Background
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1. In February 2003, we published a report on arrangements for NHS funding of the long term care, known as continuing care, of older and disabled people (NHS funding for long term care - HC 399). NHS funded continuing care is a package of care arranged and funded solely by the NHS for people who need it because of disability, accident or illness. It can cover physical and mental health needs and can be provided in a range of settings - care homes, patients' homes or hospitals.
2. A pattern was emerging from the complaints we had received about NHS funding for such care. Our investigations found that some NHS organisations had made decisions about eligibility for NHS funding based on local criteria that appeared to us to be over-restrictive or not in accordance with the law as it stood. The indications were that this might be a widespread problem. We also concluded that national guidance did not provide a clear, well-defined framework for making fair, logical and transparent decisions about individual entitlement. The effect was to cause injustice and hardship to some vulnerable and elderly people and their relatives.
3. We therefore recommended that strategic health authorities and primary care trusts, which have taken over the work of the former health authorities, should review the criteria used by their predecessor bodies, and the way those criteria were applied, since 1996 (when it first became mandatory to have written criteria). They also needed to identify those patients who might have been disadvantaged by wrongly interpreted or unfair criteria and remedy any consequent financial or other injustice. We recommended that the Department of Health should consider how to monitor those bodies in that work, review and clarify national guidance on eligibility, check that criteria used in the future followed that guidance and consider how to clarify the framework for assessment of eligibility. Annex A lists the conclusions and full recommendations from our report.
