Conclusions and recommendations
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41. Since the publication of our report in February 2003, there has been much effort locally to make restitution for previous failures to grant continuing care funding where patients had in fact been eligible. Progress would have been faster, and the process less onerous for claimants and NHS staff, if the Department of Health had provided clearer national guidance and stronger support in carrying out the reviews. We welcome recent actions taken by the Department to expedite the remaining retrospective reviews. We also appreciate the Department's willingness to tackle persistent problems at individual NHS bodies, and recognise that their intervention, at our request, in some individual cases has led to a swift resolution of the problem. We are pleased that the Department, at a senior level, is now engaging with us in a positive dialogue aimed at taking forward the issues we have raised with them
42. For new (non-retrospective) requests for continuing care funding, there have been some improvements to the national framework for assessing eligibility since February 2003. The Continuing Care (NHS Responsibilities) Directions 2004 set out the procedure that must be followed for continuing care funding assessments and reviews, with effect from 27th February 2004. And the Delayed Discharge (Continuing Care) Directions 2004 strengthen the requirement that the NHS should assess a patient for continuing care before discharging them from hospital to social services. These developments provide clarification in areas where it was badly needed.
43. However, in our view these developments still fall short of the kind of guidance and support for healthcare professionals in this difficult area that we had envisaged when we published our previous report. We recommend that the Department of Health needs to lead further work in six key areas to improve the national framework for continuing care, and its application by:
- Establishing clear, national, minimum eligibility criteria which are understandable to health professionals and patients and carers alike;
- Developing a set of accredited assessment tools and good practice guidance to support the criteria;
- Supporting training and development to expand local capacity and ensure that new continuing care cases are assessed and decided properly and promptly;
- Clarifying standards for record keeping and documentation both by health care providers and those involved in the review process;
- Seeking assurance that the retrospective reviews have covered all those who might be affected; and
- Monitoring the situation in relation to retrospective reviews and using the lessons learned to inform the handling of continuing care assessments in the future
