Open Forum

The sick are being wrongly denied continuing care because of the way in which primary care trusts are applying strategic health authority eligibility criteria. These people then either become the responsibility of the local authority or fund themselves depending on their financial situation.

People likely to die in the “near future” (and this definition is taken from Department of Health national guidance) should automatically qualify. Local criteria suggests “near future” means four to six weeks from death while some councils suggest 12 weeks. Doctors should not be asked to guess a timescale so short. Moreover, no delay should be acceptable once a person has a diagnosis that needs palliative care. Also, prognoses are often wrong and consequently people lose out financially.

At a Help the Hospices workshop on continuing care in 2003, delegates were told of payments being delayed for anything from four weeks to six months. This led DH representatives to tell delegates that applying these timescales was not in the spirit of the guidance.

While the continuing care national framework is due imminently, I don’t believe it will improve things.

What is needed is an enormous cash injection to ensure that people are provided with adequate services, but with a £700m NHS deficit and redundancies abounding, this is unlikely.

Ignorance about continuing care is rife. The policy has been so inaccessible and inexplicable (even to most professionals), that patients and their families are mostly unaware of its existence and their rights. Most ofthose who are dying will have neither the stamina nor the time to go to the ombudsman. And the Department of Health is unlikely to have the resources to end the lottery even if it does better promote its policy.

So it looks like the cost shunting will continue as cash-starved local authorities and people who are dying pick up the tab.

Annie Warburton-Stephens has worked in hospice social work and management, and is currently a carer


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