New guidelines may end postcode lottery

Long-term care is one of the less palatable realities of life. It is something most of us would rather leave as a bridge to cross when we come to it. But in doing so many are then shocked at the high costs of care homes, and at the fact that they must often meet all those costs themselves.

But following the victory of an ex-Scotland Yard detective in winning back £50,000 from the NHS for the care of his mother, thousands of families could find that they are eligible for funding under new NHS guidelines.

Around 500,000 people are in care, of whom only 5-6 per cent receive full funding. The Department of Health says that if it funded all the care required in the country it would cost an extra £1.5bn a year.

There are two basic levels of care for those unable to look after themselves: residential homes and care homes with nursing. The average residential care home in the UK costs £400- £500 a week. But if nursing is required, weekly costs can range from £550 to £1,200. It is not therefore surprising that an estimated 70,000 homes are being sold each year by families to pay for a relative’s care home fees.

Mike Pearce, an ex-Scotland Yard detective, had to sell his mother’s house to pay for the constant care required by her Alzheimer’s condition. Although his mother died in 2005, Pearce continued to argue that her case had been so extreme she should have been eligible for NHS funding from Torbay Care Trust.

In Scotland, personal care is paid for by the state, but in England the funding system requires NHS trusts to decide whether an individual needs medical or social care. If the need is medical, the NHS will foot the bill.

However, if the primary needs are personal, such as assistance with dressing, the case goes to the social services for means testing. Anyone with assets over £21,000, including their home, must meet all the costs for care themselves.

Problems have arisen when the care trusts interpret the distinction between medical and personal needs differently. This has given rise to a postcode lottery where the same condition could merit different treatment in different parts of the country. “There was concern about how clear the guidelines were,” says the Department of Health.

This was not the first time disparities between trusts were highlighted. In January 2006 Maureen Grogan won a High Court case against Bexley NHS trust after she was forced to sell her home to meet nursing fees. The trust’s criteria for eligibility were found to be flawed, which led the government to send draft guidelines to health authorities in June 2006 – the first such attempt to provide a national standard on who is eligible for funding.

The consultation period on the draft closed on September 22 and the government is considering the responses before it publishes the final guidelines in the spring.

The proposed framework defines eligibility by looking at an individual’s care needs rather than their diagnosis. Pearce was the first to use the new framework to argue that his mother’s Alzheimer’s condition, which was degenerative, could not be adequately cared for by social services and was a medical issue for which the NHS should have been responsible. The Alzheimer’s Society say the new framework is long overdue.

The changes are not being met with approval from all quarters. The shadow health secretary has said the changes could lead to 40,000 people who currently receive funding becoming ineligible.

The Department of Health refutes these claims, saying that all indications from the consultation period show that the framework will improve consistency around the country and that several areas will see an increase
in the numbers of people provided with fully funded care.

Continuing care, which is fully funded by the NHS, is required by individuals with complex, unstable or unpredictable conditions that require regular support. The bar is set extremely high. One woman received care after suffering from a stroke which left her incapacitated, aggressive and bedridden. However, funding was removed because her situation became stable, even though her condition did not improve.

If funding is denied there are still options available to lessen the financial burden. Council social services can charge you for the services they provide for you or a
relative. Social services can set their own rules for charging but these must be reasonable and not put you into financial difficulty. Nursing care allowances may also be granted. The person who requires assistance will be assessed and put into a tiered system of bands. Those in the top band can get up to £133 a week.

Toni Chalmers from Symponia, the specialist financial advisers for long-term care, says that Pearce’s case took issue with the distinction between the top band for nursing care and continuing care. “Many individuals receiving the higher band contribution may qualify to receive continuing care,” she says.

The Department for Health sponsors a guide to care home fees and conditions. See: www.counselandcare.org.uk/helping-you/careguides