For anyone requiring long-term care the impact on family can be devastating, but for farmers it can affect their business as well as their home life – and often the two are intertwined.
The financial implications of a farmer unable to work the land, or a family carer having to run the farming business at the same time, are often at the forefront of the family’s mind. Appropriate funding for care and support can help to alleviate such pressures, and the type of funding will depend primarily on the overall level of care and support required to meet all of the farmer’s needs.
The NHS was created to ensure that everyone, regardless of their wealth, has access to free healthcare. Non-healthcare needs can be met by the local authority, but this is means-tested, and for individuals with savings over the threshold (currently £23,250) any support will need to be self-funded.
A community nurse can meet basic healthcare requirements but if a farmer has particularly high needs, a more substantial care package is required, which could be funded by NHS Continuing Healthcare.
What is NHS Continuing Healthcare?
The National Framework for NHS Continuing Healthcare and Funded Nursing Care 2018 (the National Framework) states that “NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been assessed and found to have a ‘primary health need’.” These needs may have arisen as a result of accident, illness or disability, and care can be provided either in a residential setting (i.e. a nursing home) or in the individual’s home.
Determining a “primary health need” involves an assessment process, set out in the National Framework.
How do I know if I’m eligible?
There is a two-stage assessment process for NHS Continuing Healthcare eligibility. The first is the Checklist screening tool. The threshold for this relatively quick assessment is deliberately low, identifying those who require a full assessment to ensure they are given the opportunity to be considered for full funding.
Where a Checklist indicates someone should be referred for a full assessment, a multi-disciplinary team of at least two professionals from different disciplines will consider, using a Decision Support Tool (DST), whether the individual has a primary health need.
There is no definition of a primary health need, but there have been a number of significant cases (notably Pamela Coughlan and Maureen Grogan) that have helped define its meaning. The National Framework incorporates these decisions and sets out the primary health need test during assessment: “a decision of ineligibility for NHS Continuing Healthcare is only possible where, taken as a whole, the nursing or other health services required by the individual:
- are no more than incidental or ancillary to the provision of accommodation which local authority social services are, or would be but for a person’s means, under a duty to provide; and
- are not of a nature beyond which a local authority whose primary responsibility it is to provide social services could be expected to provide.”
The team uses the DST to record a person’s care needs across 12 different areas, including mental and physical, as well as characteristics of their needs, such as their nature, intensity, complexity and unpredictability. This helps to decide whether the quality or quantity of a person’s care goes beyond the limit of a Local Authority’s responsibilities, as outlined in the primary health need test.
In cases of a poor prognosis and a person’s health deteriorating quickly, a Fast Track pathway bypassing the lengthy assessment process ensures care is put in place as soon as possible.
What might increase the complexity of care for farmers?
Eligibility for NHS Continuing Healthcare is not based on a person’s diagnosis, but on the level of care they require as a result of their condition.
Farms are dangerous places to work, and farmers are susceptible to injuries from machinery, animals and vehicles, as well as falls from a height. The fatality rate for workers in agriculture was above the five-year average in 2017-18, despite a focus on health, safety and wellbeing, and the number of serious accidents within the farming community remains high. Often these result in life-changing injuries and long-term care needs.
Farmers with conditions such as dementia may also require extra day-to-day help, in some cases experiencing personality changes and being resistant to care interventions. This may increase the need for specialist intervention. A farmer with dementia is likely to have needs in areas such as mobility, toileting, nutrition and maintaining skin integrity. A sufferer may have a primary-health need due to the complexity in just one area, or because of the totality of their needs.
A serious injury or the diagnosis of a long-term condition may result in complex mental-health needs as well as physical, particularly where the diagnosis has had life-altering consequences. Psychological and emotional needs are also considered as part of the assessment process for NHS Continuing Healthcare, and should not be overlooked.
How to ask for an assessment?
Responsibility for establishing eligibility for NHS Continuing Healthcare rests with the Clinical Commissioning Group that holds the contract with your GP practice at the time of your assessment. In the first instance, a farmer can ask for a social worker or district nurse to complete the Checklist.
Moore Blatch provides expert advice and assistance at all stages of the assessment process, and offers a free initial assessment to those who think they might be eligible for funding.