At issue is the NHS commitment reaffirmed in 1989 that 'no NHS patient (being discharged from hospital) 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'. Given the ageing population and the closure of long-stay NHS beds, health authorities have warned that is a 'financial time bomb' under the NHS.
Sir Duncan was yesterday accused of 'really muddying the waters' by Dr Tony Wright, MP for Cannock and Burntwood, after the Labour MP had asked him at a Commons Select Committee hearing whether that guidance still stood.
Sir Duncan said that if the medical assessment - the doctor's assessment - was that continuing care was needed that was plainly an NHS responsibility, and the NHS would pay. In those cases there was 'no ambiguity,' he said. But 'in a majority of situations' a mix of health and social care would be required - and with social services involved that could lead to nursing home care 'for which there will be a means-test'.
Sir Duncan's explanation came as the select committee was investigating a ruling by William Reid, the Health Ombudsman, that the NHS had a duty to provide long-term care to a profoundly brain-damaged man whom a Leeds hospital had discharged to a private nursing home, leaving his wife to pick up the bill.
Dr Wright said that after Sir Duncan's evidence, the situation was now 'a total mess. Whether patients get free long- term care on the NHS or means-tested care is going to depend on the decision by particular doctors, in particular NHS trusts, each doing their own thing'.
If a hospital doctor accepted patients purely needed health care they would get it free, but if the NHS trust insisted that social services should be involved then means-tested care was likely to result, he said.
Health ministers have said the NHS has 'a clear obligation to pay for continuing health care of seriously ill patients' but health authorities, who have been closing long- stay NHS beds, have warned they will be financially crippled if they have to pay large numbers of private nursing home fees.
Mike Watson, Labour MP for Glasgow Central, said MPs were receiving repeated complaints from constituents and their relatives over the pressure patients were facing to leave NHS beds for private care homes.
In evidence, Sir Duncan said that was not an effect of the new Community Care Act. But Mr Watson said 'while that is the theory it is not the practice. People are being forced to leave NHS beds for private homes for which they have to pay if they do not pass the means test. We must get clarification over this issue. I don't think there should be a line between health and social care.'