APPENDIX 8
Memorandum by BUPA (CC 13)
SUMMARY
BUPA welcomes the Committee's Inquiry into NHS
continuing care and broadly advocates a national framework for
NHS continuing care. We recommend that rather than develop a new
tool for assessing continuing care the NHS adopts the internationally
used and well-established Minimum Data Set. We also suggest that
the various assessments should be consolidated into a single assessment.
In addition, we propose that a single assessment be repeated in
a structured manner for those eligible and ineligible at time
of entry into care to ensure those with progressive conditions
do not get forgotten.
INTRODUCTION
BUPA is a global health and care organisation
with eight million members and over 40,000 employees in 192 countries.
We are a provident association, which means that any profit we
make is re-invested in better health and care services. BUPA's
interests include health insurance, hospitals, nursing and care
homes, health assessments, occupational health and recruitment
services.
BUPA Care Services is the UK's leading care
home operator caring for over 16,000 residents in 258 care homes.
The NHS or local authorities fund more than 70% of BUPA's residents.
We have around 5,000 dementia care beds in our care homes across
the UK. A recent census of our care homes revealed that over 90%
of BUPA's care home residents were admitted as a result of defined
medical conditions and associated disabilities and over 70% of
admissions were related to dementia, stroke or Parkinson's disease.
BUPA is submitting this evidence on behalf of
BUPA Care Services.
1. THE WRITTEN
MINISTERIAL STATEMENT
ON NHS CONTINUING
CARE ISSUED
BY DR
STEPHEN LADYMAN
ON 9 DECEMBER
2004
BUPA broadly welcomes Dr Stephen Ladyman's announcement
of the development of a national approach to continuing care.
BUPA has long advocated a national consistent approach to assessment
for NHS continuing care. This is due to our concerns about the
inconsistent and unsystematic way the current assessment criteria
are used, which often mean many older people are unfairly denied
their care entitlement.
2. HOW THE
CHANGES WILL
BUILD ON
THE WORK
ALREADY UNDERTAKEN
BY STRATEGIC
HEALTH AUTHORITIES
IN REVIEWING
CRITERIA FOR
NHS CONTINUING CARE
AND DEVELOPING
POLICIES
From BUPA's experience Strategic Health Authorities
do not proactively seek eligible cases and do not seem to routinely
question whether individuals are eligible for fully funded care.
In addition, decisions about eligibility are not currently publicly
reported.
BUPA advocates a consistent national approach
to assessment. Rather than delay implementation further through
the development of a new assessment tool, BUPA would support the
use of the internationally used and well proven Minimum Data Set
(MDS).
At the same time as implementing a consistent
national approach to assessment BUPA recommends a consolidation
of the assessments for eligibility for NHS continuing care and
NHS continuing support in the form of the "Registered Nursing
Care Contribution to Care" (RNCC). The current system is
both complex and confusing and so a single assessment would highlight
to individuals their responsibilities for funding personal care.
A clearer and consistent assessment process
will not only benefit patients but also health care regulators
by enabling them to determine the appropriateness of care being
commissioned.
3. WHETHER THE
REVIEW OF
PAST FUNDING
DECISIONS HAS
SUCCEEDED IN
ADDRESSING THE
NEEDS OF
PATIENTS WRONGLY
DENIED NHS FUNDING
FOR THEIR
LONG-TERM
CARE
Despite the Ombudsman's involvement, there are
cases where individuals have been denied funding due to their
ineligibility at the time of entry into care but due to progressive
diseases they may subsequently meet the criteria. Planned reassessment
of those who are ineligible for fully funded care at the point
of entry is rare. By comparison those who are eligible and are
regularly reviewed to ensure they are still eligible.
Since chronic diseases like Alzheimer's are
progressive, some patients who do not meet the eligibility criteria
initially may do so later. BUPA therefore recommends that the
single assessment should be repeated in a structured manner. This
would avoid eligible people failing to receive the help to which
they are entitled.
4. WHAT FURTHER
DEVELOPMENTS ARE
REQUIRED TO
SUPPORT THE
IMPLEMENTATION OF
A NATIONAL
FRAMEWORK?
BUPA encourages the Committee to support a statutory
requirement for a standard single assessment measurement for all
types of care. A programme of staff training and support must
accompany the implementation of a national framework for continuing
care. We also recommend that the process of assessment for eligibility
be monitored in a structured manner by a regulator.
February 2005
| 
