Hi,

In preparation for the full CHC Assessment, I would like to have a clear understanding of what constitutes a HEALTH NEED and what constitutes a SOCIAL NEED.

For example, which would the following fit into, as these services are needed by my father and are currently being provided on the hospital ward by the NHS;

a) turning in bed to reduce the risk of bed sores (he can't do this himself)
b) regular checking to ensure he isn’t in a dangerous/uncomfortable position in bed
c) transfer from bed to a wheelchair
d) assisting with daily hygiene (i.e. washing, shaving etc)
e) assisting with dressing
f) continence checking (he has continence but sometimes has accidents)
g) toilet care (i.e. taking to the toilet; and without being crude, doing the paperwork)
h) providing physio (to maintain physical health more than rehabilitation)
i) administering medication (i.e. ensuring the correct amount is taken at the appropriate times throughout the day)
j) cutting food up to enable one to eat with one only working arm
k) providing meals & fluids
l) regular visits by staff to provide reassurance to address anxiety and periods of distress
m) providing the necessary environment to socialise with others (e.g. other patients & lunch club)

Is there a legal definition of the difference?

As always, any help and guidance would be greatly appreciated.

Kind regards,

Trevor

My assertion that such things needed to be done for my mother:
(i) as a reult of incapacity generated by disease;
(ii) to prevent any further breakdown of health
fell on deaf ears, I am sad to say. How administering necessary nutrition, maintaining hygeine and taking action to prevent skin breakdown etc can be described only as 'social care'beggars belief.

Interesting and highly relevant question Trev.

I've had much use of "we understand your rel has needs, but they are mainly social needs". Don't get excited about "mainly" because "the health needs are outweighed by the personal/social care needs in terms of impact on your life and as such a primary healthcare need is not evidenced".

What this seems to mean on a daily basis is having food prepared, delivered to room because rel. now rarely leaves his room, being constantly reminded to eat and drink, ditto all help with getting up, toileted, washed and dressed (takes 2 carers 3 hours most days), reminded to do up clothing so he doesn't fall over it, being picked up from falls,won't go to bed at night, having no medication in room and having it dispensed often with refusal, but then constant complaint re unrelieved symptoms of longstanding other conditions, all set against his constant insistence there is nothing to stop his return home and generally no insight into condition.

Apparently these symptoms of dementia are NOT health needs, they are social and personal needs. I wonder what would happen if these needs weren't provided? Would his health and condition improve suddenly?

Is it worth challenging the PCT to cite the stautory authority for personal or social needs and asking them how this has precedence or revokes Health Need in the 1946 Act? I appreciate a purely legal approach seems to get nowhere, but it also appears we do all the running and they just spout s***.

Trev,

This is taken from

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_115477.pdf

Which is a copy of what is written in http://www.lga.gov.uk/lga/aio/19069, although now retired, IMO still very relevant.

This doesn’t exactly answer your question specifically, because that’s unfortunately why most of us are posting on this forum.

"What is the difference between a healthcare need and a social care need?"
"Whilst there is not a legal definition of a healthcare need (in the context of NHS continuing healthcare), in general terms it can be said that such a need is one related to the treatment, control or prevention of a disease, illness, injury or disability, and the care or aftercare of a person with these needs (whether or not the tasks involved have to be carried out by a health professional).

In general terms (not a legal definition) it can be said that a social care need is one that is focused on providing assistance with activities of daily living, maintaining independence, social interaction, enabling the individual to play a fuller part in society, protecting them in vulnerable situations, helping them to manage complex relationships and (in some circumstances) accessing a care home or other supported accommodation.

Social care needs are directly related to the type of welfare services that LAs have a duty or power to provide. These include, but are not limited to: social work services; advice; support; practical assistance in the home; assistance with equipment and home adaptations; visiting and sitting services; provision of meals; facilities for occupational, social, cultural and recreational activities outside the home; assistance to take advantage of educational facilities; and assistance in finding accommodation (e.g. a care home), etc.

PCTs should be mindful that where a person is eligible for NHS continuing healthcare the NHS is responsible for meeting their assessed health and social care needs".

