Letter from Dr Stephen Ladyman MP, Parliamentary
Under-Secretary of State, Department of Health, to the Chairman
of the Committee (PC 18E)
EVIDENCE TO HEALTH SELECT COMMITTEE, 26 MAY
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
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.