Thursday 18th September 2014
A colleague asked me recently if I could distil the Care Act into a few easy messages, relevant for people who might soon need to make plans for their future care needs, or for those who have parents or grandparents who could do with some support in the not too distant future.
In order to answer my colleague, I looked up the Care Act and examined all 129 sections and 8 schedules of the new law. I read about duties, and financial caps. I read about personal budgets, direct payments, deferred payments and assessments and, to be honest, I began to get a bit confused.
Then, having paused, two words kept recurring in my mind and after giving some time for reflection, those two words gained more and more resonance to help explain how the Care Act would affect each and every one of us.
The two words that sprung to mind were ELIGIBLE NEEDS.
In order to explain why these two words struck such a cord with me, I will need to tell you a bit about myself.
My name is Sarah Clarke, and I am currently training to be a Solicitor with Stone King Solicitors.
Before training in law, I spent several years in Parliament acting as a parliamentary researcher and political advisor to a number of MPs and Lords (it still amazes me, how you need no qualification to do that job!).
My first position was with an MP called Philip Hammond, who is now the Foreign Secretary, but when I worked for him, he held the post of Frontbench Spokesman on Health for the Official Opposition.
During my time in his office, Philip was asked by the Whips to lead on the Health and Social Care Bill on behalf of the Opposition. What this meant in practice, was that it was his job, and by default, my job as his only parliamentary researcher, to scrutinise line by line, every element of that Bill and bring any issues, political or otherwise to the attention of the Government during its passage through the House of Commons. In preparation for one of the stages of the bill we received a briefing from a confident and charismatic American called Dr Beverly Malone, who at the time was the General Secretary of the Royal College of Nursing.
I was fortunate enough to meet with Beverly Malone and together we discussed an issue with the Bill that was of concern to nurses. The issue was in the definition of ‘nursing’ care. The importance in getting such a definition right was crucial because if an individual needed ‘nursing’ care then this would be provided for free, paid for by the NHS, whereas any other type of care, provided to that same individual would not. The ‘any other type of care’ would be subject to local authority means testing and consequently payable by the individual concerned if they had adequate financial resources to cover the cost.
At the time, both the Commons and the Lords had extensive debates on what nursing care should be. The RCN came up with case studies, highlighting an elderly individual will a motor neurone disease that resulted in him having fluctuating ability to carry out day-to-day tasks. Sometimes the individual could do without any assistance at all; at other times that individual needed some help from a health care assistant. On bad days a nurse could be called in to administer medication or assist with the acute care needs of the individual.
We talked about real people with real care needs. We talked about what was more important to a nurse - helping an elderly gentleman ensure he takes the correct medication for controlling his high blood pressure, or making sure a dementia patient has turned off the stove after cooking. What about the gentleman who perhaps suffers from arthritis and back pain who needs to bend down to put his shoes on so that he can get to his appointment on time.
What became clear was that each individual’s needs was different and that each one of us will place greater importance to differing aspects of our care. For some it may be security, for others it is maintaining independence.
In the end, the Government defined nursing care as the care provided by a registered nurse. However, wherever the definition was drawn, it could not cover all the circumstances of each individual’s personal nursing care needs.
Over a decade has passed, and in reading the Care Act 2014 , I believe that the same holds true today. I noted a section in the Care Act entitled ‘assessing needs’, the eligibility criteria.
What this section attempts to do is to define the level of need you have to reach before the care and financial support package talked about in the rest of Part 1 of the Care Act applies.
If you do not have eligible needs, then the financial cap found in s.15 will not apply to you.
And if you do not have eligible needs, then the care and support plan and personal budget will not be available to you.
And if you do not have eligible needs then the ability of the council to pay for some or all of your costs does not apply.
So the definition of eligible needs seems quite crucial to you and me.
I tried to find the definition of eligible needs in the Act, but it wasn’t there. The legislation states that it will be published, in regulations to follow.
I check on the Government website and find the draft regulations and bingo! I find a definition of the eligible needs criteria.
However I see a ‘disclaimer’ by the Department of Health stating that since the draft regulations were published, further thought on an outcomes based approach was under consideration. We will have to await the publication of the final regulations to be published.
And yet, I don’t think the publication of the regulations will change my view on what the Care Act means for you and me.
Legislatures have tried previously to define care needs and they will try again in the future, no doubt with these impending regulations.
But legal definitions, by default, will rule some people in and some people out. They do not take in to account real human beings with a full range of needs – needs which can’t be categorised into nursing care and personal care.
Which is why I support the aims of Care Planning Services.
If we, as individuals, can take small steps today to plan our affairs and finances for the future, without compromising financially or taking away from what we want to achieve today, only then can we be sure that we will be able to continue with the kind of lifestyle we have envisaged for later life.
And, if I were to sum up the Care Act for my colleague I would do it in two words - ‘Eligible Needs’.
Do you want someone else to tell you what your needs can or can’t be – or do you want to take control of that for yourself?
If you are interested in reading some of the Committee debates on the definition of nursing care – look back.
For further information or advice please contact
Image
Image
Image
Image
Image
