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House of Commons Health Committee NHS Continuing Care Sixth Report of Session 2004–05 Volume II Oral and written evidence Ordered by The House of Commons to be printed 5 April 2005 HC 399-II Published on 3 May 2005 by authority of the House of Commons London: The Stationery Office Limited £16.50 The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Current membership Mr David Hinchliffe MP (Labour, Wakefield) (Chairman) Mr David Amess MP (Conservative, Southend West) John Austin MP (Labour, Erith and Thamesmead) Mr Keith Bradley MP (Labour, Manchester Withington) Simon Burns MP (Conservative, Chelmsford West) Mrs Patsy Calton MP (Liberal Democrat, Cheadle) Jim Dowd MP (Labour, Lewisham West) Mr Jon Owen Jones MP (Labour, Cardiff Central) Siobhain McDonagh MP (Labour, Mitcham and Morden) Dr Doug Naysmith MP (Labour, Bristol North West) Dr Richard Taylor MP (Independent, Wyre Forest) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/parliamentary_committees/health_committee.cfm A list of Reports of the Committee in the present Parliament is at the back of this volume. Committee staff The current staff of the Committee are Dr David Harrison (Clerk), Keith Neary (Second Clerk), Laura Hilder (Committee Specialist), Christine Kirkpatrick (Committee Specialist), Frank McShane (Committee Assistant), Mr Darren Hackett, (Committee Assistant), and Rowena Macdonald (Secretary). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 6182. The Committee’s email address is [email protected]. Footnotes In the footnotes of this Report, references to oral evidence are indicated by ‘Q’ followed by the question number. Written evidence is cited by reference to Volume II of this Report, in the form ‘Ev’ followed by the page number. List of written evidence Local Government Association and Association of Directors of Social Services (CC 30) Ev 1 Age Concern (CC 29) Ev 17 Alzheimer’s Society (CC 26) Ev 28 Citizens Advice (CC 15) Ev 36 Royal College of Nursing (CC 21) Ev 47 English Community Care Association (CC 4) Ev 52 British Geriatrics Society (CC 19) Ev 53 Office of Parliamentary and Health Service Ombudsman (CC 23, 23A, 23B, 23C) Ev 64, 94, 96, 98 Department of Health (CC 9, 9A) Ev 76, 92 Paul Overton (CC 1) Ev 99 Southampton City Council Ev 99 Progressive Supranuclear Palsy [PSP-Europe] Association (CC 6) Ev 101 NHFA (CC 8) Ev 104 Enfield Disability Association (CC 10) Ev 105 Royal College of Physicians of Edinburgh (CC 11) Ev 106 Hampshire Social Services (CC 12) Ev 108 BUPA (CC 13) Ev 111 NHS Confederation (CC 14) Ev 113 Association for Children with Life-threatening or Terminal Conditions (CC 16) Ev 114 Solicitors for the Elderly (CC 17) Ev 116 Mr Andrew Shaw (CC 18) Ev 118 Continence Foundation (CC 20) Ev 119 Motor Neurone Disease Association (CC 22) Ev 119 Parkinson’s Disease Society (CC 24) Ev 121 Relatives and Residents Association (CC 25) Ev 123 Help the Aged (CC 28) Ev 124 Help the Hospices (CC 31) Ev 129 Mackintosh Duncan Solicitiors (CC 32) Ev 133 Continuing Care Conference (CC 33) Ev 136 The Law Society (CC 35) Ev 138 Ms Marion Shoard (CC 36) Ev 144 Royal College of Physicians (CC 37) Ev 147 Commission for Social Care Inspection (CC 38) Ev 147 List of unprinted written evidence Additional papers have been received from the following and have been reported to the House but to save printing costs they have not been printed and copies have been placed in the House of Commons library where they may be inspected by members. Other copies are in the Record Office, House of Lords and are available to the public for inspection. Requests for inspection should be addressed to the Record Office, House of Lords, London SW1. (Tel 020 7219 3074) hours of inspection are from 9:30am to 5:00pm on Mondays to Fridays. Elizabeth Balsom (CC 2) Gay Lee (CC 5) Jane Williams (CC 7) Pamela Coughlan (CC 27) London Borough of Richmond Upon Thames (CC 34) Ruth Hudsom (CC 39) Fiona Burt (CC 40) 303859PAG1 Page Type [SO] 27-04-05 23:20:24 Pag Table: COENEW PPSysB Unit: PAG1 Health Committee: Evidence Ev 1 Oral evidence Taken before the Health Committee on Thursday 10 March 2005 Members present: Mr David HinchliVe, in the Chair Mr David Amess Jim Dowd John Austin Dr Doug Naysmith Mr Keith Bradley Dr Richard Taylor Mr Simon Burns Memorandum submitted by The Local Government Association (LGA) and the Association of Directors of Social Services (ADSS) (CC 30) The Local Government Association (LGA) represents over 400 local authorities in England and Wales and exists to promote better local government, enabling local people to