Committee calls for end to 'lottery' of NHS care

Health policy: MPs say present shortcomings show need for charter to govern long-term treatment of elderly patients
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MPs yesterday called on the Department of Health to end the "care lottery", by setting up a national long-term care charter which makes clear the service people can expect in their later years.

Their call came the day after the Health Service Ombudsman criticised North Worcestershire Health Authority for failing to provide NHS care by discharging a 55-year-old stroke victim into a private nursing home and saddling his wife with a bill for thousands of pounds.

The charter, outlined by the Commons' Health Select Committee report, should include a named list of services and a "minimum" list of specialist equipment, home aids, and time scales for assessment.

Eligibility criteria for these should also be "needs-led" rather than "resource-led", with the committee saying it "failed to see" why the NHS should not be responsible for funding all the care of people in nursing homes who required special health care support.

During the mid to late 1980s, there was a huge increase in private residential and nursing home places for elderly people, with the number of places in private-sector residential accommodation rising from 44,000 in 1982 to 164,000 in 1994. Over the same period, the number of nursing home places rose from 18,000 to nearly 150,000. During the same period, the number of local authority residential home places fell by nearly 50,000 - from 116,000 to 69,000.

The MPs, from all parties, had earlier expressed concerns on "significant geographical variations" and called for national eligibility criteria to be set. Subsequently the Department of Health announced that itwould monitor arrangements.

The committee called on the department to publish the outcome of individual health authorities' policies and criteria, and to outline the action it will take against those who depart from the national framework.

It added that the charter should specify that NHS-funded patients entering a nursing home should have the right, subject to necessary clinical or financial conditions, to choose their own nursing home.

The department should also seek evidence from local authorities to discover the extent of the problem concerning "preserved rights" residents.

In April 1993, the Government transferred the financial responsibility for all new occupants from the DSS to local authorities, but left funding of existing residents with the DSS.

Where homes' charges now exceed Income Support, relatives have had to make up the shortfall, with local authorities not allowed to intervene until the old person faces eviction. "We recommend that the Department conduct a review of the existing arrangements," it said. "No elderly resident should face eviction in the future."

The Royal College of Nursing welcomed the MPs' call for national standards and backed the proposal for a charter, but said it wanted to see radical reform of funding arrangements.

General Secretary Christine Hancock said: "I urge the Government to act now to end the care lottery. Nursing must be an NHS responsibility. We need a strong national framework and clear national standards to keep faith with a generation of older people who believed that the NHS would take care of their health needs in later life."

Harry Cayton, executive director of the Alzheimer's Society applauded the recommendations. "If they are acted on by the Government they will do much to improve the present uneven and unfair provision of NHS long- term care," he said.

The Association of Metropolitan Authorities said the report's rhetoric must be translated into action: "That means extra resources," said Cllr Rita Stringfellow, chair of its social services committee.