Hello Sally Sally, Beetle and Trev

It is perfectly true that there is no legal definition as to what constitutes health care, social care, health need, social need. So the PCT just approximates what it thinks fit the bill.

The question we have to put to them is : that the so called social care needs would not need to be meet if the cause of them ; disease, disability etc, had not occurred.

The social care needs should not be viewed as though they were an isolated factor.

There is in my opinion only one category of person who would qualify for purely social care needs. Over the years in my local area I have known several cases where an elderly person has gone into a care home with no medical issues. But have felt that he or she could not cope living at home alone. IN that context that is social care, pure and simple.

Even I could accept that in these circumstances there could be no CHC funding.

Take another example: vascular dementia. This is caused by physical factors and is not of social causation and therefore it is totally not relevant if much of the care needed falls within so called "social care". What is important it has a physical cause and the social needs have been created by it, not the other way round.

From Ian

Thanks for that Ian. Isn't it wonderful how the definitions even say (not a legal definition) and include the phrase "in general terms".

I will adopt this approach and bat back their own definitions. I am astonished that SS up and down the land could let this piece of drafting clobber them for so much!! particularly when their own advisory notes put their threshold for responsibility lower than that of the NHS. No surprise they then come after non payers, they must be sore as hell at being stitched up again by the NHS.

Well, if anyone knows of a definition of 'nursing' you'd think it should be the Royal College of Nursing, and there's lots of very useful words in this document from 2003. (I haven't found a more recent version, but nursing is as old as the hills, so perhaps the RCN can be used as a reliable reference.)

Defining Nursing: http://www.rcn.org.uk/__data/assets/pdf_file/0008/78569/001998.pdf

Page 5 discusses the artificial distinction created between 'nursing care' and 'social or personal care' .... created as a result of the 1990 NHS and Community Care Act (which gave local authority social services departments the lead responsibility for the provision of such services).

The RCN website is quite good at definitions, so it may be worth using the search facility and include the word 'defninition' or 'defining' within the results, for lots of 'domains'.

But, main thing is that there are lots of very useful words in the RCN doc.

VM

Good Post (No 5)Ian

I have been arguing this point since my original letter to the PCT in Feb 2003, and still fighting!
HK

We're on a roll of excellent posts and information here. Thank you. Do you think yer average PCT chc assessor will be up for considering these, or will we hear the immortal words uttered at the most recent chc attended "we are here to consider the evidence on ineligibility"

Trev - The answer to your question is provided by the briefing note I sent you today. Further clarification is provided by the 'Coughlan' judgement. If you consult 'Pamsday' you'll see that ALL Pam's needs are health needs and as Lord Woolf said "beyond the scope of local authority services". Note that a 'health need' simply means an 'illness, disability or injury' and is NOT synonymous with 'a need for health care or treatment' Many patients have 'health needs' which are not amenable to clinical intervention or 'treatment'of any sort. It is the care requirement which arises as a CONSEQUENCE of a 'health need'for which the NHS is responsible - exactly as with Pam Coughlan.

Esquires wrote: The answer to your question is provided by the briefing note I sent you today.

Steve, would you send me that briefing note too please.

Thanks.

VM

Re Post 5.

Ian,

I totally agree with you and Steve's later post. My mum was living totally independantly with no help from anyone for anything before her stroke. All her health and social needs were as a direct result of her stroke, which I have made abundantly clear to the PCT.

Yet the PCT stick rigidly to the NF/DST with complete disregard to common sense. All the SHA can do is ensure they have stuck rigidly to the NF/DST. All the HSO can do is to make sure the PCT/SHA have stuck rigidly to the NF/DST. As far as I am aware none of them are empowered to stray into the realms of common sense for fear of non compliance with the NF/DST!

As Steve posted recently, people who try and fit the patient to the criteria are doomed to failure as they just move the goal posts. But, unless you have deep pockets which I certainly do not, then 'fit the patient' as far as I can see is the only option unless Steve's Class Action gets of the ground.

