Local continuing care criteria are heading for a national shake-up, writes care services minister Ivan Lewis

Since the 1990s, when patients in long-stay hospitals started moving into the community, the NHS has faced the task of deciding which patients should remain its responsibility in community settings.

Developments such as the Coughlan judgment and the introduction of NHS-funded nursing care in October 2001 have influenced the development of continuing care. Over time, the system has become, stated the Commons health select committee, “characterised by confusion, complexity and inequity” – and one where accusations of a postcode lottery persist.

In response to these criticisms, the government has set out its proposals for a national framework. Implementing this framework will do away with the many local continuing care policies, creating a single set of national criteria on who should be eligible for NHS continuing healthcare and NHS-funded nursing care.

A coherent assessment process will ensure that patients are correctly assessed for NHS funding at the right time, regardless of setting. This assessment process will be supported by a national assessment tool to promote consistent decision-making.

The national framework is explicit about the principles that underpin this policy – that decisions are made on the basis of the individual’s needs, not their diagnosis, nor location, nor who provides the care. The proposals also suggest reforms to remove the complicated banding system for NHS-funded nursing care, and replacing this with a single weekly rate.

The national framework does not attempt to change which services the NHS provides, nor does it answer the questions on the health and social care divide, or charging for social care. But we must not forget that social care has never been free on the NHS and no government could afford to provide it free. What our framework does do, however, is propose a system that is simpler, fairer and easier to operate.

We encourage anyone with an interest to send us their comments.

Ivan Lewis is care services minister, Department of Health

* New continuing care eligility proposals. For: Stephen Burke,  Against: Mervyn Kohler

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