Editor—Last March the Royal Commission on Long Term Care recommended a clear, consistent national policy to guide the partnership between public and private provision of long term care of older people.1
Two important recommendations were:
Personal care should be funded by taxation and board and lodging by individuals, with state help for the poorest
The government should establish a national care commission to set criteria and monitor standards.
Legislation is before parliament to establish a national care standards commission that partially meets the second recommendation, but funding will be considered as part of the current comprehensive spending review. Funding, however, causes the most hardship and anxiety to older people and is the main source of inequity in the current system. Until the issue is resolved, the distortions caused through friction between different authorities and budget holders will impede the introduction of a fair and satisfactory system of long term care.
When free (NHS funded) nursing care should be provided was the subject of Pamela Coughlan's court case with North and East Devon Health Authority last July.2 The Court of Appeal found that the NHS was responsible for providing free nursing care when health was the predominant need, although nursing care could form part of a social services—means tested—package. The judgment concluded that the eligibility criteria used by North and East Devon Health Authority had been unlawful. Worryingly, these criteria had been faithfully taken from official health service guidance and were considered by the court to be confusing though technically not unlawful. If this was only an isolated case it would be important, but it is typical of the situation nationally.
A survey in January by the British Geriatrics Society of its members found that most would not be able to offer or even recommend NHS funded nursing care for a person who was partially paralysed in all four limbs with double incontinence and great difficulties in speaking and eating. The wide variations across the United Kingdom depended mainly on the available NHS resources.
This lack of equity is a national disgrace, disenfranchising the most needy people from the care they have every right to expect through the NHS. We appeal for the long term care of older people to be included in the ongoing public debate on the funding of health care. We also strongly urge the government to fund long term care properly and respond positively to the recommendations of the commission.
References
- 1.Royal Commission on Long Term Care. With respect to old age. Report. London: Stationery Office; 1999. . (Cm 4192-I.) [Google Scholar]
- 2.Age Concern; Alzheimer's Disease Society; Carers Association; British Geriatrics Society; Help the Aged; Patients Association. Who should fund long-term nursing care? Implications of the Court of Appeal judgment in R v North and east Devon Health Authority ex parte Coughlan (July 1999). London: Royal College of Nursing; 1999. . (Reorder No 00 1150.) [Google Scholar]