Cradle to grave NHS buried by Government

THE GOVERNMENT yesterday formally marked the end of the 'cradle to grave' National Health Service by abandoning a national guarantee that elderly patients needing long-term care cannot be placed in private nursing homes against their wishes.

Instead, under draft guidance published yesterday, health authorities will draw up their own local definitions of who is entitled to continuing NHS care.

The guidance was attacked by Labour and groups involved in the care of elderly people. David Blunkett, the Opposition health spokesman, called for a Royal Commission, saying that health and social support for older people 'is one of the most important issues facing us as a nation over the coming years'.

Instead of children inheriting their parents' property, 'millions of people are now finding that their expected legacy is disappearing in enormous private sector care and nursing charges,' he said.

The Government said that the NHS should remain responsible for the care of some people with 'complex or multiple health care needs'. But 'the significant majority' of those requiring continuing care in a nursing home will have to depend on means-tested social services.

For those with more than pounds 8,000 in savings, the state will pay nothing and they will have to pay the full weekly charges. If they have savings of between pounds 3,000 and pounds 8,000 the state's contribution will be reduced at the rate of pounds 1 for every pounds 250 of capital. Once savings have been exhausted children might find they have to sell the parents' home to continue paying the charges.

Sheila Scott, chairwoman of the National Care Homes Association, which represents 2,000 nursing and residential homes, said the usual fees ranged between pounds 290 and pounds 350 a week for nursing homes. The most luxurious would charge between pounds 700 and pounds 800.

The guidance was issued following a ruling last February by William Reid, the Health Service Ombudsman, that the NHS had a duty to provide long-term care to a helpless 55-year old man, profoundly brain-damaged after a stroke, who had been discharged by Leeds Healthcare to a private nursing home because the NHS could no longer do anything to improve his condition. His wife had to contribute to the fees.

Mr Reid drew attention to guidance dating from 1989 which states that 'no NHS patient should be placed in a private nursing or residential care home against his/her wishes if it means that he/she or a relative will be personally responsible for the home's charges'. Already frequently not honoured by health authorities, that guidance was superseded by yesterday's announcement.

Announcing the new guidelines, John Bowis, Under-Secretary of State for Health, said: 'Health authorities do have a responsibility, within available resources, to meet the needs of their residents for long-term health care.'

He added that people would be entitled to a multi-disciplinary assessment of their needs, and a clear decision on whether they were eligible for continuing care.

Chris Vellenoweth, special adviser to the National Association of Health Authorities and Trusts, said the draft guidance meant that NHS provision 'is going to vary across the country, and one of the things that has changed - and some would say for the worse - is that the concept of the NHS providing care from the cradle to grave no longer applies.'

Mr Reid, whose report triggered the review, welcomed the guidance for underlining that authorities, as in Leeds, could no longer make 'absolutely no provision' for long-term care.