Sir: Your story "Doctors fear end of cradle-to-grave care" (24 February) gives the misleading impression that our guidance on continuing care takes away or reduces elderly people's right to free NHS care. The guidance does not change two fundamental principles that have been in place since the foundation of the welfare state in 1948.
First, that NHS care is provided, free at the point of delivery, to patients on the basis of clinical need, whatever their age. Crucially, it is doctors with nurses and other health and social services staff who decide whether a patient needs continuing care from the NHS.
Second, since 1948, there has been a widely recognised boundary between the responsibilities of the NHS and social services. The guidance does not shift that boundary. It does make it considerably clearer where the responsibilities of the NHS lie, by offering a comprehensive national framework of the full range of NHS responsibilities.
Yesterday's guidance requires health authorities to review all their continuing care services, including hospital beds, rehabilitation, and community health services. They will have to justify to us and to local people the range of continuing health care they fund. Where there are gaps, investment will have to be increased to fill them.
The guidance is clear about the discharge arrangements for frail and elderly people, it makes decisions about continuing care more transparent and it gives patients the right to have their case reviewed.
Notwithstanding the dismal response from the BMA, our guidance has been welcomed as a significant step forward by the Royal College of Nursing, the British Geriatrics Association, Age Concern, Carers' National Association and others. It will strengthen the contribution which the NHS makes to the care of the elderly.
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