Number 10 response to continuing care

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5 September 2007

We received a petition asking:

"We the undersigned petition the Prime Minister to Fully fund long term care for our sick and elderly under the 1946 National Health Service Act and the 'Coughlan' Judgement in the Court of Appeal 1999."

Details of petition:

"The Core Principles of the NHS can be summed up as follows: To provide care which is free at the point of need, meets the needs of everyone and is based on a patient's clinical need not their ability to pay. Tony Blair said at the Labour Party Conference in 1997 that he didn't want his children brought up in a country where pensioners had to sell their homes to pay for long term care. Since then approx 700,000 homes have been sold to pay for care. This applies to sick people of all ages. These people have paid taxes and national insurance all their lives, then suddenly they get taxed again when they become ill by funding their own long term care. What an absolute disgrace!!!!! IF YOU HAVE AN ILLNESS OR DISABILITY YOU ARE ENTITLED TO FULLY FUNDED NHS CONTINUING HEALTH CARE UNDER THE NATIONAL HEALTH SERVICE ACT 1946."


Read the Government's responseThe Government values the contribution that older people have made and continue to make to our society, and recognises the efforts older people have made to prepare for their old age through pension provision, through savings and through investment in their homes.

Concern that residents' resources are taken into account by the local authority in the assessment of their ability to pay towards the cost of residential accommodation is understandable. However, charging for residential accommodation is not new. Since the introduction of the 1948 National Assistance Act people have had to contribute towards the cost of their care, and capital assets have always been taken into account.

Under the current assessment rules, all forms of capital, including a person's former home, will be looked at when deciding how much capital a resident has. However, the local council must ignore the value of the property where it continues to be occupied by the resident's spouse or partner, another relative who is over 60 or incapacitated, or the parent resident of a child under 16 whom he/she is liable to maintain.

Property is now disregarded from the means test for residential accommodation for the first 12 weeks of a permanent move into a care home. This change took effect from April 2001, and has three direct benefits. It provides breathing space between entering a care home and having to sell the family home to pay for care; it gives time for residents to assess the move into a care home; and it means savings on care home costs for residents.

From 9 April 2007, under the local authority charging rules no account is taken of capital below £13,000. For capital of between £13,000 and £21,500, an income of £1 a week is assumed for each complete £250, or part of £250, held. A person with capital over £21,500 is expected to pay the full charge for their accommodation. As soon as the person's capital reduces to £21,500 they should contact the social services department and ask for an assessment or reassessment, as they may then be entitled to financial support.

If a person has capital below £21,500 and has been assessed as needing residential or nursing care, it is the responsibility of his or her local authority to find a suitable placement. The local authority will either provide a place in one of their own homes or contract with an independent sector home owner. In these circumstances the local authority is responsible for meeting the contracted cost of the home in full and will recover from the resident such amount as the resident can afford to pay according to their means. It is not the responsibility of the person concerned or their family to find a place.

However, where a resident wishes to enter residential accommodation which is more expensive than the authority would normally pay for the level of care provided, they may do so if someone else, such as a relative or friend of the resident, agrees to make up the difference. A resident may also top-up from their own resources if they and the local authority have made a deferred payments agreement or the resident is subject to the 12-week property disregard.

These rules do not mean that local authorities can set arbitrary ceilings on the amount that they will pay. The local authority cannot simply say that it will only pay a certain amount, without being able to show where it could arrange a place at the price which also suits a person's assessed needs. If, for example, a resident believes they have particular needs which would not be met in the accommodation offered, they, or someone acting on their behalf, may wish to use the complaints procedure to argue that the local authority should pay more than its normal level to meet these needs.

The Government has also provided councils with a special grant to enable them to place charges on people's homes as an alternative means of contributing to their care costs. The charge can remain in place until the property is sold or the resident dies. If the resident or their family decide they wish to repay the charge earlier, they will be able to do so. This is known as the deferred payments scheme. A charge on their property gives residents another option for paying for their care. In addition, families will be able to explore options other than the sale of the home in order to repay the debt accrued.

The Coughlan judgement concerns the distinction between nursing care and personal care. Personal care is any care that may be needed by someone to help him or her with personal needs such as bathing, dressing and undressing, eating and using the toilet. It may also cover advice, encouragement and supervision in these activities. Personal care costs are met either by the recipient or by the local authority on a means-tested basis so there may be a charge for this aspect of an individual's care, depending on their circumstances.

In contrast, nursing care refers to any action taken by a registered nurse in providing, planning and supervising a person's health care. Such care can be provided at home, in a care home, or a residential home. In October 2001, the Department of Health delivered on its commitment as set out in the NHS Plan to make nursing care for people in care homes and other settings free of charge too. This is generally referred to as 'NHS funded nursing care', and an individual's needs are assessed on their need for care from a registered nurse. Today, approximately 125,000 people enjoy access to nursing care.

The Coughlan judgement does not provide a clear distinction between health and social care, and it is not considered possible to create such a distinction within eligibility criteria. The Department of Health continues to emphasise that eligibility for continuing care must be assessed on the healthcare needs of the individual on a case-by-case basis.
http://www.pm.gov.uk/output/Page13055.asp

Hi Wendy

We must of been thinking the same thing. I posted this on another part of the forum aswell... Image

Hope that your well

Take care
Maryann x
Hi MaryAnne,
Please remove this then.
I am sorry. I rang Stephen and said I had put it on here.
He will post something later when he can get on his comp.
take care
Wendy
xx
I'll delete mine Wendy as you have very wisely put the governments response in yours, saves members having to link!

Take care
Maryann x