Esquires wrote: The answer to your question is provided by the briefing note I sent you today
Steve could i have a briefing too i am preparing my self for an IRP shortly.
Thanks Vince

Hello Silly Sally, Beetle, VM, Vince an Trev

Thats whats known as predetermination of judgement Silly Sally and constitutes possible maladministration and is possibly a breach of article 6 Bill of human rights. The right to a fair trial, hearing etc. It would appear to be procedural rather than contextual so the latter could apply.

One or two points about dementia. The World Health Organisation regards dementia as a often fatal disease of the brain. The main research opinion in the USA regards dementia likewise. In Australia and Japan the same stands true. In Japan their national medical body tried to do what The NHS did to play it down as a social condition and it didnt work..

You will all be probably be aware of the usual line of thought that dementia is a natural
part of growing old. Well this is not the case the usual forgetting of things as we get older is now in the States proved to be NOT THE SAME AS DEMENTIAS.

Another thought-provoking thought. If dementia is an inevitable part of the process of growing old then why do children have dementia? Yes the numbers are not great and the causes far more varied but the fact that they exist at all seriously questions in my opinion the rigid viewpoints of the NHS. I have read one case of a baby born with dementia. One researcher claimed to find evidence of dementia in the womb.

Dementia occurs throughout all age groups and there are many causes, some of which are genetic. The NHS argues that dementia is not a single disease but a syndrome of symptoms.
The truth is the symptoms are more signs of what to me indicates neurological programme systems failure. If you can picture in the brain a result not totally unlike that in a computer where a virus takes hold which gradually takes out file after file of programmed information. Programmed information that allows us to do what we take for granted.
Until the brain/computer system crashes and what we see is the all too common withdrawn state of the dementia sufferer.

There are indeed many causes of this but the end result is the same. I could put a topic on all of this if you think it might bring a new light on our situations?

Kind regards Ian

Thanks Ian.

It was, I suspect and insightful Freudian slip on behalf of the chair nurse assessor who seemed to be stuggling with the language and content of the whole procedure. Meant here as an ironic funny for the forum, but in actuality not that hilarious.

If anyone would like some more I'll post a section of the latest PCT letter which demonstrates an ability to try and wriggle through "healthcare need" and "socialcare needs" with more turns than The Artful Dodger could manage.

If this would help others to be forewarned and help me to prep for the next stage I'll gladly post it.

Re Steves post no.10 Is the contents of the briefing document a secret or can this be shared?

Thanks

with reference to post 10 again is there any chance of all forum members receiving this brief.Has we are all
in the same position fighting PCT

All,

Care Standards Act 2000.

Pre amble from the DoH website

“This document contains a statement of national minimum standards published by the Secretary of State under section 23(1) of the Care Standards Act 2000. The statement is applicable to care homes (as defined by section 3 of that Act) which provide accommodation, together with nursing or personal care, for older people…”

Section 121 (General interpretation etc.) of Care Standards Act 2000.

121.9 States “An establishment is not a care home for the purposes of this Act unless the care which it provides includes assistance with bodily functions where such assistance is required”.

However;

121.3 States “In this Act, the expression "personal care" does not include any prescribed activity”.

Therefore (my view), the time spent on any activity resulting from a patients singular or double incontinence, which has a care plan specifically written (prescribed activity) or any specific help with eating cannot be counted as something care home assistants can be concerned with and therefore beyond the scope of 21(1) of the NAA.

Likewise, I would also question if there is a care plan for a patient that details (prescribed activity) what personal care and/or care and attention should be provided, then again could be read as beyond the scope of 21(1) NAA.

This (again my view) would back up the statement that LA’s can only provide nursing care if its incidental or ancillary to accommodation. ‘Prescribed activity’ certainly doesn’t sound like something incidental or ancillary to me?

Thoughts anyone?

Thanks, That's another thing to think about, a tack to try and to fire back. Anything approaching a definition of Prescribed Activity in the scedule to the Act or in guidance notes to Care Standards Act 2000 I wonder?
I'll go hunting for that once I've gone through all the sections repealed or otherwise by the Various incarnations of Health Service Act 1946 to present day...... which should see me out! This is soooooo labour intensive