When discussing issues of care funding with clients, I am often asked if their relative will be eligible for NHS continuing healthcare. Unfortunately, NHS continuing healthcare no longer exists in Scotland, although it continues to apply in England. Clients will often assume that NHS funding that they read about in England applies in Scotland as well, so I thought it useful to set out what the system in Scotland is. This may also be useful for practitioners with clients in England who have relatives in Scotland, or who are thinking of moving north of the border.
As most SFE practitioners will know, NHS continuing healthcare is a package of healthcare fully funded by the NHS for adults with a complex level of healthcare needs. This healthcare could be provided in any setting including a care home, hospice or person’s own home and meant that, if a patient was eligible, the residential aspect of their care costs would be funded by the NHS out with an NHS setting. This sounds great in principal, but in practice NHS funding was rarely provided in Scotland. Individuals often were not told of the existence of NHS continuing healthcare, or, if they were assessed, it was difficult to meet the strict criteria for funding.
In June 2015, following an independent review, NHS continuing healthcare was removed in Scotland and replaced with a system called Hospital Based Complex Clinical Care. The assessment used for Hospital Based Complex Clinical Care is now based on one question: “can your care needs be properly met in any setting other than a hospital?”. If the answer to that is ‘yes’, the patient will be discharged from hospital to a community setting such as the patient’s own home, a care home or some other supported accommodation. The NHS will remain responsible for meeting medical needs in that community setting; however, the other costs of the adult’s care and accommodation will require to be met either by the local authority care funding or by the patient themselves.
This means that only those adults who need to be in hospital will be entirely exempt from charges relating to their accommodation. All other adults with healthcare needs will require to contribute towards the funding of their social care and accommodation, either through eligibility for local authority funding or by their own means. The adult still has the option of applying for the Free Personal and Nursing Care allowance to go towards the cost of their care.
The assessment for Hospital Based Complex Clinical Care will be carried out by a multi-disciplinary team of health professionals, with the decision ultimately made by a consultant or specialist. The team should consider all options, and should explain the options to the patient, family and carers. There is an appeal process if the patient or family don’t agree with the NHS decision.
This change in healthcare funding was clearly brought in to ease the burden on the NHS. However, there will be circumstances where adults end up remaining in hospital for longer than is necessary if they lack the capacity to make decisions about their own care and if care services have to be sourced and funding applied for.
(Author: Lindsay Maclean)