NHS Funding and the Agricultural Health Landscape

As individuals age, they may face severe health challenges or chronic conditions such as dementia or heart disease, which often necessitate extended hospital stays or long-term specialist care. In the UK, the cost of social care is notably high, with average monthly fees of approximately £4,640 for residential homes, and nursing homes often more. Securing financial support for these services can be a complex process, heavily influenced by personal asset values and geographic location.

For farmers, the financial impact of ageing and requiring care is particularly challenging due to the integration of their business and personal lives. Many farmers have family members with vested interests in the farm’s assets, which complicates financial planning for care. This intertwining of personal and business assets often places farmers in a difficult position, worried about the future of their homes and businesses if they need care, especially since their assets frequently exceed local authority funding thresholds.

What funding is available?

The NHS provides free healthcare "from cradle to grave," irrespective of a person’s financial means and assets. In contrast, social care is not free and is means-tested. 

NHS Continuing Healthcare (CHC) funding is a package of funding available to those with a "primary health need." This funding, which covers the full cost of care (including those elements which would typically be considered social care) is not means-tested, however, it is reserved for individuals whose needs are so complex, intense, and unpredictable that they exceed the standard care social services would be expected to provide. Many individuals requiring specialist or care home support do not qualify for CHC funding.

In the absence of NHS CHC funding, individuals must rely on means-tested financial support as outlined in the Care Act 2014. Local authorities in England and Northern Ireland assess both the care needs and financial capacity of individuals to contribute to their care costs. Currently, anyone with capital assets over £23,250 must fully fund their care. This threshold is set to rise to £100,000 from October 2025. Those with assets between £14,250 and £23,250 must make partial contributions, while individuals with assets below £14,250 will only pay from their income.

The financial assessment includes a comprehensive review of savings, property, investments, and various income sources. Although some assets may be disregarded, farming assets, such as shares in a farm or farming partnership, pose unique challenges. Farming partnerships are not automatically disregarded, though temporary disregards may occasionally apply. For jointly owned assets, only the care user’s share is assessed, but a specialist valuation may be necessary to determine the exact value of their interest. Additionally, contributions towards land purchases, maintenance, or improvements can influence the financial assessment, as councils must evaluate the value of these beneficial interests.

Farming assets can be difficult to sell and often have limited market value, complicating their valuation for care funding purposes. Attempting to transfer assets to avoid care fees can trigger "deprivation of assets" rules, potentially leading to those assets being included back into the financial assessment.

When does NHS CHC apply?

NHS CHC financing is reserved for those with medical requirements that are complex, unpredictable, intense and go beyond what is typically provided by social services. To determine whether someone is eligible for NHS CHC funding, a two-stage assessment process is used:

• Checklist Stage: An initial screening assesses the individual’s well-being across 12 domains. This stage determines whether a full assessment for NHS CHC funding is needed.
• Decision Support Tool (DST) Stage: A multidisciplinary team conducts a detailed assessment using the DST, focusing on the complexity, intensity, and unpredictability of the individual’s needs. While the Checklist may indicate a primary health need, final eligibility is based on whether these needs meet the strict “primary health need” criteria.

Navigating the CHC funding process can be complex and varies by location. Thus, seeking specialist legal support is often advisable.

Legal experts can assist with advocacy during DST reviews, challenge eligibility decisions, and provide guidance on retrospective claims.

Their expertise can be crucial in managing the intricacies of the assessment process and securing the necessary support.

Written by Lauren Godfrey, Buckles Solicitors.

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