About Care Funding

The requirement for long-term care can arise at any time and for any variety of reasons, in most cases care is required as a result of the aging process, often combined with one or more medical conditions. However, the requirement for care is not just associated with the aging process, anyone may require care as a result of a disability, serious illness, a progressive medical condition, or even an accident.

Regardless of your relative’s age, there are two distinct types of care they may require – either Healthcare or Social Care.

Often, an individual may require a combination of each type of care, and that’s what leads to uncertainty about who should pay for it.

This distinction between Healthcare needs and Social Care needs is absolutely critical to the care funding your relative may be entitled to and who pays for it:

• Healthcare is provided by the NHS and is free to everyone at the point of need.
• Social Care is provided by the Local Authority (through Social Services) and is means-tested, which means you may have to pay for your Social Care.

You can therefore see the importance of the distinction – Healthcare is FREE – Social Care is PAID FOR BY YOU.

In terms of funding for your care therefore, the first and most important aspect is to have your relative’s healthcare needs assessed first.

If you have a ‘Primary Health Need’ then your care should be paid for in full by the NHS.

As you can imagine, this is why there are often issues surrounding payment for care – because it’s all about money. Have a look at our Facts and Figures page to understand just how big an issue this is and how much people are paying, often unfairly, for their care.

If the NHS can show that your relative doesn’t have primary health needs, they can pass the responsibility for the payment of their care over to the Local Authority instead – unless your relative becomes self-funding. This is where the fight lies, in terms of who pays for your relative’s care.

Unfortunately, despite having paid Income Tax and National Insurance contributions all their life to fund the NHS, at the point your relative needs long-term care, the NHS will, by and large, do everything in its power to deny them the right to that free care. This is not a political point. It’s a fact borne out by the many hundreds of individuals we have helped over many years – who have either been wrongly assessed in terms of their healthcare needs, or else had their care funding wrongly withdrawn. Instead, they have been left to fund their own healthcare, often being forced to sell their home, needlessly, to do so.

The issue of ‘unfair assessments’ has been going on for years. As far back as February 2003, the Parliamentary and Health Services Ombudsman produced a report on “NHS Funding for Long Term Care” in response the conduct of the NHS stretching back to 1996. When this wasn’t acted on, the Ombudsmen produced another report in March 2007 on “Retrospective Continuing Care Funding and Redress” which again criticised the NHS’s approach to the funding assessment issues.

Whilst the NHS responded with the National Framework to guide Clinical Commissioning Groups on the provision of a consistent service, with the needs of the individual at the centre, we continue to see examples day after day where the procedures haven’t been properly implemented correctly or at all.

The politics of the issues however, are not really relevant to you as an individual. The vital issue for you is understand whether you have to pay for your care or ensure that you receive NHS Continuing Healthcare Funding if you are entitled to it.

At Farley Dwek, we specialise in acting for clients to ensure that their entitlement to NHS Continuing Healthcare Funding is fairly and robustly assessed – see our Supported Assessment Service and Appeals Service. Our Retrospective Reclaims Service helps families to reclaim their entitlement to care fees that were wrongly paid following a flawed or incorrect assessment, or where no assessment took place at all!