Select Committee on Health Written Evidence


Letter from Dr Stephen Ladyman MP, Parliamentary Under-Secretary of State, Department of Health, to the Chairman of the Committee (PC 18E)


  When I appeared before the Committee's inquiry into palliative care, I made a commitment to clarify a number of matters around fully funded NHS care.

  Firstly, the Committee mentioned evidence they had heard that NHS bodies and social care authorities had argued over the provision of care for a dying person and that the NHS body imposed very short time limits (for example two weeks prior to death) before the dying person became eligible for continuing care. I stated that where a person is dying then they are eligible for fully funded NHS continuing care and it should be organised as a single coordinated package of care. I would like to confirm that all Strategic Health Authority criteria for fully funded NHS care are based on assessment of an individual's health care needs, and give as two examples of the type of needs which should be fully funded by the NHS:

    —  The individual has a rapidly deteriorating or unstable medical, physical or mental health condition and requires regular supervision by a member of the NHS multidisciplinary team, such as the consultant, palliative care, therapy or other NHS member of the team.

    —  The individual is in the final stages of a terminal illness and is likely to die in the near future.

  All are clear that while life expectancy may be given as an example of one criteria which may indicate eligibility for fully funded care, this is not the only criterion nor is the application of strict time limits appropriate. The level and type of care required is the over-riding criteria, not the diagnosis or prognosis. I can assure the Committee that no SHA has a criterion that you cannot receive fully funded continuing care unless you are going to die within two (or any other number of) weeks.

  Secondly, as I said in my evidence, we are aware that these criteria were not correctly or consistently applied in the past and this was confirmed by the Ombudsman's report in February 2003. Examples of poor practice, of which the Committee heard evidence, may be from a time prior to autumn 2003 when all 28 Strategic Health Authorities (SHAs) had reviewed and aligned their eligibility criteria to ensure that the criteria fully reflected the Coughlan judgement. In addition the extensive exercise undertaken by the SHAs in both revising the criteria, and investigating and reviewing the thousands of past cases where an incorrect decision may have been made, has raised awareness and consistency of application of NHS continuing care criteria. Awareness within the NHS, and training in the consistent application of criteria, must both continue in the future. This will be reinforced by the Continuing Care (National Health Service Responsibilities) and Delayed Discharge (Continuing Care) Directions, which were developed following the Community Care (Delayed Discharges etc) Act 2003. These Directions strengthen the legal framework for provision of assessments and agreement of criteria for fully funded NHS continuing care, both in the hospital and community settings. They ensure that patients' eligibility for NHS continuing care is considered explicitly before they are discharged from hospital.

  There are two sources of information on how effective the work on revision, review and restitution has been across the NHS. One is the progress which SHAs have made in reviewing and correcting past decisions and I have enclosed, as an annex, for your reference the text of the statement that I have made today to the House on this issue. The other is a recently completed review of how a representative sample of nine SHAs have approached both the setting of a single set of criteria across the SHA and the process of investigation and restitution of past decisions. Having considered both of these pieces of information, together with the criteria used in each SHA, I will make a decision on what further guidance, if any, the NHS may need on this subject. I will also publish the report of the review of progress in the nine SHAs.

  I hope that, as I promised the Committee, this sets out the precise nature of the information which has been gathered, and the work which remains to be done, on the issue of NHS funded continuing care.

June 2004

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