The Select Committee report highlighted the difficulty around definitions of personal care and nursing care provided in the patient’s home. The Government replied by stating that people should not be denied fully funded Continuing Care at home because the people providing the care are not registered nurses. The Government has agreed that if home is the most suitable setting for the person to receive their care, the NHS will fund the care by registered nurse as a contribution to the care package.

Care providing in a care home, not providing nursing care, or in a person’s own home, will be provided by a registered nurse provided free of charge generally by the community nursing services. The Government are recommending that the new National Framework will ensure that all decisions around Continuing Care are based on good assessment leading to a suitable level of care. The Government said that there would be a ten-point programme of measurement, which was set out between 2001 and 2002, to improve standards of care.

The Select Committee argued that there was an urgent need for a single universal set of national eligibility criteria for Continuing Care. The Government responded by stating that a single set of eligibility criteria will be one element of delivering coherent but national criteria will not provide the answer alone. A new National Framework will set out national eligibility criteria to ensure that all of the patients’ needs are considered, including psychological and mental health needs, ensuring that needs of people with dementia are considered on the same basis as physical needs. The Framework will emphasise the importance of good effective communication with patients and their families, as well as a consistent approach to Continuing Care assessments.

In response to the Select Committees’ concern about delays in the Governments’ response to the Ombudsman’s report, the Government stated that they were very keen to start developing a new Framework as a priority.

Eligibility for Continuing Care will in the future always be based on need and not diagnosis. The national eligibility criteria will be designed to cover all client groups, including older people with mental health needs.

The Select Committee pointed out to government that the criteria for assessing eligibility for Continuing Care and the high band nursing care are virtually indistinguishable from each other. The Government responded by stating that the new National Framework will make the process clearer by determining the individual’s level of need for a registered nurse, which should be free at point of delivery. They accept that lack of clarity in the past may have meant that care home residents were funding their own care. But the new National Framework should ensure that this framework should also link to NHS funded nursing care through the development of a single assessment process.

On being reminded by the Select Committee that many of the sets of eligibility criteria are not in accordance with the Coughlan’s judgement the Government responded by stating that the strategic health authorities are currently responsible for formulating Continuing Care criteria. The Secretary of the State is of the opinion that those whose primary need is a health need should be the responsibility of the NHS.

The Select committee argued that it was unacceptable, that in one part of the country a person would receive fully funded NHS Continuing Care while a person with identical needs living in a different part of the country would not be deemed eligible. The Government responded by restating that The National Framework will be based on the findings of the Coughlan’s judgment. The Government reassured the Select Committee that the single assessment process was being implemented as fast as it could through the establishment of electronic social care record. The Government also reassured the Select Committee that adults discharged from acute beds are automatically screened for Continuing Care, despite the Select Committee having been told that some patients and their relatives are not offered any form of assessment for Continuing Care.

The Select Committee argued that the Government should underpin its national criteria with a national standard assessment process. The Government replied by stating that they are considering the use of a national tool or a range of compatible national tools to structure the decisions making process.

The Government recommended that assessments of Continuing Care should be carried out by professionals with relevant experience and, where necessary, specialist knowledge, to ensure that all the needs of the patient have been duly taken into account. They also recognised that it was important to have regular reviews of eligibility to ensure that individuals received the right care at the right time in the right place.

Both the Select Committee and the Government stressed the importance of patients, carers and relatives having automatic access to detailed information about the assessment process.

The Select Committee was concerned that decisions about care were often driven by budgetary concerns rather than patient need. The National Framework will be looking at the role of PCT and funding panels as part of their work of the assessment process. The Government reassured the Select Committee that they have taken account of recommendations from the Ombudsman’s office and emerging good practise.

In response to questions on the green paper on adult social care, the Government/The Department of Health said that they will consider ways of increasing flexibility for individuals to enable greater consistency for services users and for the people that support them. The Department also stated they were working to see, to pilot and evaluate the use of individual budgets for adults with disability or with an assessed need for social care support. There appears to be some understanding with regards to the perverse incentive, which awards dependency, rather than rehabilitation and dependence. The Government recognises that supervision and management of care is an essential function in ensuring that individuals maintained their optimum potential inline with the Governments’ policy of maintaining independence.

The final statement in the Governments’ response was as follows “The National Framework for Continuing Care will aim to include national criteria, which takes account of psychological and mental health needs as well as physical, and which are Coughlan compliant and based on current equal requirements. The Framework will also address the implementation issues that have arisen in recent years, around the interaction between RNCC and Continuing Care, and will examine measures, which will reward high quality care and encourage flexible approaches to care provision based on the choices, rights and preferences of the service user. The Framework will aim to improve the consistency of application of the criteria by delivering a range of compatible national determined tools to aid in the decision making process It will look at measures to disseminate learning”.