When 35-year-old Jessie was admitted to Northampton General Hospital, she never imagined she’d still be there 18 months later. Diagnosed with complex care needs, and requiring full-time care, Jessie represents the thousands of vulnerable individuals across the UK who fall through the cracks of a strained health and social care system. Her case took a shocking turn when the hospital took legal action to evict her from her bed.
Evicted from a Hospital Bed - A Story of Complex Care Needs and System Failings
In recent news, the BBC highlighted the case of a 35-year-old woman with complex health care needs. The patient, Jessie, found herself the subject of legal action by Northampton General Hospital after she was evicted from her hospital bed, having spent 550 days there. She had been deemed medically fit for discharge, but finding her somewhere to go was proving to be less than straightforward.
The article in question can be seen here: Woman evicted from NHS hospital ward after being stuck for 18 months - BBC News
The BBC commented:
“Her story is an extreme example, but it demonstrates the acute pressures faced by a care system coping with more complex cases, the knock-on effect to the NHS, and how the person at the heart of it can feel lost.”
The Department of Health and Social Care told the BBC:
"This is a troubling case which shows how our broken NHS discharge system is failing vulnerable people."
The Struggle for Appropriate Complex Care Needs Provision
According to the BBC, Jessie was admitted to Northampton General Hospital on 14 April 2023 for treatment for cellulitis. By the end of April, she was medically ready to be discharged from hospital, but her nursing home couldn’t take her back because it could no longer meet her needs.
It is unclear whether the original care home was unable to reinstate Jessie’s care due to an increase in her needs, which took them beyond what the nursing home could meet. Or whether some other reason was the justification, such as a change of staffing or availability at the nursing home. However, authorities state that Jessie has been diagnosed with an emotionally unstable personality disorder. She also needs a wheelchair, help with all personal care, and is unable to communicate effectively. The BBC article describes the acute pressures faced by a care system coping with more “complex cases”.
All of these factors suggest that Jessie has complex care needs, that are challenging to meet. Another source discussing the same case indicates that North Northamptonshire Council accepts responsibility for Jessie’s package of care outside of hospital.
Who Is Responsible in Complex Care Needs Cases?
By law, councils are responsible for managing and funding social care services in their area. As many people recognise, social care is means-tested, meaning that if your capital assets are in excess of £23,250, you’ll have to self-fund your care package.
However, responsibility for care provision should shift from the council to the NHS Integrated Care Board (ICB) in certain circumstances. The council and ICB are two separate legal entities, and how they arrange and fund care in their local areas is distinct. ICBs are NHS organisations which exist in all geographical areas of England. Their role is to plan and fund health services for the local population.
Unlike means-tested social care provided by the council, ICBs arrange and fund care packages on a non-means tested basis – free of charge. This is known as NHS Continuing Healthcare Funding (CHC funding) and it covers the full cost of the care package, whether in a care home, nursing home, or in an individual’s home. Individuals with intense, complex or unpredictable health needs are eligible to receive CHC funding.
But what is the difference between someone who needs free NHS healthcare, and someone who needs to pay for their care under the council’s means-tested system?
Understanding the Difference Between Free NHS Healthcare and Means-Tested Care
This distinction is not clearly defined and, in reality, most people who need long term care have a mixture of health and social care needs. Health and social care needs are not legally defined. Health services relate to the treatment, control, management or prevention of a disease, illness, injury or disability, whether or not those tasks are carried out by a health professional. Social care on the other hand supports people with the activities of daily living and their personal care.
According to guidance from the Department of Health and Social Care, there are key characteristics which indicate that someone may have a “Primary Health Need.” This distinction can mean that someone is eligible for CHC funding. These key characteristics are called the Nature, Intensity, Complexity and Unpredictability of a person’s complex care needs.
Jessie has complex care needs above what her nursing home can cater for. This does beg the question, why is the council is responsible for her package of care, as opposed to the ICB?
Continuing Healthcare Eligibility for Complex Care Needs
It’s important to stress that eligibility can only be determined following a detailed and comprehensive multi-disciplinary assessment. It isn’t clear from the BBC article whether Jessie underwent any such assessment.
If the ICB has not assessed her eligibility, then it seems clear that it should, because there’s an indication that she could be eligible.
However, if the ICB has already assessed her eligibility, then it should undertake ongoing and regular reviews to reconsider her eligibility. This would be a safeguard in case of deterioration in her condition. Also, there is a right of appeal against an ICB decision of ineligibility for CHC funding, which should usually be exercised within 6 months. If Jessie is still in time, then she (or her representative) could seek professional advice to establish whether there are grounds for appeal.
Seeking Professional Advice is Key for Cases Like This
There’s not enough information about Jessie’s complex care needs or her assessment history to know for certain whether she may qualify for CHC funding. However, as with all people going through the English health and social care system, it’s important to at have a sense of your rights and entitlement under law. A professional can help you to look into things further and navigate the system if necessary.
If you feel that you or someone you know is struggling with complex care needs, we can help. Contact our CHC funding expert, James Urquhart-Burton to arrange a consultation. You can reach us on 0113 320 5000, or email @email to discuss how we can support you while you navigate this process.
