Many hope that the consultation on continuing care eligibility criteria will sort out the confusion that reigns across the country, But while Stephen Burke is a fan of the proposals, Mervyn Kohler is sceptical
Stephen Burke – Chief executive of Counsel and Care
The Department of Health proposes a national framework to replace the local eligibility criteria used by individual health trusts.
It has long been recognised that the system for continuing NHS health care funding is fatally flawed – it is highly complex and is accompanied by too many variables. The differences in individual strategic health authority criteria, the type of illness, the location of the patient, and in some cases a failure to consider someone for an assessment, have all contributed to the postcode lottery associated with this funding. Inconsistency in application of the criteria has resulted in people with very different health needs receiving funding.
Counsel and Care advises many older people and their families and carers about how this system works, who to contact to arrange an assessment for the funding, and how to obtain a review if there is concern about eligibility. The attention now being focused on their struggle is long overdue.
Strenuous campaigning and lobbying of DH ministers has begun the turnaround, with officials acknowledging that there is vast room for improvement in the system and that changes are crucial. In June, care services minister Ivan Lewis launched a consultation gathering opinions on the proposals for an overhaul of the criteria for the funding and how they are applied in practice.
National eligibility criteria will mean that there are fewer people falling foul of individual primary care trust policies. One of the most frustrating aspects of the current system is its lack of consistency, and the new national criteria will help remedy this. What is proposed is an infinitely more coherent and user-friendly way of allocating funding in these cases.
Under the new system the most urgent cases could be fast-tracked – this will save time for the people who require the most urgent treatment, or who are nearing the end of life. Currently the system lets this group down badly, with additional stress created through bureaucracy.
The proposed framework also offers a solution to the problems caused by assessments for the nursing band system for nursing care in residential care homes. Creating one band that meets all needs will cut the need for multiple reassessments, and reviews.
Much of the success of the framework would rely on individual health practitioners being aware of the existence of continuing care and nursing care funding and undertaking an assessment of needs in relation to this. There are also issues to be resolved in terms of the divide between health and social care systems. It is essential that all professionals who have contact with vulnerable people are aware of this policy.
Reassessment of needs continues to be crucial, but should be sensitive. Being the subject of constant reassessment causes stress for patients and families, but there needs to be a balance between over-assessment and missing people whose needs have changed so they become eligible.
Doubts aside, this policy consultation should be welcomed. It has the potential to vastly improve what is currently a complex and confusing system. As with most policies, success will be achieved by those people who implement the policy. We need to make sure that healthcare professionals are fully on board.
Mervyn Kohler- Head of public affairs at Help the Aged
If consultations could resolve the various ilemma in this field, we should be well on the way to a Rolls Royce solution by now, or at least a reliable Ford. But the flood of consultations sponsored by the Department of Health seldom addresses the idea of building a car: they seem intent on designing powered roller blades or jet packs, or simply finding new ways to exhort people to get on their bikes.
Now we have another: a consultation on a National Framework for NHS Continuing Care and NHS-funded Nursing Care in England. The titles seem to lengthen as the levels of frustration rise. This one is beginning to show a scintilla of common sense.
First, some context. A report last month from BUPA Care Homes and others provided a census of the health of 32,000 people in residential and nursing care homes. It found that 72 per cent either were immobile or needed help with mobility, 62 per cent were confused or forgetful, and a quarter suffered the triple whammy of being immobile, confused and incontinent. These people clearly have medical needs, but insofar as they do not require qualified medical attention, they are part of the fuzzy world of social care, which is rationed by means-testing and assessments.
The good bit – the touch of common sense – is the fresh commitment to a genuinely common foundation for assessment. It was always nonsense to have each strategic health authority applying its own system: inevitably it has led to different levels of provision in different areas of the UK. But the consultation still manages to set itself apart from the world of clarity and simplicity, and has dressed up the process by prescribing an assessment against four key indicators, each of which is open to wide interpretation. Describing an individual’s physical, mental or psychological care needs with words such as “elastic as nature”, “complexity”, “intensity” and “unpredictability” is still likely to lead to a range of different outcomes – we shall replace a postcode lottery with a linguistic one. In addition, there will now be a decision- support tool, and the key indicators will be read across nine “care domains”. This implies a rather daunting administrative process, which could degenerate into a simplistic tick-box exercise, and hardly makes it easy for customers or their carers to feel at the centre of planning and choosing their options for care and support. In fact, the primary care trusts will tend to become the arbiter establishing the “primary health need”, and thus the NHS funding available to the patient.
There is little to say about collapsing the three bands into one – most people have ended up in the central band anyway. But there is a touch of desperation about this lurch to simplicity: it seems we are giving up the attempt to acknowledge that people’s health needs do indeed vary tremendously.
This is partly because the consultation has no ambition to “change the underlying legal framework on www.communitycare.co.uk 20-26 July 2006 communitycare 29 which current eligibility policies should be based”. Another opportunity lost, then, to explore the more radical ideas in the Wanless Review and the work of the Joseph Rowntree Foundation, which have sought to get to the crux of the funding issues. So long as social care is the responsibility of two bureaucracies perpetually passing the parcel, we shall have complexity and unfairness, and as we try to build in more flexibility we only add further complexity.
The judgements made under the aegis of this framework will still vex those who are immobile and incontinent, and who will feel that, at the point in their lives when their health let them down, the NHS was not there to help them.