New continuing care framework

Since the Coughlan judgement seven years ago, the “system” for deciding who should receive free continuing care on the NHS has lurched from crisis to crisis. The judgement should have clarified the boundary between free health care and means-tested social care; instead, neither it, nor the numerous attempts of the health service ombudsman, nor the three sets of guidance produced by the government have succeeded in dispelling the fog of confusion emanating from the NHS. Now the Department of Health has begun consulting on yet more guidance, should we be any more hopeful?

The answer, we courageously suggest, is yes. First, the proposed National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care in England is just what it says on the tin, a national set of eligibility criteria. If implemented, it ought to put an end to those divisive claims of a postcode lottery in care provision, where, in extreme cases, Mr Smith on one side of the street gets free care while Mrs Jones opposite has to pay despite having the same needs. It also re-emphasises something that the NHS has sometimes chosen to ignore, namely that eligibility for fully funded continuing care depends on the client’s needs, not on the location in which care is provided nor on the professional background of the person providing it.

In its promise of enforcement and threat of sanctions for non-compliance the DH evidently means business. It sets out four sensible key indicators for assessing need – nature, complexity, intensity and unpredictability – and has published a draft “assessment tool” for the purpose.

The main worry is inevitably money. The three-tier “payment bands” for NHS-funded nursing care will be replaced by a weekly average of 97. It is unclear how this will work in practice, whether some will be paid more and some less, or whether this figure is intended as the norm. Those currently in the top band of 133 could lose out unless there is more clarity about what is intended here. And when it comes to deciding who has health needs, the NHS continues to call the shots. The contest isn’t over yet.

See Continuing care criteria raise hopes that thousands will receive funding