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FAQ: Why Should A Case Manager Instruct A Community Care Lawyer?

Rachel Burley Stower, Health and Social Care Solicitor, answers Case Managers questions on Community Care Law.

1. How can a Community Care Lawyer support Case Managers?

2. Why would a Case Manager instruct a Community Care Lawyer?

3. What state funded care can I get for my adult client?

4. Will my client’s Personal Injury settlement prevent them from being eligible for funded health or social care?

5. What if my client has an undertaking as part of their Personal Injury settlement?

6. How do I know if my client qualifies for NHS Continuing Healthcare?

7. Can a client with a low score on a Decision Support Tool (DST) still qualify for NHS Continuing Healthcare?

8. What health and social care support is available for children?

9. Will my client, who is a child, have to pay from their Personal Injury trust?

10. My client has already paid for a private care package from her Personal Injury trust. Can I ask Social Services to take over?

11. If I get NHS Continuing Healthcare eligibility for my client, can it be backdated?

12. My severely disabled eight-year old client only gets 40 hours per week of funded care. Can I appeal?

13. As a Case Manager, how should I instruct you?

How can a Community Care Lawyer support Case Managers?

A Community Care Lawyer navigates the statutory provisions, guidance and case law that regulates the relationship between a person with disabilities, social services and the NHS.

Why would a Case Manager instruct a Community Care Lawyer?

Many of your vulnerable clients with Personal Injury (PI) trusts received their settlements many years ago, based on them receiving interest on their lump sum, sufficient to cover the cost of their future care. As interest rates on savings have dropped significantly, their capital is not earning sufficient interest to meet the cost of care for the rest of the individual’s life. This is particularly a problem as people’s care needs increase as they get older, yet their available funds have substantially reduced.

In addition, many of your vulnerable clients do not receive 100% settlements and therefore have to contribute to their care package over and above their compensation monies. For example, if your client was involved in a road traffic accident, but was not wearing a seat belt, they may have their award reduced by 25%. This means for every £1 spent on care they contribute 25p. A person with a £2000 per week care package will contribute £500 per week – a large sum over their life time.

For children, or adults lacking capacity, a Professional Deputy or Trustee will usually manage their PI settlement. The Office of the Public Guardian (OPG) Professional Deputies standards guidance makes it clear that the Professional Deputy has a duty to claim all sources of state funding that their client is eligible for.

Finally, those people with no fault based injuries do not have compensation packages, and will need to rely heavily on Health and Social Care provisions.

What state funded care can I get for my adult client?

The two main sources of funded care are from social services or from the NHS. Some people may get a jointly funded package. Either type of funding can cover the cost of care in a residential setting or at home. Both types of funding can be provided as a Personal Budget so your client can purchase and manage his or her own care, rather than having the care provided directly by Health or Social Services.

Will my client’s Personal Injury settlement prevent them from being eligible for funded health or social care?

No.  NHS Continuing Healthcare (NHS CHC) is non-means tested and the PI settlement must be ignored. Social Services will do a means test. However, current law and guidance requires the Local Authority to ignore the PI settlement. We can help if Health or Social Services refuse or reduce a support package because of your client’s PI settlement.

What if my client has an undertaking as part of their Personal Injury settlement?

Some PI settlements include undertakings which prevent the client making an application for Social Services funded care or NHS CHC. While an undertaking is onerous, it is always worth getting advice before deciding to discount the possibility of seeking state funding. For example, in a recent case I dealt with, the undertaking prevented the Deputy from seeking social care support from the Local Authority under a specific piece of legislation that is no longer in force. This meant their client was entitled to Social Service’s support under the Care Act.

How do I know if my client qualifies for NHS Continuing Healthcare?

Your client qualifies for NHS CHC if you can show that they have a primary healthcare need. This is a complex area of law and practice. At present, only 57,000 adults across England qualify for NHS CHC but this is always worth exploring.

Can a client with a low score on a Decision Support Tool (DST) still qualify for NHS Continuing Healthcare?

