Fundamental reset for social care?

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

The eligibility assessment is not based on *conditions e.g. e.g cancers, heart, kidney and lung problems, dementia, Parkinson's disease. It's based on the degree and severity of the care needs.

The assessment determines if the care needs in totality require specialist, professionally qualified NHS health workers to meet the needs or social care assistants ( simplification)

Basically and simplistically, but to give a flavour- can the persons car needs, in totality, be met by none professionally qualified care assistants whose skills are within the legal remit of the Local Authority. Or, are the care needs sufficiently intense, complex or unpredictable that specialist knowledge and skills of NHS professionally qualified staff are required on an ongoing basis.

So a person can have advanced dementia- be not aware, be incontinent, but straight forwardly managed by pads, have Parkinson's disease, and all care needs for all activities of daily living must met for them as they are completely unable to carte for themselves. If that care can be delivered by social care assistants (ie basic straightforward care) it is deemed is social care.

If that person becomes acutely ill at any stage- chest infection, fall, diabetes or Urinary tract infection has heightened confusion and delirium, condition is unstable etc etc and patient needs hospital admission- free care during NHS admission stay.

If the person is readmitted back to care home but condition has now deteriorated, its more unstable to extent now needs frequent input of District Nurse, and/or Mental Health services, and/or Diabetic specialists nurse, Specialist Parkinson's nurse or complex, time specific Parkinsons Disease or Diabetic medication, Speech and Language therapist for swallowing difficulties etc, or is deemed "at end of life" a new assessment is carried out which may now on reassessment now demonstrate a Primary Health Need as a result become eligible because now needs professionally qualified ongoing NHS input.

Currently the law in the UK is that NHS care is free but social care means tested. A Government would need change the law and the respective NHS and Social Care service models for that to change.

That's the fundamental issue that needs to be grappled with.

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

This needs to be part of the reset.

The reason for a rich person getting CHC funding lies in the 1948 National Health Service Act which provides health care free by law ... they are entitled to free medical care and, if they meet the criteria, to CHC funding too.

I don’t know what the answer is. But it seems so wrong that people at the end of life, and often their children who are not young themselves, should have this worry.

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

Yes!

My dear cousin has a DH who had early onset dementia and a very healthy body.

He’s now in residential care and she doesn’t get a penny from the state to help her with fees, because he doesn’t specifically traditional nursing care.

* Care is care homes is means tested* as I explained.

NHS care funding is only provided to those who are assessed and have complex, intense, unpredictable care needs that need specialist NHS care. NHS care is free at the point of delivery to all.

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

You don't think wealthy property owners with homes over £1 million should be able to access NHS care? Thats a different argument.

NHS care is free at the point of delivery to all. Wealthy property owners would have to apply for NHS care when in a care home in the first place and I have not seen any that have made an appeal in my years of reviewing cases.

They are usually of a demographic that have opted for private healthcare in the past and much more likely to pay for packages of care privately so they can continue to stay in their wealthy, very desirable homes as they can afford to do so.

Plus, even if in a care home, they would only be eligible for free NHS care if they have a Primary Health Need.

You're not suggesting that wealthy home owners should be prevented from accessing NHS care? That would be discriminatory and completely change the NHS model and current legislation.

Your’e initial statement was “ There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures*.

I responded accordingly- it's an equitable system where health care needs are assessed on an equitable evidence based process. If an NHS PHN is identified NHS provides the funding to deliver that healthcare irrespective of the person's bank balance. That is the NHS service model has been since its inception. 


ronib

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

And if everone who was entitled to it but has not got it through misinformation were to get it, that bill would be exponentially higher!

knspol

Wealthy property owners do not get free care. In fact they pay a premium in any care home so that less wealthy people can live in the same place with the home only receiving a much lower amount for them via the local authority. Wealthier people subsidise the less wealthy.

Thats my first hand observation knspol.

