Council and NHS set up panel to resolve payment disputes

The NHS has to pay if a person has ongoing healthcare needs - and must reimburse local authorities any costs which they incur
The NHS has to pay if a person has ongoing healthcare needs - and must reimburse local authorities any costs which they incur
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The NHS is taking too long to decide whether it is responsible for the on-going care needs of some Lancashire residents – and failing to quickly reimburse Lancashire County Council for any costs which the authority incurs as a result.

That was the message from a cabinet meeting at County Hall which heard that there is “compelling evidence” that the health service in the region is often failing to meet a deadline by which assessments of care requirements should take place.

The problem arises when the county council requests that the area’s clinical commissioning groups consider whether an individual is eligible for support known as “NHS Continuing Healthcare”.

If a person is deemed to require treatment for complex physical or mental health problems stemming from an accident, illness or disability, it may be the responsibility of the NHS to meet what is described as their “primary health need”. Such support is free, unlike council-provided social care which can be partially or fully-funded by the individual depending on their ability to pay.

Under legislation introduced in 2014, councils can request that the NHS carries out an assessment to determine a person’s eligibility for continuing healthcare – which should be completed within 28 days. But papers presented to the cabinet claim that “many people are waiting way beyond the recommended assessment period” – and the council is often footing the bill in the meantime.

“In the interim, we have to make the payments,” County Cllr Graham Gooch, member for adult services, said.

“The difficulty we have when [an individual] then goes onto Continuing Healthcare is getting the money back [from the NHS]. It’s an extremely long wait for some of the assessments and it’s costing us millions of pounds.”

The NHS is obliged to reimburse local authorities for any “unjustifiable delay” beyond the 28th day in completing its assessment.

A working party has now been set up to create a dispute resolution policy between the health service and County Hall. It will be chaired by a senior NHS officer and a director from Lancashire County Council and is expected to report early next year.

Deputy leader of the Labour opposition group, John Fillis, called for a consistent way of working to be applied across Lancashire.

“[It’s clear] that what’s going on in one [part of the county] isn’t exactly what’s going in another,” he said.

Councils can still have responsibility for some aspects of an individual’s support needs even if they are deemed eligible for NHS Continuing Healthcare.