Guest blog: Peter Barnett – Caring for our future

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Earlier this month, the ILC-UK presented written evidence ahead of the closure of the Department of Health’s Caring for our Future ‘engagement’.

In particular, ILC-UK expressed its concern about the place of NHS continuing healthcare (NHSCC) in the context of the proposed Dilnot reforms. Continuing care is available to recipients who have been assessed as having a “primary health need” and have a complex medical condition with substantial and ongoing care needs. It is arranged and fully funded by the NHS.

Those eligible for NHSCC will be the first group to receive personal health budgets during the roll-out in October 2012. Currently around 53,000 people are in receipt of NHS Continuing Healthcare at any one time, with a cost to the NHS of around £2billion per annum – i.e. a cost equivalent to the entire Dilnot proposals.

In his report of the Commission on Funding of Care and Support, Andrew Dilnot only mentioned NHSCC in passing. Yet as we look forward to the social care White Paper promised for Spring 2012 there is a need for clarity as to whether NHSCC will sit within a future Dilnot based funding regime or within whatever Health and Welfare Board/clinical commissioning structures/arrangements finally emerge from the Health and Social Care Bill, currently still at committee stage in the House of Lords.

This raises two key issues. Firstly, if they are to be meaningful any single needs eligibility assessment proposals that emerge from any ensuing social care White Paper must, by definition, have NHSCC at the summit of the needs severity criteria, before consideration of self or Local Authority funding of social care occurs.

The second dilemma is in the context of the recent palliative care review. This review seems to aim to incorporate free social care into palliative care provided on a free-at-point-of-use NHS basis. The Dilnot Commission conversely seeks to take social care the other way, into people paying more for what they get. The perverse incentive risk here is for people (or their families!), in order to get their care funded, to seek to get on the palliative care funding stream as soon as possible in their illness progression via NHSCC, or its future replacement under ongoing NHS reorganisiation.

As a result, people might be progressed up the levels of care quicker than necessary because anyone who gets onto palliative care funding will also get a significant element, if not all, of their ‘social care’ free, for which they and/or the local authority would otherwise have to pay. This risks placing the whole intervention/ prevention and quality of life agendas in peril as people cascade up the care severity continuum more quickly than they need to into ’free care’, to possibly their own and the taxpayers detriment – but with the ‘advantage’ of preserving both their own and the Local Authority’s funds.

In summary, going forward NHSCC will have to sit in one of these two new health and social care funding baskets, either Dilnot or the Health and Social Care Bill. Given the annual cost of NHSCC is now running at £2bn, it is vital that a new estimate is made of the future usage and costs of NHSCC, either under the present arrangements or in context with full implementation of the Dilnot proposals. This is a serious issue which if left unresolved risks de-railing the laudable Dilnot aims of dramatically improving the care funding system and making it one we can be proud of and confident to use both for our families and ourselves.

Peter Barnett

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