Yes. I have a client who had a bike accident which has left him with a brain injury and a condition that means that if he eats over 2000 calories a day he will have a heart attack and if he drinks more than 2.5 litres of liquids a day he will have a stroke. He has memory problems and can’t remember eating and drinking, so he must be monitored at all times. He received a low score on the DST but due the nature, complexity, intensity and unpredictability of his needs, he was found to have a “primary health care need” and was awarded NHS CHC. This funds his care at home package and keeps him safe.

What health and social care support is available for children?

There is little difference between the adults and children except the legislation and the pathway to eligibility. The NHS and Local Authority often offer a joint package of care. However, if the child has severe healthcare needs the NHS must take the lead. If the child has few health care needs but many social care needs then social services will take the lead.

Will my client, who is a child, have to pay from their Personal Injury trust?

NHS CHC for adults and NHS CCC for children is not means tested and therefore your client cannot be charged for the services provided by the NHS. The NHS should fully fund the entire care package for those with “primary health care needs”.

If your child client has a social care package, the situation under the Children’s Act and Chronically Sick and Disabled Persons Act is less clear cut than it is for adult clients. Most local authorities do not attempt to charge children. However, we are acting on a number of cases challenging Social Services decisions to charge against the PI trust.

My client has already paid for a private care package from her Personal Injury trust. Can I ask Social Services to take over?

Yes: one of my cases involved Patsy, a young woman with birth injuries. She has a 24-hour care package which was funded through her PI settlement. However, due to the increasing cost of care and a reduction in her capital, she was struggling to meet costs. On investigation, I found that the Local Authority had assessed Patsy, but refused to fund her care due to her PI settlement.

I sent a challenge letter, pointing out the charging regulations and disregards. Social Services backed down and put a funded care package in place.

If I get NHS Continuing Healthcare eligibility for my client, can it be backdated?

Yes. Another case I assisted with is Kevin, now aged 41, who sustained two brain injuries – one at birth and one a few years later, after contracting meningitis. He had a PI settlement at £1.1 million. He needs 24-hour care. Having bought a disability adapted property for him to live in, the remaining settlement was insufficient to meet his care needs for life. This became a problem as his mother could not fully contribute to his unpaid care as she grew older.

Kevin’s injury manifests itself in unpredictable violent mood swings, in which he, his carers or members of the public can be injured. His mother had never had any assistance from the NHS or Social Services. The bank who managed his PI trust referred the family to us. After a battle with two local CCGs about which was responsible for Kevin, he was assessed, found to have a “primary healthcare need” and awarded NHS CHC. We are now working on a retrospective application for NHS CHC for his care which should have been paid for, in the past.

My severely disabled eight-year old client only gets 40 hours per week of funded care. Can I appeal?

You can challenge this situation, as I did for a child called Leah. Leah was brain damaged at birth. She was cared for at home with a 24.7 care package, which includes suctioning, catheterisation and PEG feeding. The joint assessment by Health and Social Services determined that she required only 40 hours of care a week. Her parents were expected to provide the rest of her care. Leah was awake much of the night as well as during the day. This meant her parents were providing 128 hours care each week with little respite.

Leah’s Professional Deputy took advantage of our Services for Professional Deputies to assist in challenging the joint funded package. It was immediately clear that the 40 hours per week was not a lawful or reasonable care package, given Leah’s extensive needs. I obtained an independent nurse assessor’s report and sent a strongly worded Letter Before Claim to the CCG. The CCG carried out a new assessment of Leah, and agreed she needed a 24.7 care package. Leah’s Deputy now receives a Personal Health Budget, allowing Leah’s mother to organise the best possible care package for Leah.

As a Case Manager, how should I instruct you?

You will need to involve the Professional Deputy or Trustee. The Deputy needs to be satisfied that it’s in the best interest of your client to instruct Community Care/Health and Social Care lawyers to investigate all state funding options to protect your client’s PI settlement. We will work closely with the Professional Deputy team and you, as the Case Manager, to support the best outcome for your client.

If you are a Case Manager and would like to find out more about how we can assist you and Martin Searle Solicitor’s Services for Professional Deputies & Attorneys, contact our Community Care Law solicitors today on 01273 609911, or email info@ms-solicitors.co.uk

 

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