The NHS is paying reparations for the care system’s broken funding model

Elena Siniscalco

CONSIDERING whether a parent, relative or partner might need to move into a care home is no happy business. The process is all-consuming, delicate and above all, expensive. People selling their houses to be able to afford care is now accepted as a fact in the UK, but would look extreme in many other countries.

Of the estimated 360,792 care home residents in England, almost 35 per cent are self-funders. The costs are high: the average weekly cost of a residential care home in the country is £704. For a nursing home, where residents get 24-hour support, the cost is £888 per week.

The NHS differentiates between health needs - related to disease, illness, injury or disability - and care needs, which is when you need help to go about with everyday tasks. If someone’s needs are primarily related to health, the NHS covers all costs under something called Continuing Healthcare Funding (CHC). Or at least, it should. But there are families across the country now claiming back money which was owed to them, because of the myriad flaws in how social care funding is organised. These are people who had to go through the trauma of selling their family home to ensure an elderly relative was looked after, and were often paid a pittance years after the fact.

To be eligible for the funding, the person needs to go through a screening process managed by the local integrated care board. But the assessment tool used by the care boards is open to interpretation. It leads to a postcode lottery system that sees huge disparities in the number of people who get the money in different parts of England.

In the north west of England, 5,059 individuals were eligible for funding in the third quarter of 2022/2023, while 6,709 got the funding in north east and Yorkshire and 6,225 got it in the Midlands. By contrast, only 3,724 people were eligible in the east of Eng- land, 2,858 in the south west and 3,890 in London. The population size does not account for the differences: you’re simply more likely to get funding in the north than in the south. The assessment is based on indicators including mobility problems, medications and cognitive impairment. They’re judged on a scale that goes from no need to priority. The board also looks at the nature, intensity, unpredictability and complexity of someone’s needs. It’s easy to see how these descriptive indicators lead to subjectivity.

“It shouldn’t be a financial decision, but we’ve seen cases where it has”, says Lisa Morgan, partner and head of nursing care at Hugh James. Some local boards, pressured by reduced social care budgets, enforce a restrictive - or sometimes just wrong - interpretation of the indicators.

On top of that, a lot of people don’t know about this funding, so don’t even ask for the assessment to be undertaken. The number of people receiving it has reduced over the years, and yet we are an ageing population. Care homes earn more from self-funded residents, so have no incentive in advertising it - and broke local boards have no incentive either.

Paul and Jill Pearsons are only one of the many families affected by the cracks in the system. In 2006, they decided that Kath, Paul’s mum, needed to be in a care home as she suffered