All none Local Authority care homes set their fees. They get a lower amount for LA funded residents- so by default to balance the books and make a profit- the fees for self funders at each annual budget review rise proportionately the greater the number of LA residents in the care home at each review.

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

ronib

There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures.

Then there’s the problem of who should monitor for mini strokes, kidney infections and the rest if an elderly person is at home. Care at home is time limited to washing, using the commode/changing pads, dressing, feeding, administering medications. Not enough time to ensure physical mobility and mental stimulation so not ideal.

Definitely agree about the well off people gaming the system and living in Nursing homes when they haveaa property worth a fortune.

You know running up hundreds of thousands of pounds in Nursing home fees. When there house is worth over a million pounds

This is made by legal moves like Trusts and Tenants in Common Agreements.

I know a family who have been doing this for years. Retired son pretends to live in the old family home..

But has his own very expensive Cheshire Countryside home.

An absolute disgrace. Total Deprivation of Assets. Needs immediate change and prosecutions.

I think Ms Casey did an OK job with her report. But she was told to do it to shut people up.

I will be very surprised if anything will be acted upon. And it will sink without trace, as this what tends to happen to such reports.

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

Wealthy property owners do not get free care. In fact they pay a premium in any care home so that less wealthy people can live in the same place with the home only receiving a much lower amount for them via the local authority. Wealthier people subsidise the less wealthy.

ViceVersa

ronib

There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures.

Then there’s the problem of who should monitor for mini strokes, kidney infections and the rest if an elderly person is at home. Care at home is time limited to washing, using the commode/changing pads, dressing, feeding, administering medications. Not enough time to ensure physical mobility and mental stimulation so not ideal.

Please explain how 'wealthy property owners' get free end of life care?

I respectfully disagree ronib- there is no factual basis for your claim that 'Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures*.

All people (older adult or younger adults with Learning disabilities for example) are assessed by the Local authority * before they enter a care home, nursing home or assisted living care* for LA funding eligibility . The care home will only accept admissions on the basis of knowing who will be paying the bill!

To be eligible for LA funding at this stage the person ( or their family if they have dementia for example) must complete a financial assessment carried out by a LA social worker- who secures all financial evidence of assets. The total value of assets must be under the £23,250 threshold in England and Northern Ireland to be eligible for LA funding. The funding available is capped- so limits care home choice. By definition that knocks out any home owner, let alone wealthy property owners

All other patients are self funding andcare home fees in my area can easily average £2,000 a week. So most patients or their family representative, usually son or daughter set to inherit. make an application to see whether their loved one is eligible. for free NHS Continuing Health Care.

ALL are home residents, without exception are entitled to an NHS Continuing Health Care (NHS CHC) assessment to determine whether their care needs are health or social care. A checklist would be completed and if base need threshold met go forward to a Decision Support Tool assessment. This is a detailed and comprehensive assessment of all care needs- Breathing, Nutrition, Continence, Mobility, Behaviour, Cognition, Communication, Psychological and Emotional, Medications and Symptom Control, Altered States of Consciousness etc. Also part of the assessment if to determine whether there is a Primary Health Need (PMH) as a result of the nature, intensity, complexity and unpredictability of the person's' care needs. That is there must be a Primary Health Need. to be eligible for NHS funding.

The DST assessment is carried out, by a multi disciplinary team, usually a Registered Nurse and Social worker. Their recommendations then goes to the NHS Local Integrated Care (ICB) Board to verify the outcome. The ICB then writes to the applicant or their respresntive with the eligibility outcome.

The applicant has the right then to a local appeal- and why would a son or daughter not apply for one when around £2,000 may be going out each week for care? The case is reviewed comprehensively by the ICB and the application may be rejected or upheld.

