Read or watch any news programme and it is littered with articles about a failing health service; the NHS is under increasing pressure to deliver nursing care; and by all accounts, failing miserably and local government is not delivering on social care and you would argue, it all comes down to money.
And that fundamentally is the difference between the two: who pays!
The National Framework for NHS Continuing Healthcare attempts to clarify the definition of each type of care but acknowledges that there is no legal definition for either.
Nursing care is defined as a healthcare need and is associated with the treatment, care or aftercare of someone with a disease, illness, injury or disability.
Social care relates to the assistance of daily living – maintaining independence, social interaction and supported accommodation such as a care home.
So far, so good? In theory, if you or your relative has a continuing healthcare assessment and your needs are healthcare related, i.e. as a result of disease, illness, injury or disability, then this qualifies as a nursing care need and should be free to the individual, provided for by the NHS.
If not, and your needs are, for example, age-related support; then this is a social care need.
In practice though, many people who have healthcare and nursing care needs are being cared for through the social care system. A system where care is means tested - it is worth noting, however, that if a local authority takes responsibility for care that should be provided by the NHS then this could be illegal, as highlighted by a landmark case back in the late 1990’s.
The news is full of stories about hospital bed blocking; where patients are ‘stuck’ in hospital as there is no room for them in an appropriate nursing home. Once a patient is moved into continuing healthcare they undergo a formal assessment to determine whether their needs are healthcare or social based. If the needs are deemed to be social then the process of means testing determines who pays for this care, the individual or the local authority.
The BBC‘s Today programme recently reported a case which mirrors the practice rather than the theory of healthcare assessments. Families report that their relatives, who suffer from dementia, double incontinence, immobility and need 24-hour nursing care, are being assessed as having social, not healthcare needs. This makes the individuals the responsibility of the local authority, not the NHS and requires them to fund their own care if, when assessed, they have the means to do so.
Aside from the significant financial considerations, it is hard to understand that an individual who is doubly incontinent, has dementia and needs 24-hour care is categorised as not having a nursing care need.
Local authorities are under pressure to provide nursing care within a system which is designed to provide social care. Patients are required to pay for healthcare which is the responsibility of the NHS to provide. Neither have the funding to cope with our ageing population, so is it any wonder that there are weekly reports of a social care crisis?
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