorrectly withdrawn, then there are likely to have been flaws in the review process, and the eligibility criteria are likely to have been incorrectly applied. In such a situation, the NHS will have falsely declared that you are not entitled to NHS care.
How to argue against paying care fees
It’s worth using the following arguments when you’re asked to start paying for care:
- If the care provider has previously been paid by the NHS (through Continuing Healthcare) and then suddenly receives no further payments (and yet no safe decision about who’s responsible for funding has been made), the NHS is effectively breaking its agreement with the care provider. It is then, arguably, for the care provider to chase payment. Bear in mind that any dispute over care fees can potentially damage the relationship you have with you care provider, so keep this in mind throughout.
- State that you would have had no problem paying for care if it had been properly shown that it is your responsibility. The mistakes and flaws are not your fault.
- State that the NHS has stopped paying, and yet has done so with without regard to the relevant Dept. of Health guidelines. You should therefore not be forced to pay for someone else’s errors and maladministration.
- Suggest that the care provider forwards their invoices either to the local authority or to the NHS; if the assessment/review process had been conducted properly, this whole situation would not have arisen in the first place.
The NHS, the local authority and the care provider will of course fight back if you refuse to pay – and it’s understandable that a care provider wants to be paid for its services. However, the more you object, the more notice the health and social care authorities will take of your situation, and there’s a chance they may start to do things properly.
Remember also that if the NHS withdraws funding, it is by default passing responsibility for care to the local authority (LA). However, the local authority should scrutinise that decision – to make sure the LA is not being put in an illegal position. The LA can only accept responsibility for social care that is within their legal remit. It doesn’t matter whether a case is retrospective or current – that legal divide remains the same.