Warning over national framework after recipients lose out in pilot

The government has been warned against restricting eligibility for continuing care under its new national framework after tests of an early draft suggested many existing recipients would be excluded.

Hillingdon Council this week confirmed that, of 20 older people and 13 disabled people receiving continuing care, just two and four recipients from the respective groups were judged eligible for full funding under draft government criteria.

The information was contained in a leaked internal briefing by council officers. The Department of Health described the criteria used in Hillingdon as “an early draft to test the views of stakeholders [that] has been subject to ongoing revisions”.

John Dixon, co-chair of the Association of Directors of Social Services’ disabilities committee, said: “If a result like that was projected nationally there would be tremendous [financial] implications for service users and local authorities in terms of cost shunting from the NHS.”

That is because those denied continuing care would be forced to fund their long-term care themselves or receive funding from social services.

Kate Jopling, senior parliamentary officer at Help the Aged, said: “The government must act now to stop the unfairness and injustice faced by our older population needing long-term care. Enforcing stringent eligibility criteria is not the answer.”

The DH could fall foul of the courts and the health ombudsman, should it use overly restrictive criteria. In January, a High Court judge ordered Bexley Care Trust to reassess Maureen Grogan after using criteria that did not follow the 1999 Coughlan judgement, which stated that anyone with a “primary health need” should be eligible for continuing care (High Court joins chorus of criticism of ‘unclear’ continuing care system, 2 February).

In two highly critical reports, the health ombudsman has said that many people have been wrongly denied continuing care by overly restrictive criteria drawn up by strategic health authorities and their predecessor bodies.