This blog post was contributed by Angela Kitching, Joint Head of External Affairs at Age UK.
Staffing the ‘Campaigns’ inbox for Age UK is one of the more challenging tasks for our team. People email us about our campaigns, they tell us what’s wrong with the world, what’s wrong with the Government or the NHS and what we should be doing to sort it out; then we have to respond. Usually, the Monday morning run through of the inbox trying to make sure everyone gets an answer or is directed to the help or advice they need, is quite a task. This Monday was no exception.
Sometimes, something slaps you round the face and you realise that the issue someone has written to you about is a symptom that things have really gone wrong. That happened on Monday and the email was about the injustices thrown up by the NHS Continuing Healthcare system.
It’s not news to me, having worked for Age UK for over 10 years, that NHS Continuing Healthcare is a poorly understood and esoteric process to establish whether the NHS or the social care system (which often means the family or individual themselves) should be paying for someone’s care. Continuing Healthcare assessments are only carried out when someone is very ill, so by definition it applies to people in very vulnerable circumstances. Indeed, Age UK is an active member of the Continuing Healthcare Alliance which calls for significant changes to the Continuing healthcare system.
But the email made me sit up because it contained the account of someone whose seriously ill family members have had to fight through a lot of paperwork, be challenged by assessors who may have little understanding of the complexity of the conditions they are weighing up and then being threatened with reassessment in order to remove care packages after these have been put in place. When we listen carefully to such stories, we hear not only the justified distress of the individuals involved, but also the financial pressures the NHS is under. In these circumstances, the NHS and local authorities are fighting hard about the cost ‘incurred’ when care is provided and who should pay for it. This runs counter to the framework for assessing Continuing Healthcare, runs counter to the case law that helped to establish this framework, and ultimately runs counter to basic decency.
It is a symptom of serious pressure in the NHS because this is not just one story but part of a pattern that we regular hear of, each story with the same underlying issue: when you put the NHS under pressure to save money, systems that are already little understood and applied inconsistently, fail. In the case of Continuing healthcare, they fail some of the most vulnerable older people in our country.
This is a sign that the NHS is under huge strain and is trying to retreat from areas where it believes the line between health and social care is woolly. Ultimately, it will mean that people with very high care needs do not get proper support in the community and will be hospitalised, or their carers will be placed under undue and unsafe strain to try and keep them at home.
Norman Lamb MP held a debate on Continuing Care in the House of Commons this week and we will work with him and with other politicians who are keen to see the Continuing Care system reformed. You can find the full debate here.
Introducing the debate, Norman Lamb highlighted that at a time when demand should be growing due to higher numbers of older people, qualification for Continuing Care is falling:
‘At the end of March 2017, 57,000 patients were eligible for continuing healthcare in England, which was down 1.6% on the previous quarter and 2.7% on the previous year. What possible explanation for that can there be? Demand is rising significantly every year across the country, yet the number of people [deemed to be] entitled is going down. That must be due to decision makers imposing tougher eligibility criteria.’
At Age UK, we will keep trying to influence changes to the Continuing healthcare system to improve it. We will also listen to older people and their families because the evidence they give us helps to direct us towards the places where the cracks in the system are deepest as cost pressures force the NHS and social care to withdraw from providing adequate support for those who need it most.