The government has seriously underestimated the costs involved
in providing free nursing care to older people in nursing homes,
according to the Registered Nursing Home Association (RNHA).
A survey by the RNHA shows that nursing costs of some very
dependent patients could be as high as £420 a week. But the
maximum payment under the new banding scheme would be £110 a
Unison has also objected to the plans for funding, describing
them as “grossly inadequate”, and calling for the banding system to
be rejected. The union has written to health minister Jacqui
Its deputy general secretary, Keith Sonnet, said: “Provision
should be based on need and the NHS should meet the full cost of an
individual’s nursing and health care with no artificial cap on that
“As it stands, nurses may be put in a difficult position of
having to determine how much free nursing care a patient will
The union has also criticised the prospect of a two-tier system
of long-term care in the UK, which would see older people in
Scotland entitled to free provision of services while those in the
rest of the UK would have to pay. Sonnet said he could envisage a
scenario where “elderly people slip over the border to take
advantage of free nursing care they so desperately need”.
Concerns have also been raised by the Coalition for Quality in
Care, which has criticised a “too-narrow” definition of free
nursing that excludes the work of care assistants who perform
Another worry is that the guidance talks about nursing homes and
dual registered homes rather than care homes, which, according to
the coalition, ignores the changes to regulations to be introduced
under the Care Standards Act 2000.
Meanwhile, the charity Counsel and Care has warned that cost
considerations will be placed above older people’s choices when it
comes to selecting a nursing home.
Spokesperson Paul Martindale said: “Many local authorities
already ignore Department of Health directions on choice of
accommodation and restrict older people in homes which offer the
cheapest fees or with whom the authority has block- booked
He urged the government to ensure older people’s rights to
choice and control were promoted in the new arrangements.
However, the Department of Health said: “The provision of free
nursing care will not affect most older people’s choice of homes
and the majority of placements will continue to be made by local
councils. Only in cases where the homes are unable to match nursing
care needs of a person will choice be reduced.”
More than 130 organisations contributed to a four-week
consultation exercise on free nursing care, which ended last week,
and their responses are now being analysed.