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Six steps to a fairer way

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Colin Houghton

Investigations Manager


The Health Service Ombudsman's latest report on NHS funding for long-term care shows that there are still problems in achieving fair and robust decisions on who should be eligible for full NHS funding.

Using evidence from complaints, the Ombudsman set out the problems encountered by those who have tried to find their way through the processes used by the 28 strategic health authorities (SHA) in order to obtain retrospective funding for often elderly and frail relatives.

The main problem facing those involved in multidisciplinary assessments of patients' health-care needs was the absence of clear, understandable national criteria. The existence of 28 - often opaque - criteria across the country, and very different assessment methods and 'triggers' for granting funding, meant that a patient might meet the eligibility criteria in the area of one SHA, yet not meet those of its neighbour. A lack of staff training, inadequacy of resources, accredited assessment tools and good practice guidance were also found.

A second major cause for concern was the difficulty in distinguishing between eligibility for the highest band of 'free' nursing care and eligibility for NHS-funded continuing care.

Sometimes nursing assessments have been used as the sole basis on which to arrive at funding decisions. A full needs assessment and decision on entitlement to NHS continuing care should come first. Only if an individual does not meet this criteria does the second issue arise, whether they are entitled to Registered Nursing Care Contribution (RNCC) and, if so, at what band.

The Ombudsman also criticises the variable quality of clinical assessments and undocumented decision-making; inconsistent review panel procedures and documentation; poor communication and delays in making agreed restitution payments. The report concludes that the Department of Health needs to lead further work in six key areas, by:

- Establishing clear, national minimum eligibility criteria which are understandable to all

- Developing a set of accredited assessment tools and good practice guidance

- Supporting training and development to expand local capacity and ensure that new continuing care cases are assessed and decided properly and promptly

- Clarifying the 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

- Monitoring the progress of retrospective reviews and using the lessons learned to inform assessment handling in the future.

Now the DH has the opportunity to show the leadership necessary to achieve the goal of fair and equitable treatment for those entitled to NHS funding for long-term care.


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