Memorandum by the Department of Health
NHS CONTINUING CARE
1. The Government welcomes the opportunity
provided by the Select Committee Inquiry to set out the range
of policy initiatives that form the National Approach to continuing
care, and to comment on the progress made in reviewing past funding
2. Considerable progress has been made in
the development of continuing care since the early 1990s. In 1995
the Department issued guidance requiring health authorities to
develop eligibility for continuing care. Following the Coughlan
judgement, a legal case from 1999, which provided some clarification
of the responsibilities of the NHS and social services for long
term care, the Department issued further guidance in 1999, and
again in 2001. The former required Strategic Health Authorities
(SHAs) to ensure that their criteria were Coughlan compliant,
and the latter provided further consolidation. Following shortcomings
raised by the Health Service Ombudsman's report in 2003, the Department
responded to her recommendations including providing appropriate
recompense for those who were wrongly made to pay for the cost
of their care. Following the amalgamation of the numerous former
health authority criteria, to the 28 legally compliant SHA criteria
it is now an opportune time to revisit the area and to improve
practice and understanding. The Department would like to remind
the Committee that three written ministerial statements have been
made on the subject of continuing care in June, September and
December of 2004.
NHS CONTINUING CARE
3. The Department acknowledges the work
already carried out by the SHAs in bringing together past criteria
from over 95 sets into 28 sets of legally compliant eligibility
criteria. In addition, the independent report on SHAs' work on
reviewing criteria and retrospective case reviews made clear how
this has raised awareness and knowledge of the issues within the
NHS. It is important that the momentum and progress are not lost.
4. The Department is working with the SHAs
and other key stakeholders to establish the issues that the National
Framework for continuing care should address. Other key stakeholders
involved in this process are local authorities, voluntary organisations
and the Ombudsman's office.
5. One aspect of this framework will be
developing a single national set of eligibility criteria. The
SHAs have direct experience of amalgamating these eligibility
criteria, and as such we will be working closely with them in
order to learn from their past experiences, and from their best
practice, to create a set of eligibility criteria that will be
used by all 28 SHAs.
6. The Department will issue guidance around
the implementation and application of these criteria, and will
of course consult with all the key stakeholders and relevant bodies
before its publication. This guidance will be drawn up following
close working with SHAs.
7. SHAs have also developed local protocols
in many areas for conducting the continuing care assessment process.
The Department is setting up a website and discussion forum on
continuing care which will facilitate the dissemination of best
practice. The Health and Social Care Change Agent Team are also
amalgamating current best practice protocols, and will be working
with the Department and SHAs in order to issue best practice guidelines
around issues which will make the assessment process easier to
understand and to operate. This national framework of process
and best practice will introduce a consistency of approach and
8. The Department will also work with its
stakeholders including SHAs to look at the current range of assessment
tools, and their role in the assessment process. Based on a consideration
of all the benefits and drawbacks of the use of tools, the Department
will agree an approach with SHAs.
9. The Department has met on several occasions
with SHAs at a national level in order to work on the National
Framework. As a result of these meetings several workgroups have
been set up covering areas such as NHS funded nursing care bands,
training and public awareness, assessment tools and process, panel
process, the integration of eligibility criteria, and interaction
with local authorities. The national group have met twice to date,
and the first workgroup on eligibility criteria has also already
10. This work will continue to raise the
profile of continuing care within the NHS and aims to improve
the public's understanding of eligibility, and of the assessment
DENIED NHS FUNDING
11. Strategic health authorities have been
required to investigate cases where individuals may have been
inappropriately denied fully funded NHS continuing care since
1996. Where investigations have revealed that care should have
been provided the NHS has been recompensing individuals for the
cost of that care. This process has formed part of the Department's
response to the Health Service Ombudsman's report into long term
care, which was published in February 2003.
12. The review of past funding decisions
has in many cases concerned individuals who are now deceased.
Where individuals are living the assessment has also meant that
individuals future care needs (as well as funding) have been addressed.
13. The number and complex nature of cases
that arose, further complicated in many cases by the difficulty
of obtaining the relevant documentation for deceased patients,
or care home records which date back a considerable number of
years, has meant that there was initially a backlog of cases.
14. The Department has been working with
SHAs with a low rate of completion to ensure that they have processes
in place to complete cases swiftly and thoroughly.
15. The Department is only aware of one
SHA where cases which were lodged before April 2004 have not been
completed, and dates for the completion of these cases have been
scheduled with the families concerned.
16. The NHS is committed to completing investigations
as accurately and thoroughly as possible, and is striving to meet
the aim of completing new requests within two months of the receipt
of all the relevant documentation.
17. Having developed the core of the framework,
there needs to be a successful implementation of the criteria,
tools, guidance and guidelines. Attention will need to be focused
on training, and a work group has been set up to look at the issues
of training and public awareness.
18. The Department is considering a range
of options which will improve the application of the policy at
a local level, including developing and endorsing packages of
training for front line assessors and practitioners.
19. The Department is looking forward to
the outcome of this inquiry, which will provide useful information
for this initiative.