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Blog: Elvis and the funding fiasco

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In his debut blog, Registered Nursing Home Association chief executive Frank Ursell reports on why recent funding policy is an 'unmitigated disaster'

Caught in a trap – that famous line from a classic Elvis Presley song – is exactly how many nursing homes and their elderly patients are feeling right now. The trap is a financial one.

I know this may be surprising. After all, the public funding of older people’s care has been a complex nightmare for so long that it’s difficult to remember a time when it wasn’t. Maybe Elvis was at the top of the charts when things were last hunky-dory.

The current trap to which I refer was intended to be a blessing rather than a curse. I’m talking about the so-called registered nursing care contribution (RNCC) – the sum of money that the NHS contributes towards the cost of a nursing home patient’s care.

All nursing home patients are entitled to it, including those whose fees are paid by social services and those (around a third of the total) who do not otherwise qualify for financial help and have to meet their own costs.

In effect, the RNCC was intended to be a flagship policy under which every single older persn in England who needed residential nursing care would receive some money from their local primary care trust to cover the ‘nursing’ element of that care.

A good idea in principle, I am sure we would all agree. The trouble is, like a lot of seemingly good ideas, it got pretty messed up in the implementation.

First we had the problem of three cost bandings (high, medium and low) that were supposed to match up to individuals’ level of nursing need. Those of us who had to make the system work found it bureaucratic and often unfair. So it was with relief that we welcomed the government’s declaration that, from the autumn of 2007, the three bands would be replaced by a single one. The across the board figure would be £101 per patient per week.

Now we can probably argue till the cows come home about whether that amount does or does not cover the full and true cost of delivering 24-hour nursing care. Setting aside that debate, I doubt whether any of us anticipated the unmitigated disaster that the single banded RNCC has proved to be so far.

At the root of the problem is the traditional rivalry between the NHS and social services. Now that the NHS is putting a bit more money into the pot (the single band is £14 a week more than those previously on the medium band used to get), many local authorities have decided to freeze the amounts they pay nursing homes.

That’s no doubt good news for local government treasurers. They can channel funds away from elderly care towards whatever latest wheeze their political masters have dreamt up for spending council taxpayers’ money.

Unfortunately, it ignores the uncomfortable reality that nursing homes are facing well above inflation increases in their costs, not least because of a 7% increase in the national minimum wage and staff holiday entitlements. That’s even before you factor in spiralling energy and food costs.

Many local authorities have opportunistically grasped what they sees as a windfall, made possible by the NHS switching to the new single RNCC band. In doing so, they have left nursing homes and their patients very much in the lurch. The attitude seems to be: if your costs are rising, that’s your problem, not ours.

In such a scenario, it might be expected that the government would intervene, bang a few heads together and put the interests of older people first. On second thoughts, did you see those pigs flying overhead?

The position adopted by the Department of Health appears to have been one of encouraging local councils to pocket the windfall and pay little or nothing more towards the care of older people in nursing homes, whatever happens to inflation over the next twelve months.

Yet again, the needs of some of the country’s most vulnerable people have been swept aside. Right now, the government is supposed to be putting the finishing touches to a major review of our system for financing elderly care. If anyone has been hoping for a ray of light, a glimmer of fairness and a strong dose of justice, don’t hold your breath. We’ve probably got a better chance of Elvis being top of the charts again.

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