Long term nursing: social care or health care?

Judgment clarified the law but did not remedy its unfairness

The Court of Appeal last year lent support to the Royal Commission on Long Term Care in a case that marked a watershed in the politics of long term care in Britain. The Department of Heath guidance that followed the judgment is a partial retreat from three decades of policy which has seen responsibility for funding long term care shift from the NHS to individuals and local authorities.

The landmark case was brought by Pamela Coughlan, who sought judicial review of a health authority's decision to close the NHS home, Mardon House, where she had been promised “a home for life.” Ms Coughlan, rendered quadriplegic in a road accident in 1971, won at both the High Court and the Court of Appeal. The health authority was forced to make good its promise, and the court upheld Ms Coughlan's right under article 8 of the European Convention of Human Rights to respect for her home.1 In the High Court the judge went further and declared that nursing is “health care” and can never be “social care.”2 The effect of that judgment would have been to make the NHS responsible once more for long term nursing care and the extra costs of some 200 000 residents whose nursing home places are funded by the local authority, the Department of Social Security, or private payers.

The critical issue for the Court of Appeal was whether …