Even those who were most critical of the Westminster
government’s decision to pay for nursing care and means-test
personal care thought they had won a partial victory. The principle
that nursing care, wherever provided, should be free at the point
of delivery appeared to have prevailed.
Well, not quite. It has been suspected for a while that the
Department of Health’s definition of nursing care would differ from
any common sense notion of it, and so it has proved.
If its new draft guidance on free nursing care in nursing homes
was supposed to mark off health care needs from social care needs,
it is a dismal failure. Instead, some health care in nursing homes
will be paid for by the state, but some won’t because nursing care
has been given an excessively narrow interpretation. It is as if
someone, asked to trace the border between England and Wales, had
drawn the line through Birmingham. The result, of course, pleases
“A slap with a cold flannel” was how Frank Ursell of the
Registered Nursing Home Association described the proposals.
Self-funding clients are angry because they will receive an average
of £85 a week to fund their nursing care.
They will get nothing to pay for nursing tasks delegated to
health care assistants, such as dressing ulcers and pressure sores,
although these mundane ministrations are a large part of day-to-day
health maintenance for them just as they are for their non
fee-paying counterparts in hospitals.
Nurses are upset because they have got to assess 35,000 clients
for nursing care needs by October. They dislike having to become
“gatekeepers to care”, rationing services to patients in whose best
interests they should be acting, and are anxious because they will
have as little as 10 minutes to spend on each assessment.
Social workers, for many of whom hurried assessments and service
rationing are a necessary evil, may well empathise. They will point
to last year’s £750 million government underspend on health
and local authority services as evidence that too many needs are
going unmet. But social workers ought to be angry too at the way
the government has handed responsibility for deciding the
difference between nursing care and personal care to nurses
Does the government think social workers have nothing worthwhile
to say about clients who straddle the boundary between health and
social care? Not only has it allowed the boundary to be drawn in
the wrong place, it has allowed it to be drawn by the wrong