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It is estimated that as many as one in three women and one in five men will eventually require long term residential care. While in the past, people requiring long term residential care were likely to be cared for in NHS long stay community hospitals, entirely funded by the NHS, the number of hospitals providing such care has dwindled over the past twenty years. In many respects this has been a positive change, enabling more people to be cared for in their own homes. However, it has also meant that increasing numbers of people who would previously have received free NHS care, are now cared for in private, fee-paying residential or nursing homes. How this care should be funded has been a contentious issue for over a decade.
Current arrangements for funding long term care are beset with complexity, and lack of clear Government guidance has led to widespread variations across the country. The artificial barriers between health and social care lie at the heart of the problems surrounding access to continuing care funding. It will be impossible to resolve these problems without first establishing a fully integrated health and social care system. We have therefore recommended, as this Committee and its predecessor Committees have done on numerous previous occasions, that the Government removes the structural division between health and social care.
Recognising that this radical reorganisation will take time, we have also made a number of recommendations for the Government's forthcoming national framework for NHS continuing care. First and foremost, the framework must include the establishment of a long-overdue single set of national eligibility criteria for continuing care to end the 'postcode lottery' in access to continuing care funding. Rather than solely focusing on physical health, these criteria must also take full account of psychological and mental health needs. They should also be rigorously reviewed to ensure they are compliant with the tests established by the Coughlan judgement.
It is also crucial that the Government underpins its national eligibility criteria with the establishment of a national standard assessment methodology to ensure assessments against national criteria are carried out robustly and uniformly across the country.
There are currently two parallel systems for funding NHS continuing care and for funding nursing care for those who do not qualify for fully funded NHS continuing care, and overlap between these is causing major confusion. We have therefore recommended that these two systems are integrated.
Very worryingly, our evidence suggested that the current systems reward dependency rather than encouraging care staff to help increase and maintain patients' independence. We have therefore recommended that the system for funding continuing care and nursing care is redesigned, so that the system has inbuilt incentives which reward high quality care and promote rehabilitation and independence.
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