Before The National Framework

A Brief History Of Continuing Care

Before the National Framework was introduced in October 2007, there was no single set of eligibility criteria to decide if a patient qualified for continuing care. Instead, in response to the Leeds court case, the Department of Health published national guidelines in 1995 to help the various Health Authorities draw up their own eligibility criteria for awarding NHS Continuing Healthcare. The guidelines came into force in April 19961.

Unfortunately, the guidelines were interpreted differently by England’s 95 Health Authorities2, so continuing care criteria and assessments varied widely across the country. Unsurprisingly, a ‘postcode lottery’ developed where patients in some areas were hundreds of times more likely to qualify for funding than patients elsewhere. As a result, many seriously ill people were denied funding and forced to fund their own care costs.

The Department of Health tried to tackle the ‘postcode lottery’ by issuing revised guidance several times between 1997 and 2006. Despite these changes, a number of high profile court cases showed that some Health Authorities were either applying unlawful eligibility criteria, or applying the criteria unlawfully during the assessment process.

Following a damning continuing care report by the Health Services Ombudsman in 2003, the Department of Health announced plans to develop the National Framework in December 2004, although the consultation process did not actually start until June 2006.

When the National Framework was introduced, it solved many of the issues around continuing care assessments by standardising eligibility criteria, decision-making tools and paperwork. However, some of the key problems remain, including:

• Accurately defining a Primary Health Need
• Defining the boundary between health care and social care, and therefore which services the NHS and the local authority can be lawfully expected to provide
• The ‘postcode lottery’ – it is still easier to qualify for funding in some areas of the country than in others
• Ensuring equal and fair access to continuing care for people whose Primary Health Need is mental, especially dementia sufferers.

Find Out More

You can find out more about the history of continuing care and how developments have unfolded over time in our Factsheets 2 and 3.

Denied Funding Before October 2007?

If you or a relative were assessed for and denied continuing care funding before October 2007, you can ask to be re-assessed under the National Framework. However, this does not guarantee you will be reimbursed for the care home fees you have already paid.

If you are in this situation, contact Cheselden so we can carry out a free, no-obligation review of your case. We can still help if you are no longer paying for care but wrongly had to pay in the past, or if a relative paid for care and is now deceased.

Notes

1. Before April 1996, there was no requirement for a Health Authority to have formal, written criteria in place for assessing patients for continuing care funding.
2. Reduced to 28 in 2002 and 10 in 2006. Now called Strategic Health Authorities (SHAs).