Foreword
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In February 2003, I published a report on the NHS funding of long term, or continuing, care. It highlighted problems with the application of local eligibility criteria and with the national guidance framework. This had resulted in actual or potential injustice to some disabled and elderly people, who were paying for their own care when the NHS should have paid for it. I recommended that strategic health authorities and primary care trusts should take steps to remedy retrospectively any injustice and that the Department of Health should clarify its guidance and provide support to the NHS bodies concerned in carrying out that work.
Following our report, more people claimed retrospective funding than were initially expected. We recognise that considerable efforts and resources have been expended in dealing with these cases, which have raised the profile of an important area of health care. In a written statement to the House of Commons on 16 September 2004, Dr Stephen Ladyman, the Parliamentary Secretary of State for Community, said that around 20% of those cases reviewed by the end of July 2004 were found to be eligible for full funding and the NHS expected to pay around £180 million in restitution. However, we have received, and continue to receive, numerous complaints about continuing care - almost 4,000 in all since February 2003. Many of the complainants are themselves frail, elderly people who have been trying unsuccessfully to obtain and understand the criteria for funding continuing care in their area and find out whether or not their spouse or relative will qualify. Complaints have arisen partly because of a lack of available information about how to go about getting an assessment for continuing care funding and partly because of the significant delays in carrying out the retrospective reviews; it looks unlikely to me that all 28 strategic health authorities will completely clear the backlog by the end of 2004. I have also received many complaints about the process for carrying out reviews, the reasonableness of the decisions reached and delays in providing agreed restitution.
Evidence from these complaints suggests to me that it is in the public interest to lay this further report before Parliament in accordance with Section 14(4)(b) of the Health Service Commissioners Act 1993 
(www).. These complaints reveal some persistent problems at the heart of the continuing care framework. First, it has become clear that the absence of clear and consistent national criteria for continuing care funding has resulted in much confusion and potential inequity in the way strategic health authorities made decisions on patients' continuing health care needs. Secondly, NHS bodies need further support and guidance from the Department of Health to ensure all new requests for continuing care are decided promptly and properly and according to a national framework.
My main concern (once we are reasonably satisfied that no-one has been wrongly denied funding) is to look to the future. I welcome the outline commitment to commission the development of a national consistent approach to assessment for fully funded NHS continuing care given by Dr Ladyman in a written statement to the House of Commons on 9 December and hope that it addresses all the shortcomings identified in this report. The independent review commissioned by the Department endorses the recommendations in this report and their findings closely match what we have found in the complaints to my Office. We both identify the need for national criteria; accredited assessment tools; training for NHS staff; better record keeping and documentation; and assurance that people who should have had their case reviewed have not been overlooked. In the short term, the process of retrospective reviews needs to be promptly and thoroughly completed. Some people have already had to wait far too long. Longer term, much learning has come out of the reviews and this should inform future work on continuing care both nationally and locally. The ultimate goal must be to secure the foundations for fair and equitable treatment of those who are entitled to NHS funding of their long-term care.
Ann Abraham
Health Service Commissioner for England
December 2004
