The British Geriatrics Society has always recommended that multidisciplinary assessment of frail elderly people, being considered for receipt of continuing care, is the basis of good practice.

It therefore welcomed the 2003 Ombudsman report on Continuing Care which stated :

• “The Department of Health’s guidance has been misinterpreted and misapplied by some health authorities and trusts leading to hardship and injustice for some individuals”
  
• “The Department of Health’s guidance and support has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding to be operated across the country.”
  
• Health authorities should review the criteria in use since 1996 to reflect the guidance and the law as it was defined by the Coughlan judgement in 1999.”
  
• “The Department of Health should review and clarify the guidance and that they are more proactive in checking the criteria the local criteria following the guidance.”

The British Geriatrics Society welcome the Department of Health’s response: Policy and guidance issued on Continuing Care Assessments and Hospital Discharge in February 2004 which clarified the assessment procedure and stressed the impor tan ce of communication with families by professional members of clinicians. It also recommended that the process is informed by the single assessment process making full use of the multidisciplinary team .It recommended that the input of a consul tan t geriatrician should always be available and called upon whenever indicated.

The British Geriatrics Society welcomes the introduction of the single assessment process and sees this as a way of facilitating the implementation of effective comprehensive geriatric assessment.

However the British Geriatrics Society believes that these recent changes will not bring about sufficient change to the care of frail older people .We continue to be of the opinion that:

“Regardless of the source of funding no individual should enter a system of domiciliary or institutional care without prior exposure to an effective system of specialist and multidisciplinary assessment backed up by appropriate treatment and rehabilitation. By maximising an individual’s health and functional capacity their need for and usage of expensive prosthetic long term care can be minimised. Comprehensive geriatric assessment is the cornerstone of effective health and social care for older people and has been identified as a major clinical advance that systematically reduces the disability and institutionalisation of older people.”(BGS response to the Royal Commission)