NHS CHC law allows families the right to appeal for an independent review of the case. I am an Independent Review Chair- this is one of my day jobs. First I review the case and application submission and the patient's case file to advise nHS England whether it is ready for IRP or more information required. I then hold a panel meeting with the family ( predominantly on Microsoft teams), plus their solicitor if they have one, plus they. local ICB representative to consider all parties positions. That lasts several hours. Then the IRP Panel- myself as Chair supported by a Social Worker and Registered Nurse (from different areas to patient and independent) review everything we have heard and read and we make independent recommendations for every DST care domain weighting and PHN test.

We make an independent decision whether the patients eligible or not. Financial consideration does not form part of the decision making process. It is of no relevance to me whether the patient is wealthy or not. I then write up a detailed report and the ICBin question is expected to respect the recommendations. The only next stage of recourse open to the applicant is to go to the Health Service Ombudsman or High Court to appeal our Independent Review Panel Decision.

In factual summary The only way to receive NHS finding for care home fees is to have an assessed, evidenced based PHN

The only way to receive LA funding is to have evidenced based assets below the threshold of £23,250

The same process can and is applied to patients being cared for at home those patients are. as every citizen is, under the care of their GP and any other ancillary NHS services such as District Nurse, Continence advisor, Dietician, Speech and Language Therapist, Mental Health services etc etc. that may be required and involved/ All and each can make an application for a NHS CHC checklist and the assessment process is just the same as if in a care home. If a PHN is found, the NHS will pay the eligible care amount to the family.and this can be used to buy in care agency support.

The only wealthy properties given free NHS CHC have a PHN of which you may not be aware it is of course a confidential, patient sensitive information, evidenced based process.

ronib

There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures.

Then there’s the problem of who should monitor for mini strokes, kidney infections and the rest if an elderly person is at home. Care at home is time limited to washing, using the commode/changing pads, dressing, feeding, administering medications. Not enough time to ensure physical mobility and mental stimulation so not ideal.

From all I’ve ever read or heard, it’s notoriously difficult to get funding for a end of life care, even when it’s a genuine medical issue, not what they call ‘social care’.

As for the rest, both my FiL and my DM, plus an aunt, were all self funded in their care homes (all with dementia too advanced to be managed at home any more) and I don’t see why anyone with enough assets to pay, should not do so.

None of these relatives needed their houses for living in any more, so they were sold.

Yes NHS continuing healthcare funding.

ronib

There’s a fundamental unfairness about the present system for sure. Wealthy property owners are given free end of life care in nursing homes which goes on for years and not months. Others are inaccurately assessed and it takes forever for social services to correct their figures.

Then there’s the problem of who should monitor for mini strokes, kidney infections and the rest if an elderly person is at home. Care at home is time limited to washing, using the commode/changing pads, dressing, feeding, administering medications. Not enough time to ensure physical mobility and mental stimulation so not ideal.

I wonder if you mean NHS Continuing Healthcare funding? If not could you let us know what you do mean?

Luckygirl3

How do we feed into this consultation I wonder? Can't find anything online.

There doesn't seem to be anywhere at the moment. I think they are just trying to encourage conversation.

Having personal experience of local care, both within the home (DM & MiL) and within current residential care.

Care in the home, both carers for both ladies above was originally arranged via the hospital using council led carers, sadly in both instances it was below par.

Once we discovered, fairly quickly, it wasn’t working as both we (DH & I) and both ladies required, we explored using direct payments from our LA to employ carers directly. M

DM didn’t qualify and also didn’t wish to continue with “strangers” in her home, so up until her final year in 2022, my daughter and shared care, from 2015-2022. Anything extra needed at any point was paid for directly by DM. Both DD and I worked full time throughout this period and it was extremely hard for both of us.

MiL was more “pliable” and qualified for direct payments, however, we had to fight for every penny and still only ended up with 13 hours paid care a week, utterly ridiculous as she had both schizophrenia and vascular dementia. We moved her a few years previously from one part of Essex, around 35 miles from us, to part sheltered accommodation (council) around the corner from where we live.

