On 31st July 2020, NHS England set out the third phase of the NHS’ response to COVID-19 in a letter to relevant NHS bodies and partners. A copy of the letter is available by clicking here.
The Coronavirus Act 2020 – What has changed?
As a reminder, with the passing of the Coronavirus Act 2020 earlier this year, key changes included:
- A simplified Hospital Discharge process;
- Alterations to Local Authority-funded social care which include the introduction of “Care Act Easements”; and
- Modifications to NHS Continuing Healthcare.
NHS England’s Update: A “Window of Opportunity”
The letter sets out five principle priorities for the next phase of the NHS’ Coronavirus response. The intention is to accelerate “the return of non-COVID health services, making full use of the capacity available in the window of opportunity between now and winter”.
Crucially, for patients in receipt of care funded through the temporary COVID-19 NHS funding, which was announced in tandem with the simplified hospital discharge process known as Discharge to Assess, the letter confirms that from the 1st September 2020, the Hospital Discharge process will be updated and Clinical Commissioning Groups (CCGs) must resume NHS Continuing Healthcare assessments.
1st September 2020: What will change?
NHS England’s letter summarises the revisions we can expect to the Hospital Discharge Service Requirements as follows:
“The Government is continuing to provide funding to support timely and appropriate discharge from hospital inpatient care in line with forthcoming updated Hospital Discharge Service Requirements. From 1 September 2020, hospitals and community health and social care partners should fully embed the discharge to assess processes. New or extended health and care support will be funded for a period of up to six weeks, following discharge from hospital and during this period in a comprehensive care and health assessment for any ongoing care needs, including determining funding eligibility, must now take place. The fund can also be used to provide short term urgent care support for those who would otherwise have been admitted to hospital”.
With regard to NHS Continuing Healthcare, it states:
“The Government has further decided that CCGs must resume NHS Continuing Healthcare assessments from 1 September 2020 and work with local authorities using the trusted assessor model. Any patients discharged from hospital between 19 March 2020 and 31 August 2020, whose discharge support package has been paid for by the NHS, will need to be assessed and move to core NHS, social care or self-funding arrangements”.
How does this impact funding care?
In terms of paying for care, the transition back to assessing eligibility for NHS Continuing Healthcare on 1st September 2020 is a reminder of the real importance of considering NHS Continuing Healthcare eligibility if a loved one requires care.
Once the temporary COVID-19 NHS funding ceases, patients, families and representatives will need to think very carefully about funding care, particularly given the average costs. According to Laing Buisson’s research, the average cost of residential care in the UK in 2019 was £33,852 a year. This had risen to over £47,320 a year if a patient required nursing care. When the average costs of care are so high, identifying how to meet these costs in a way which maximises a patient or loved one’s income is vital.
If a package of care is not funded through the COVID-19 funding, and the patient does not satisfy the means tests to qualify for a Local Authority funded package of social care, the patient will be a self-funder unless and until eligibility for NHS Continuing Healthcare or NHS Fast Track funding has been established. This means the patient; their family or representatives will need to be prepared to fund care unless and until an eligibility decision has been made. If the patient is likely to be a self-funder, it may be helpful to consider taking specialist financial advice about other care funding mechanisms available to maximise income and help manage the potentially huge costs of care.
The indication that the Updated Hospital Discharge Service Requirements will include Discharge to Assess funding for a period of up to 6 weeks does, at least, provide some reassurance for any patients discharged from 1 September 2020. Discharge to Assess is a concept introduced with the revision to the National Framework for NHS Continuing Healthcare in October 2018, albeit, in our experience prior to the pandemic, practice between CCGs often varied.
What is the eligibility criteria and what can I expect from the Assessment Process?
A full explanation of the eligibility criteria and assessment process can be found by clicking here to access our NHS Continuing Healthcare information sheet. Due to the need to comply with current social distancing guidelines, in the majority of cases, it is highly likely that most eligibility assessments (MDTs) will be conducted remotely using video technology.
If an assessment does not identify eligibility for NHS Continuing Healthcare, can I challenge the decision?
Yes. There is nothing within the Coronavirus Act 2020, which prohibits appealing a refusal to award NHS Continuing Healthcare. As with eligibility assessments, most appeals are likely to be conducted remotely using video technology. This is something we have seen a number of CCGs already doing to assist with tackling the backlog of local resolution requests. A full explanation of the process for challenging NHS funding decisions can be found by clicking here.
How can I prepare?
In order to prepare, it is essential that a patient or family representative works with any carers or care providers over the coming weeks to begin preparing for the assessment process. As NHS Continuing Healthcare is an evidence-based process, it will be vital to ensure detailed care records, diaries, intervention charts, and notes are available to demonstrate the ‘primary health need’ criteria is met. Thorough preparation is critical to success.
We offer a free initial consultation and we run a weekly legal advice clinic between 4-5pm every Tuesday where no prior appointment is required if you would like to discuss funding care with a Community Care specialist.