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Home > Publications > Reports - Health > NHS funding for long term care > Annex A
Extracts from HSC 2001/015, LAC (2001)18, 28 June 2001 Continuing Care: NHS and Local Councils’ responsibilities
18. There are a number of key issues to bear in mind when arranging or reviewing continuing NHS health care:
- the setting of the care should not be the sole or main determinant of eligibility. Continuing NHS health care does not have to be provided in an NHS hospital and could be provided in a nursing home, hospice or the individual’s own home;
- the timescale of the care can vary between the remainder of an individual’s life and episodes of care;
- the local eligibility criteria for continuing NHS health care are based on the nature or complexity or intensity or unpredictability of health care needs (see Annex C for further details on eligibility criteria for continuing NHS health care);
- patients who require palliative care and whose prognosis is that they are likely to die in the near future should be able to choose to remain in NHS-funded accommodation (including in a nursing home), or to return home with the appropriate support. Patients may also require episodes of palliative care to deal with complex situations (including respite palliative care). The number of episodes required will be unpredictable and applications of time limits for this care are not appropriate;
- the impact on social security benefits for people receiving continuing NHS healthcare will vary according to the location of that care:
if an individual is placed, under the NHS Act 1977, as an in-patient in a hospital or similar institution (which may include a nursing home) where food and accommodation costs are met by the NHS, certain social security benefits are downrated after six weeks and again after 52 weeks (see Schedule 7 of the Income Support (General) Regulations 1987 [S.I. 1987/1967]);
where people are receiving continuing NHS health care in their own home, the NHS meets the full cost of their health care needs. Social security benefits (which may include disability benefits) available to support the individual’s other costs are not downrated.
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All Health Authorities, in discussion with local councils, should pay attention to the details below when establishing their eligibility criteria for continuing NHS health care.
- The eligibility criteria or application of rigorous time limits for the availability of services by a health authority should not require a local council to provide services beyond those they can provide under section 21 of the National Assistance Act (see point 20 of the guidance for the definition of nursing care used in the Coughlan judgment).
- The nature or complexity or intensity or unpredictability of the individual’s health care needs (and any combination of these needs) requires regular supervision by a member of the NHS multidisciplinary team, such as the consultant, palliative care, therapy or other NHS member of the team.
- The individual’s needs require the routine use of specialist health care equipment under supervision of NHS staff.
- The individual has a rapidly deteriorating or unstable medical, physical or mental health condition and requires regular supervision by a member of the NHS multidisciplinary team, such as the consultant, palliative care, therapy or other NHS member of the team.
- The individual is in the final stages of a terminal illness and is likely to die in the near future.
- A need for care or supervision from a registered nurse and/or a GP is not, by itself, sufficient reason to receive continuing NHS health care.
- The location of care should not be the sole or main determinant of eligibility. Continuing NHS health care may be provided in an NHS hospital, a nursing home, hospice or the individual’s own home.
Guidance on free nursing care will include more details on determining registered nurse input to services in a nursing home, where the care package does not meet continuing NHS health care eligibility criteria.’
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