Not a lot of people know that the NHS has a responsibility to provide Continuing Care. It’s not surprising because the whole issue is shrouded in confusion and complexity. I will try to unravel the issues in this blog.
Basically if you have a continuing need for health care from a clinician, the NHS should provide it FREE. But therein lies the problem, because the NHS is short of cash and has been for some considerable time. The issue is about people who are chronically ill and have a long-term condition which requires the regular attention of a clinician, usually a doctor but it could be another clinical specialist such as a physiotherapist.
That continued involvement, particularly if it involves a hospital stay, can be very expensive. Hence the confusion and complexity. My first experience of the issue was in running nursing homes in the 1980’s and 1990’s. Some of our residents with serious health conditions, were paid for in full by the NHS. This was usually an alternative to them staying in hospital.
Then in 1993 everything changed when Social Services became responsible for assessing peoples’ eligibility for admission to nursing and residential care homes. Along with that responsiblity came the liability for providing public funds for people with limited resources. The conundrum was that there were still some individuals who were paid for entirely by the NHS because of their continuing health care needs.
Individual Health Authorities and Social Services Departments intepreted the boundaries of this type of care differently, which led to accusations that the NHS was not providing a universal service for people with the same condition. The other big anomaly was the treatment of patients with dementia where previously many dementia patients were looked after by the NHS in long-stay wards. Progressively those wards were closed and the patients moved into nursing homes. This shunting of costs from the NHS to Social Services led to endless disputes and delays in transferring people out of hospital.
Then came the Coughlan case where a woman who had previously been funded by the NHS, was refused further financial support on the basis that there was no further treatment that the NHS could give her. She contested that view in the Appeai Court and won, which opened the door to an ongoing argument about “Continuing Care” which exists right up to today.
In researching this blog, I looked up the Government Assessment Form for Long-Term Health Conditions, which was only eventually published in November in 2012. It’s 18 pages long and full of loaded questions which can only easily be answered by qualified staff, even though it is intended to inform patients of their rights.
The ongoing arguments have spawned a host of legal firms specialising in advising on patients’ rights to long-term care. Equally, on the NHS side of the argument, there are private health care consultancies whose aim is to restrict the number of people entitled to claim NHS financial support. This whole issue has developed into a multi-million pound industry.
All because successive Governments have not had the courage to face up to the problem. The reality is, particularly with dementia, the NHS cannot afford the cost of caring for the increasing numbers of people with a serious health issue to which there is no cure.