We did apply for attendance allowance for her and she got a premium on this due to her mental health issues, we used this money to supplement care. We interviewed various carers directly and found a fabulous carer who was with us for many years sharing care between her and my DH who retired early to help care for her, in 2017. This arrangement worked well until mid COVID, in 2020, when he had a serious heart attack.

She’s now been in council funded residential care since October 2020 and is cared for extremely well.

We researched the company thoroughly who own a large group of care homes, it’s one my Aunt was already using and we’ve been extremely fortunate.

I agree things require a big overhaul, I just don’t know what the answers are.

Many many years ago I worked briefly for a council owned and run care home, I left as it was horrific and I would never ever have placed with my own DH or my MiL in a place such as this!

Sorry, poor formatting, forgot to preview.

^This is where the feedback opportunity is: caseycommission.co.uk/contact/?utm_source=chatgpt.com
But .... "This page will remain open until the end of June 2026. After it closes, there will still be further opportunities to share your feedback with the Commission. Updates on how you can engage with the Commission’s work will be shared on this page, and you can also sign up for email alerts to stay up-to-date on our work here."^

This from early June this year:

www.theguardian.com/society/2026/jun/04/why-is-andy-burnham-talking-about-fixing-englands-social-care-system

If Burnham is taking an interest in 'fixing social care' may be he would have some input into the work of the Commission or take it seriously (i.e look to implementation) when it reports? So many things seem to reach the report stage and go no further.

From comments so far on this thread it seems to me that there needs to be better integration between Social care and the NHS.

I would like to see the privatisation of social care reversed as, while there may be some excellent examples of privatised care provision. its failure rate seems to be high and it can be very expensive for local authorities which have a statutory duty to provide it. I don't like seeing what should be a universal provision of care being a victim of private equity companies and profiteering.

Samsara1 - I agree. And this is the crux of the problem. A great deal of time, energy and money is wasted trying to decide whether it is a social/care need or a nursing/medical need.

It needs a huge radical rethink in order to sort this out and no government has been brave enough to grasp the nettle - or, in the current media-led climate, had time to to do this.

Long overdue but many 'projects' have been tried. The problem of course is defining what is a health care need and what is a social care one. Perhaps remove the barrier and have a sliding scale instead. social care and health care staff have very different policies and procedures, training and ethical basis. I suspect there is no one answer.

This is where the feedback opportunity is: caseycommission.co.uk/contact/?utm_source=chatgpt.com
But .... "This page will remain open until the end of June 2026. After it closes, there will still be further opportunities to share your feedback with the Commission. Updates on how you can engage with the Commission’s work will be shared on this page, and you can also sign up for email alerts to stay up-to-date on our work here."

The eagle-eyed amongst you will have spotted that the consultation is now closed - so why the availability of sharing views has suddenly appeared ion the news I do not know! I will continue to look into this and let you know.

Iam64 .... "My understanding is the nhs funds nursing care if life expectancy is three months or less." This is a common fallacy and results in thousands of people not getting the care funding they are entitled to. NHS care funding can continue for years and is not contingent on a terminal diagnosis. It is based solely on medical/nursing needs criteria. My OH's care was paid for by the NHS for 9 months because he fulfilled the criteria and qualifying younger people get it for years. beaconchc.co.uk/ - they can advise.

It is basically part of the original NHS act which says that if someone has nursing and medical needs they are entitled to care from cradle to grave.

This is where one of the central unfairnesses of the current system lies because people are given misinformation about their entitlement and wrong judgements are made by people who are trained in other disciplines and are making a guess about it!- my OH was refused twice but because I had worked in the field I was certain they were wrong and he got it on appeal.

However the basic truth is that if everyone who was entitled received this the NHS would go bankrupt overnight! This is why there needs to be a fundamental review of the whole issue of funding care so that it is fair.

There are carers who work for the agency I briefly used that have to deal with a range of special needs- carers don't just cover physical health - poor Mental Health and borderline dementia don't necessarily involve physical caring.