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The diagram showing the approximate £1.5 billion increase in NHS
spending on long term care between 2007-8 and 2008-9 and the reducing
numbers of councils funding low or moderate needs is misleading and makes
a causal connection where one does not in fact exist. [1,2] The Audit
Commission’s 2008 report Fair Access to Care Services Bands on Expenditure
and Service Provision [3] noted that "tightening of FACS bands is not a
particularly powerful way of controlling costs” , that the effect on
social care budget was relatively small, and that “there is no directly
observable impact from a council’s choice of FACS policy on emergency
admissions to or delayed discharges from hospital”. Given those findings
of no changes in the NHS, it is difficult to see how on the basis of the
published evidence that Featherstone and Whitham can claim that “as local
authorities tighten eligibility criteria for long term care funding costs
shift into the NHS.” [2]
The true cause of the recent dramatic rise in NHS spending on long
term care has not been due to a tightening of local authority eligibility
criteria but to the Department of Health producing new guidance in 2007
about the eligibility for NHS continuing healthcare funding. This guidance
was further updated in July 2009.[4] The Commission for Social Care
Inspection publication “Cutting the cake fairly” [5] noted that the
guidance was expected to increase numbers of people supported by NHS
funded continuing care by 7,000 a year to a total of 31,000. The reality
was that in England the number in receipt of NHS funded continuing care
rose from 24,952 in 2007-08, to 37,920 in 2008-09 after the guidance was
introduced and reached 44,924 in the first quarter of 2009-10.[6] By the
fourth quarter of 2009/10 it had risen by almost a further 6000 to
50,426.[4]
These yearly rises in numbers do not reflect any tightening of
council eligibility criteria. They do have a major impact on health
spending on long term care. For example, the NHS South West - that covers
some 10% of England’s population - has just published its 2009/10 annual
report for continuing healthcare showing a £66.8 million rise in spending
on this aspect of long term care. [7] That rise represented a 34.4% on the
previous year. If that pattern is replicated across the NHS in England
then 2009/10 will have seen around an extra £0.7 billion a year of
additional NHS costs on NHS long term care.
A fair way does need to be found to support long term care funding
but simply merging local authority and NHS spending on care for elderly
people will not keep costs in check as it is not simply a matter of
shifting costs from social to NHS budgets with changes in eligibility
criteria.
[1] Cole A. Report wants pooled funding to meet older people’s care
costs. BMJ 2010;341:c4121
Department of Health continuing care guidance caused dramatic rise in long term care spending not tightened local authority eligibility criteria
The diagram showing the approximate £1.5 billion increase in NHS
spending on long term care between 2007-8 and 2008-9 and the reducing
numbers of councils funding low or moderate needs is misleading and makes
a causal connection where one does not in fact exist. [1,2] The Audit
Commission’s 2008 report Fair Access to Care Services Bands on Expenditure
and Service Provision [3] noted that "tightening of FACS bands is not a
particularly powerful way of controlling costs” , that the effect on
social care budget was relatively small, and that “there is no directly
observable impact from a council’s choice of FACS policy on emergency
admissions to or delayed discharges from hospital”. Given those findings
of no changes in the NHS, it is difficult to see how on the basis of the
published evidence that Featherstone and Whitham can claim that “as local
authorities tighten eligibility criteria for long term care funding costs
shift into the NHS.” [2]
The true cause of the recent dramatic rise in NHS spending on long
term care has not been due to a tightening of local authority eligibility
criteria but to the Department of Health producing new guidance in 2007
about the eligibility for NHS continuing healthcare funding. This guidance
was further updated in July 2009.[4] The Commission for Social Care
Inspection publication “Cutting the cake fairly” [5] noted that the
guidance was expected to increase numbers of people supported by NHS
funded continuing care by 7,000 a year to a total of 31,000. The reality
was that in England the number in receipt of NHS funded continuing care
rose from 24,952 in 2007-08, to 37,920 in 2008-09 after the guidance was
introduced and reached 44,924 in the first quarter of 2009-10.[6] By the
fourth quarter of 2009/10 it had risen by almost a further 6000 to
50,426.[4]
These yearly rises in numbers do not reflect any tightening of
council eligibility criteria. They do have a major impact on health
spending on long term care. For example, the NHS South West - that covers
some 10% of England’s population - has just published its 2009/10 annual
report for continuing healthcare showing a £66.8 million rise in spending
on this aspect of long term care. [7] That rise represented a 34.4% on the
previous year. If that pattern is replicated across the NHS in England
then 2009/10 will have seen around an extra £0.7 billion a year of
additional NHS costs on NHS long term care.
A fair way does need to be found to support long term care funding
but simply merging local authority and NHS spending on care for elderly
people will not keep costs in check as it is not simply a matter of
shifting costs from social to NHS budgets with changes in eligibility
criteria.
[1] Cole A. Report wants pooled funding to meet older people’s care
costs. BMJ 2010;341:c4121
[2] Featherstone H, Whithman L. Careless: Funding Long-Term Care for
the Elderly. www.policyexchange.org.uk/publications/publication.cgi?id=198
[3] Audit Commission [2008]. The effect of Fair Access to Care
Services Bands on Expenditure and Service Provision, London: CSCI and
Audit Commission.
www.cqc.org.uk/_db/_documents/Tracked%20Audit%20Commission%20report%20on...
[4] Department of Health. The national framework for NHS continuing
healthcare and NHS-funded nursing care - July 2009 (revised).
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli...
[5] Commission for Social Care Inspection [2008]. Cutting the cake
fairly: CSCI review of eligibility criteria for social care.
www.cqc.org.uk/_db/_documents/FACS_2008_03.pdf
[6] Continuing care: written answer 11 January 2010; Columns 748-
753W.
www.publications.parliament.uk/pa/cm200910/cmhansrd/cm100111/text/10011w...
[7] NHS South West. Annual Report on NHS Continuing Healthcare in NHS
South West for 2009/10.
www.southwest.nhs.uk/boardpapers/pdf/july2010/Annual_Report_CHC_09-
10_SMT%2028-06-10.pdf
Competing interests:
None declared
Competing interests: No competing interests