APPENDIX 4
Memorandum by the NHFA (CC 08)
THE WRITTEN
MINISTERIAL STATEMENT
ON NHS CONTINUING
CARE ISSUED
BY DR
STEPHEN LADYMAN
ON 9 DECEMBER
2004
"The Parliamentary Under-Secretary of
State for Health (Dr Stephen Ladyman): Today I am commissioning
the development of a national consistent approach to assessment
for fully funded national health service continuing care and announce
the publication of the independent report on continuing care entitled
"Continuing Health Care: Review, Revision and Restitution".
I would like to acknowledge the work during 2003-04 carried out
in bringing together more than 95 health authority criteria into
the legally compliant 28 strategic health authority (SHA) criteria
which exist today. Having achieved this objective and significantly
improved arrangements for assessing new cases, and having made
good progress with the retrospective review of cases where people
have been wrongly denied funding in the past, it is now practical
to move forward and improve the system further. The Department
will work with the SHAs to build on all the good work done so
far. Learning from good practice, we will produce a national approach
to continuing care to improve consistency and ease of understanding.
We want to help to achieve these aims. This does not constitute
a break from past practice. As I have said before all the current
criteria are fair and legal. It will however make the process
easier to understand for practitioners and patients alike."
HOW THE
CHANGES WILL
BUILD ON
THE WORK
ALREADY UNDERTAKEN
BY STRATEGIC
HEALTH AUTHORITIES
IN REVIEWING
CRITERIA FOR
NHS CONTINUING CARE
AND DEVELOPING
POLICIES
— The assessment process for determination
of eligibility to NHS continuing care needs to be clearly defined
to identify responsibility for what is considered to be the "grey"
areas between health and social care—see table below.
— For those resident in nursing homes
the point at which they are assessed for their level of Registered
Nursing Care Contribution (RNCC) would also be an effective time
to identify eligibility to continuing care funding. Lead nurses
conducting these assessments should be trained to identify such
cases based on a uniform nationally adopted assessment process/tool.
— As health changes so do needs therefore
regular reviews of assessments in a timely manner need to be carried
out as mandatory.
— Some cases retrospectively considered
to be eligible to fully funded NHS care were previously either
banded as middle or high dependency in determining their RNCC.
The definition of these bands needs to be examined and redefined
to separate them from each other and eligibility to continuing
care.
— Self-funding care home residents
must not be overlooked. NHFA care advice line is aware of cases
that once identified as self-funding are often left to their own
devices in seeking care, particularly on discharge from hospital.
This can lead to inappropriate care being chosen either a nursing
home where if assessed residential care funding would only be
offered or into care homes that are more expensive than local
or health authorities would be prepared to pay for if the individuals
resources fell below the LA means test limit or they became eligible
for continuing care funding.
— Multi-disciplinary assessments to include
qualified medical staff are essential to determine all the patients
care needs. Such initial assessments and regular reviews need
to be mandatory.
— Patients and their families need to be
made aware of the consequences of choosing accommodation that
may not be affordable over the long-term and instructed on how
to address this issue at the outset.
WHETHER THE
REVIEW OF
PAST FUNDING
DECISIONS HAS
SUCCEEDED IN
ADDRESSING THE
NEEDS OF
PATIENTS WRONGLY
DENIED NHS FUNDING
FOR THEIR
LONG-TERM
CARE
— NHFA experience indicates that many
cases reviewed were done so because of requests from their families
who were made aware of the possibility of continuing care funding
through the media or other sources. To be certain that all possible
cases have been reviewed families or representatives of all cases
that may have been eligible since 1996 should be written to offering
guidance on how to determine whether care received was primarily
health care as opposed to social care and, how to obtain a review
if appropriate.
— Local authority funded residents
should also be included. Although much of their care costs may
have been borne by the local authority many would have wrongly
contributed their pensions/welfare benefits which accruing over
time would not be an insignificant financial loss.
— Once assessed as being entitled to
NHS continuing care consideration needs to be given as to where
that care is delivered. Patients should be given the opportunity
to top-up NHS funding to facilitate a move to preferred accommodation.
— Many self-funding care home residents
may already reside in accommodation which is more costly than
the NHS would normally pay for and a subsequent entitlement to
NHS funding may require a move to less expensive accommodation.
Moving older people as this vulnerable stage of their lives can
be extremely detrimental to their health and well-being and, in
some cases could cause premature death.
WHAT FURTHER
DEVELOPMENTS ARE
REQUIRED TO
SUPPORT THE
IMPLEMENTATION OF
A NATIONAL
FRAMEWORK
The introduction of a single assessment
process/tool based on national criteria would assist in removing
the existing postcode lottery to continuing care funding. Training
programmes of assessors should be determined nationally and adopted
by all SHAs.
NHFA provides advice and information on obtaining
and paying for care. Combining advice to illustrate the affordability
of chosen care together with the many other complex issues older
people and their families should consider including local authority
charging procedures, health authority responsibilities, DWP benefits
and legal matters. The NHFA aims to enable older people receive
and choose appropriate care according to their personal circumstances
whilst also preserving their independence, dignity and right of
choice.
February 2005
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