9 Conclusions
189. The
funding of long term care is a policy area which has, for over
ten years, been characterised by confusion, complexity and inequity.
Despite the considerable investment by Government in recent years
in researching, reviewing and changing systems for the funding
of long term care, it seems we are no closer to a fair and transparent
system that ensures security and dignity for people who need long
term care, and which promotes their independence.
190. The artificial
barriers between health and social care lie at the heart of the
problems surrounding access to continuing care funding, and we
believe that 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.
191. 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. The framework should
include:
- the establishment
of a single set of national criteria for continuing care, which
takes account of psychological and mental health needs as well
as physical, and which must be fully Coughlan-compliant
- the integration of the two parallel
systems for funding continuing care and nursing care, as overlap
is currently causing major confusion
- the establishment of a national
standard assessment methodology to ensure assessments against
national criteria are carried out robustly and uniformly across
the country, supported by a national training programme
- the redesigning of the system
for funding continuing care and nursing care, so that rather
than rewarding dependency, as the system currently does, the system
has inbuilt incentives which reward high quality care and promote
rehabilitation and independence
- the introduction of greater flexibility
in funding for NHS continuing care, to enable people to be cared
for more easily in their own homes, where that is their preference
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