The main provisions on community care are dealt with in the government’s white paper “Caring for People”, which says that those people who need health or social care due to old age, mental illness or learning, physical or sensory disabilities should receive care services and support suitable for their particular needs, either at home or in residential accommodation.

NHS Continuing Healthcare is the whole package of health and personal care that is provided to some people who are affected by disability, accident or illness, even life limiting illness. Those eligible, whilst in a nursing or residential home, will receive the full cost of their care and accommodation for life. It also applies to some people living in their own home.

Those who want to receive the Continuing Healthcare funding have to meet the relevant criteria. That is they have to have a primary care need. The four key indicators which the scheme uses to test whether a person is eligible are : -

1. Nature (Particular characteristics of a condition)
2. Intensity (Extent and severity of needs and support)
3. Complexity (How needs present and interact)
4. Unpredictability (Fluctuations)

Assessors use a Decision Support Tool to help them break down a person’s overall health needs list a range of factors that have a bearing on eligibility, behaviour, cognition, pyschological and emotional needs, communication, mobility, nutrition, continence, skin, breathing, drug therapies and medication, altered states of consciousness and other significant care needs.

Age Concern says that there is still much confusion surrounding Continuing Healthcare because of the problems surrounding the criteria with inconsistency in who is awarded the full funding. The body says that the main criteria should be whether that person’s care needs can be legally managed by Social and Community Services. If they can’t be then that person’s care should be funded by the NHS.

Many organisations complain that the inconsistency has led to some people not even being assessed to see whether or not they would qualify for continuing care. If the person concerned has a primary need for health care then it may be possible to reclaim fees that shouldn’t have been paid. As can be seen in the case law on the subject, such refunds can be substantial, dependant on what has already been paid out for a person’s care.