Health Committee

08 April 2005

08 April 2005



Elderly, disabled and other people with chronic and degenerative conditions, are subject to a 'postcode lottery' when trying to access NHS funding for their long term care.

Responding to the Government's announcement of a new national framework for NHS continuing care, the Commons Health Select Committee has called for urgent reform of the funding system to ensure that everyone gets a fair deal.

In their report, MPs concluded that funding arrangements are too complex and that a single set of new national eligibility criteria are required for NHS continuing care.

Currently, each strategic health authority uses their own set of criteria to determine someone's eligibility.

This means that while you might be forced to use your savings or the equity in your home, someone else a few miles away could receive their care for free.

MPs recommend that the national criteria take account of psychological and mental health needs, to ensure that people with dementia, as well as those with progressive neurological conditions, receive the funding they are entitled to. Currently many SHA criteria effectively exclude people with health care needs of this nature.

One in three women and one in five men will eventually need long term residential care. In the past, people requiring long term residential care were usually cared for in NHS long stay community hospitals, entirely funded by the NHS, but increasing numbers of people are now cared for in private, fee-paying residential or nursing homes. How this care should be paid for has been a contentious issue for over a decade.

The artificial barriers between health and social care lie at the heart of the problems surrounding access to continuing care funding, as in practice it is very difficult to draw distinctions between health care, social care, nursing care and personal care. 

The Committee recommends that in the long run, the Government must remove the structural division between health and social care.

Chairman, David Hinchliffe said:

"It is now ten years since a predecessor Health Committee raised concerns about funding arrangements for long term care. However, despite attempts to address this by successive

Governments, our evidence suggests the current system is still confusing and inequitable.

In our view, this confusion stems from a more fundamental problem - the separate systems for providing and funding health care and social care. Our witnesses found it impossible to give a firm definition of what is 'health care' and what is 'social care'. This has led to the absurd position where carers providing complex medical support for their loved ones are denied funding because they are not registered nurses, when if the same care was to be given by a registered nurse, it would be regarded as nursing care and fully funded. We have therefore again strongly recommended that the Government integrates the health and social care systems.

Very worryingly, it also seems that the current funding systems reward dependency rather than encouraging care staff to help increase patients' independence. The Government must ensure that the system has inbuilt incentives which reward high quality care and promote rehabilitation and independence.

Integrating the health and social care systems will not provide an overnight solution to problems surrounding the funding of continuing care. In Scotland, where personal care is free, people who need residential care still have to find the funding to cover the costs of their board and lodging. However, removing the artificial boundaries between health and social care will be a crucial first step towards establishing a fair and transparent system that ensures security and dignity for people who need long term care."

The Health Committee recommends:

  • The integration of the health and social care systems

  • 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 legally 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

Notes for Editors:

  1. Embargoed hard copies of the report will be available from the House of Commons Press Gallery and the Reception 7 Millbank SW1P 3JA from 1130hrs on Friday 8th April 2005.

  2. Media Bids/Request for interviews with the Chairman should be directed to Luke Robinson on 07834 312 705

  3. For detailed information on the report the Committee can be contacted on 020 7219 2348.

  4. Committee Memberships is as follows: Mr David Hinchliffe MP (Chairman), Mr David Amess MP, John Austin MP, Mr Keith Bradley MP, Simon Burns MP, Mrs Patsy Calton MP, Jim Dowd MP, Mr Jon Owen Jones MP, Siobhain McDonagh MP, Dr Doug Naysmith MP, Dr Richard Taylor MP.

  5. The report's title is 'NHS Continuing Care' and will be published as their sixth report of Session 2004-05 (HC 252). Volume II of the Report will be published in due course.