Councils face mounting pressures as PCTs cut continuing care

Adult social services are facing increased pressures and families higher care bills due to NHS cuts to continuing healthcare, warn social care leaders.

The potential crisis has led the Department of Health to remind the NHS of its legal obligations to fully fund long-term care for individuals whose care needs arise primarily from a health condition.

Those deemed ineligible – or those who have eligibility removed – have to fund care themselves or have it paid for by councils, increasing pressures on cash-strapped adult care departments. There are fears that more disputes between councils and primary care trusts will result and that families might challenge PCT decisions in the courts.

More than a quarter of PCTs oversaw a 10% cut in the rate of access to continuing care in their areas between January and April 2010 and the same period this year. However, the national rate increased from 49.7 to 52.5 per 50,000 population during this period, according to Department of Health figures.

“In many areas, continuing care is working very well, in others it’s not. PCTs have used it as an obvious area to cap costs,” said Jeff Jerome, who represents the Association of Directors of Adult Social Services on the issue. He said some trusts were delaying continuing care assessments for “considerable periods of time which means the individual is paying for the costs or their local authority is”.

Age UK said PCTs seemed to be over-cautious with their spending. “We’ve heard of people go into a care home [after being deemed eligible for continuing care] and then have their continuing care funding stopped at review,” said Tom Gentry, the charity’s policy adviser on health services. “This can be for legitimate reasons, but undoubtedly the impact of cuts is being felt across the board and this is going to affect individuals in many ways.”

Some people with learning disabilities are also having funding removed, said Clive Powell, a former civil servant who runs independent arbitration panels to resolve disputes over continuing care funding between councils and PCTs. “I think disputes are going to increase,” he warned.

Jerome warned that the NHS could face a legal challenge. “It’s inevitable if people are paying out thousands of pounds for social care that they are bound to raise arguments over whether the NHS is doing what it is supposed to.” He said Adass was telling adult care directors to encourage service users to challenge PCTs where they believed they had a case.

Jerome welcomed the intervention from the Department of Health, through a letter to strategic health authorities from deputy director for social care, local government and care partnerships Gill Ayling. She told strategic health authorities to ensure attempts to make efficiency savings in continuing care by PCTs should be “undertaken within the appropriate legal parameters for determining eligibility” set out by the 2009 national framework for continuing care.

NHS leaders defended the reductions in eligibility. A spokesperson for NHS South Central, where rates of access fell from 45.4 to 37.5 people per 50,000 population from 2010-11, said the framework was being correctly applied in the region.

“Although numbers have declined, we rank fourth in the amount of money spent on continuing healthcare per head. Thus, the data suggest that our PCTs provide a higher level of care for a smaller number of people with more substantial need, which would seem to be in line with the government’s policy on long-term care.”

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