Sector wants Ladyman to revamp long-term care funding criteria

    When community care minister Stephen Ladyman promised to produce a
    national framework for assessing funding for continuing care, he
    said it would not “constitute a break from past practice” and that
    current criteria “are fair and legal”.

    But according to health ombudsman Ann Abraham and many on the
    front line there has to be a break from past practice and there
    needs to be legal clarification of the different systems of
    assessment for care.

    Abraham’s December 2004 report on the issue found there was
    confusion about the distinction between continuing care, a care
    package fully funded by the NHS for people whose primary needs are
    health-related, and free nursing care, which only covers nursing
    costs.

    Currently, many people with significant health needs are being
    given the highest band of registered nursing care contribution
    (RNCC), rather than continuing care.

    In the case of someone in a nursing home, this would be around
    £125 per week and the rest of the charges – up to as much as
    £600-700 a week – would have to be made up by the individual
    or by means-tested social services payments. It is this distinction
    that is being challenged.

    Head of the ombudsman’s continuing care team Colin Houghton says
    legal advice given to the ombudsman about the way eligibility
    criteria are being used has been passed to the Department of
    Health.

    The DoH says it has promised to meet Houghton and his team to
    discuss their concerns.

    He says: “We are concerned about the RNCC. We have had counsel’s
    advice that it is very difficult to distinguish between the
    eligibility criteria, but we haven’t gone as far as to say it is
    unlawful to [only] give high band.”

    Houghton last month wrote to the DoH about the “huge confusion”
    surrounding free nursing. He says: “There really is a case that if
    you qualify for high band, you should get [continuing] care…
    However, we have not gone as far as saying everyone having
    high-band should have full-funding.”

    Houghton suggests the new framework might only work if the high
    band is scrapped. “In a new national framework, if they want to
    keep free nursing, a solution may be they might keep the low and
    medium bands.”
    Age Concern has also made the same point in its submission to the
    health select committee, which started its inquiry on continuing
    care funding this week. The charity’s care finance policy adviser
    Pauline Thompson says: “It is confusing nursing care guidance –
    they set the highest nursing bands at a level that is [equivalent
    to] continuing care. What we are saying is that the whole of the
    nursing criteria need to be sorted at the same time. They have got
    to pull nursing criteria into the Coughlan judgement (see below) –
    that is, when the primary needs are health needs, the NHS will fund
    it.”

    But in terms of what the national framework might look like,
    nobody is clear what the DoH intends to do. Houghton says: “Within
    the national framework, we are looking for a single set of national
    eligibility criteria. What we are looking for is something that is
    robust, transparent and open.”

    Thompson says: “If you have a national framework, there has to
    be one assessment tool. When you do the assessment, you should
    screen people in and not screen people out. It does open up the
    debate about how daft this whole divide between health and social
    care is.”

    Help The Aged public affairs officer Kate Joplin says: “The big
    thing is clarity and transparency, so someone can read the guidance
    themselves, and making easier the process for initial assessment
    and what happens if your situation changes.

    “National eligibility criteria are what we are looking for. It
    needs to link with the single assessment process and RNCC. Also we
    don’t think this whole issue is separate from the whole issue of
    personal care.”

    She claims that everyone recognises the system would be simpler
    if there wasn’t the issue of paying for personal care.

    “Ultimately, the government is going to have to tackle this. The
    whole thing is an absolute quagmire but there is a long-term
    solution, which is to get rid of the different systems,” she
    says.

    The NHS Confederation, which represents the NHS organisations
    that carry out assessments, has called for linking any new
    assessment framework with existing assessments.

    In its evidence to the select committee, it calls for assessment
    for continuing care to be linked to the single assessment process
    (SAP).

    It says that for patients under 65, the “multi-disciplinary
    assessment afforded by SAP is still the most pragmatic and suitable
    assessment tool available”. It says new assessment systems should
    not be necessary where that linkage is in place.

    The confederation’s evidence highlights the problem of how
    continuing care eligibility criteria can be applied to different
    client groups, to ensure both equality of access and care packages
    that reflect users’ needs.

    But the ombudsman’s office is concerned the government will not
    go far enough as it has said it will only build on strategic health
    authorities’ reassessments of past claims and their reviews of
    eligibility criteria, triggered by Abraham’s 2003 report.

    Houghton says: “[Ladyman] said this does not represent a break
    from the past, but we do want a break from past practice. We want a
    new national framework. We can’t just forget about all the [review]
    cases.”

    According to a government statement last September, about a
    fifth of cases reviewed were eligible for full funding at a cost to
    the NHS of about £180m. That cost may now rise significantly
    if many more cases are eligible as a result of referral back to
    strategic health authorities by the ombudsman. There is a lot
    riding on what happens to the funding of continuing care, and it is
    not just financial considerations.

    As health select committee chair David Hinchliffe says of its
    inquiry: “It brings into sharp focus the whole question of the way
    health and social care interact.”

    History of funding eligibility

    • 1996: Written criteria are first used in assessing funding for
      continuing care.
    • 1999: The Coughlan judgement rules that the NHS is responsible
      for paying for the care of patients whose needs were primarily
      health-based.
    • 2001: Department of Health issues guidance on continuing care
      eligibility.
    • August 2002: DoH asks SHAs to bring all former health authority
      criteria for eligibility into a single set.
    • February 2003: Health ombudsman Ann Abraham publishes a report
      highlighting problems across England for people trying to secure
      funding for continuing care, and calls for re-assessment of
      claims.
    • April 2003: DoH issues a suggested procedure for carrying out
      the retrospective reviews by December 2003. This is later revised
      to March 2004.
    • December 2004: Ombudsman publishes a follow-up report on NHS
      funding for long-term care. It says not all claims have yet been
      reviewed and calls for national eligibility criteria. Days prior to
      publication, health minister Stephen Ladyman says a national
      approach will be commissioned.
    • March 2005: Ombudsman says huge number of cases still waiting
      to be finished.

     

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