Issues that may arise with cross-border placements
What if the person leaves the accommodation?
In general terms, if the person who has been placed cross-border subsequently leaves the accommodation of their own volition and, for instance, enters a tenancy agreement in rented accommodation in the area in which they had been placed, they will normally become ordinarily resident in that area. However, the position in Scotland is different. A person in this case would only become ordinarily resident in a Scottish authority if they had capacity to make decisions about living arrangements or the decision to reside there was taken by someone authorised to do so on their behalf. Therefore, the authority in which they had been placed would become responsible for any social care needs. This would be the case even if the person’s needs remained the same.
However, there may be cases where the person leaves the accommodation provided by the local authority in circumstances which do not result from a voluntary decision. For example, this may occur because of de-registration, provider failure (see discussion on the relevant regulations below) or a dispute with the authority about the quality of the accommodation or the services being provided. In such cases the question of whether the person remains the responsibility of the first authority will need careful consideration and practitioners would need to consider the relevant ordinary residence guidance (set out earlier in this guidance) in the light of the circumstances of the case.
What if the care home de-registers?
Sometimes a care home may ‘de-register’ and become accommodation with support, with the individual signing their own tenancy agreement (if they have capacity to do so). In some cases the individual will be agreeing to continue with the same arrangements, live in the same place and receive the same services.
If a person lacks capacity to sign the tenancy agreement the relevant mental capacity legislation will need to be considered (see above). For instance, in Scotland only the person with legal authority would be authorised to sign.
What if the person requires a stay in NHS or health accommodation?
If NHS or health accommodation is needed during the placement, for any period of time, responsibility for the person’s social care needs will not alter. In other words, the first authority will continue to be responsible overall for the individual’s placement and social care needs.
During the placement in NHS or health accommodation it is normal practice for a ‘retention fee’ to be paid to the care provider to ensure the individual’s place is secured. This is the responsibility of the first authority.
What if the person requires NHS-funded nursing care?
In England, Scotland and Wales, if a care home resident requires nursing care, but nursing is not his or her primary need, the relevant NHS body will pay part of the care costs. This contribution is known as NHS-funded nursing care.
In Northern Ireland, the relevant health and social care trust is responsible for the provision of nursing care to people in care homes. In Northern Ireland, in order to qualify for the nursing payment, the person must be responsible for the full costs of their nursing home care and the person must also be assessed as needing nursing care.
Where, prior to the cross-border placement, the person is in receipt of NHS-funded nursing care (or it is evident that they have a need for such care), the relevant authorities should work together to ensure this continues to be provided (or is provided) from the start of the placement. The relevant authorities will include:
- The first authority.
- The NHS body (or health and social care trust in Northern Ireland) delivering the care.
- The NHS body (or health and social care trust in Northern Ireland) funding the care.
- The care provider prior to the placement commencing.
Where the need for NHS-funded nursing care becomes evident after the placement has commenced, the relevant authorities and the NHS body (or health and social care trust in Northern Ireland) should work together to ensure this is provided without delay.
Early (indeed advance) engagement with the NHS body (or health and social care trust in Northern Ireland) in such circumstances is important in ensuring smooth and integrated provision of services in cross-border placements.
The four UK governments have reached separate bilateral agreements as to which NHS body (or health and social care trust in Northern Ireland) should be responsible for t he cost of NHS-funded nursing care required for individuals placed cross-border into a care home. (25) In general terms:
- where the cross-border placement is between England and Scotland or between England and Northern Ireland (in either direction) the health service of the country of the first authority will be responsible for nursing costs
- where the cross-border placement is between England and Wales (in either direction), the second authority’s health service will be responsible for the costs of NHS nursing care
- where the cross-border placement is between Wales and Scotland, Wales and Northern Ireland, or between Scotland and Northern Ireland, the first authority’s health service will retain responsibility for the costs of NHS-funded nursing care.
Placement from England:
- Placement to Scotland: Clinical commissioning group (England)
- Placement to Wales: Local health board (Wales)
- Placement to Northern Ireland: Clinical commissioning group (England)
Placement from Scotland:
- Placement to England: NHS board (Scotland)
- Placement to Wales: NHS board (Scotland)
- Placement to Northern Ireland: NHS board (Scotland)
Placement from Wales:
- Placement to England: Clinical commissioning group (England)
- Placement to Scotland: Local health board (Wales)
- Placement to Northern Ireland: Local health board (Wales)
Placement from Northern Ireland:
- Placement to England: Health and social care trust (NI)
- Placement to Scotland: Health and social care trust (NI)
- Placement to Wales: Health and social care trust (NI)
What if the individual’s care needs change during the placement?
Any changes in the person’s needs should be picked up in the course of a review and the care plan amended as needed.
The first authority retains responsibility for review and amendment of the individual’s care plan, although it may have agreed with the second authority that the latter will assist it in certain ways. It is also open to the second authority to make any necessary arrangements that will assist the adult, and then seek additional payment subsequently from the funding authority, having agreed this beforehand with the first authority. In all of these cases, clarity and communication will be important as to each authority’s roles.