shape a distinctive and better future for their communities. It aims to put local councils at the heart of the drive for better public services, working with the Government to secure that objective. The Association of Directors of Social Services (ADSS) represents the 187 Directors of Social Services in England, Wales and Northern Ireland. Directors of Social Services are responsible through the activities of their departments for the well-being, protection and care of vulnerable people including older people, people with disabilities, people with mental health problems and children in need and their families. The purpose in collaborating to make this submission is to set out key issues for the local government community in the development of a national framework for NHS continuing care which resolves previous and current diYculties. Introduction and Local Government/Social Care Perspective The LGA and ADSS welcome the intention to establish a national and consistent approach to fully funded NHS continuing care. The absence of clear guidance; diVerential approaches over time and in diVerent health organisations and health/social care communities is and has been problematic to health and social care organisations (including the independent sector), their workforce and, most significantly to communities and individuals needing and relying upon NHS services critical to their health and wellbeing. We are concerned to ensure however that the move to national criteria should not deliver a more restricted entitlement to continuing NHS care overall, and that it should draw upon those existing arrangements in SHA’s around the country that best address the issues we outline below. Our submission sets out what we believe to be continuing diYculties caused by lack of clear guidance; issues that we believe need to be addressed in establishing a national and consistent approach and a number of specific examples of continuing diYculty. We would be pleased to explore these issues further in oral evidence to the committee. 1. It is evident that lack of clear guidance has resulted in diVerential criteria and a range of interpretations that have resulted in lack of transparency and a lack of fairness. The findings of the ombudsman set out concerns that: — Central guidance and support had not provided a secure foundation to enable a fair and transparent system of eligibility for funding for long-term care. — What guidance has been available has been misinterpreted and misapplied by some health authorities when developing and reviewing their own criteria. — There have been further diYculties in the application of local criteria to individuals. —TheeVect of this has been to cause injustice and hardship to some people, both in relation to the nature of the services they receive and in terms of what they pay for them. — Where the person was to be supported even partly by the Local Authority (LA), the LA will have suVered financially, with an associated impact on ability to meet others’ needs. — The experience of local authorities in many areas underwrites these concerns. Additionally we would add to issues that need to be addressed in a new and consistent approach: 3038591001 Page Type [E] 27-04-05 23:20:24 Pag Table: COENEW PPSysB Unit: PAG1 Ev 2 Health Committee: Evidence — Much of the guidance that has been issued since the early 1990’s has been directed at the NHS, albeit with requirements that local authorities are engaged and “Sign up” to criteria within the area. The experience of local authorities in a number of places indicates that this had not happened. This will have caused or compounded diYculties in some areas. — Narrow interpretations of eligibility for continuing NHS care have resulted in injustice and hardship for individuals, but have also resulted in shifts in responsibility—both in the provision of care and its funding—from the NHS to LA funded social care in a number of places. Not only has an individual’s entitlement to “Free” NHS care been compromised by local processes, local resources intended for social care services will have been used to subsidise health care services. — Narrow interpretations have tended to centre on definitions of what care is “complex or intensive”, rather than consideration of the overall health and wellbeing of the individual and his/her circumstances. This is inappropriate and can lead to individual decisions that are diYcult to understand. — Considerable resource has also been tied up in arguments both about organisational responsibilities and individual entitlements.
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