Authorities want clearer guidelines about funding long term care
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《英国医生杂志》
The NHS must take more responsibility for the care of chronically sick and elderly people, charities and non-governmental organisations told the parliamentary health committee last week. Representatives from organisations including Age Concern, the British Geriatrics Society, and the Citizens Advice Bureau claimed that the NHS guidelines used to assess a person抯 eligibility for long term care had been failing patients.
Representatives from the North West London Strategic Health Authority also told the committee that the government needed to give clearer guidelines so that the NHS knew which long term patients they were required to provide funding for and which they were not.
Health authorities had already been obliged to pay out a substantial amount in restitution after the 2003 health service ombudsman抯 report found that the NHS had failed in its duty to give continuing care to many elderly patients who should have been eligible for funding (BMJ 2003;326:466, 1 Mar).
A pot of ?80m ($347m; �258m) had been put aside to pay restitution to people who had been wrongly denied financial help, and it is estimated that more than two fifths of appeals by patients had been successful. The strategic health authority told the committee that it needed more help from the government to prevent such large errors.
Those giving evidence said that provision for continuing care varied enormously round the country. Anne Williams, of the Independent Complaints Advocacy Service, and regional coordinator for North West Citizen抯 Advice, labelled continuing care "the biggest postcode lottery of them all." Strategic health authorities were free to draw up their own guidelines to assess who was eligible for funded treatment, and professionals differed substantially in their application of the criteria. Also patients were not clear about how the decision making process worked, and this was more likely to lead to dissatisfaction with the outcome.
Those giving evidence called for clearer guidelines on eligibility and a structured review process. They also made the suggestion that GPs could be made responsible for informing patients of their options. Other criticisms of the guidelines were their focus on physical rather than mental health problems and their tendency to favour people with unpredictable health needs over those with relatively stable but severe or deteriorating conditions.
The evidence seemed to support a further mingling of NHS responsibilities with those traditionally associated with social services. Catherine Attlee, director of commissioning and modernisation at Hounslow Primary Care Trust, said, "We are now looking at in terms of delivering a care package by a range of individuals, rather than dividing duties between the two camps."(Madeleine Brettingham)
Representatives from the North West London Strategic Health Authority also told the committee that the government needed to give clearer guidelines so that the NHS knew which long term patients they were required to provide funding for and which they were not.
Health authorities had already been obliged to pay out a substantial amount in restitution after the 2003 health service ombudsman抯 report found that the NHS had failed in its duty to give continuing care to many elderly patients who should have been eligible for funding (BMJ 2003;326:466, 1 Mar).
A pot of ?80m ($347m; �258m) had been put aside to pay restitution to people who had been wrongly denied financial help, and it is estimated that more than two fifths of appeals by patients had been successful. The strategic health authority told the committee that it needed more help from the government to prevent such large errors.
Those giving evidence said that provision for continuing care varied enormously round the country. Anne Williams, of the Independent Complaints Advocacy Service, and regional coordinator for North West Citizen抯 Advice, labelled continuing care "the biggest postcode lottery of them all." Strategic health authorities were free to draw up their own guidelines to assess who was eligible for funded treatment, and professionals differed substantially in their application of the criteria. Also patients were not clear about how the decision making process worked, and this was more likely to lead to dissatisfaction with the outcome.
Those giving evidence called for clearer guidelines on eligibility and a structured review process. They also made the suggestion that GPs could be made responsible for informing patients of their options. Other criticisms of the guidelines were their focus on physical rather than mental health problems and their tendency to favour people with unpredictable health needs over those with relatively stable but severe or deteriorating conditions.
The evidence seemed to support a further mingling of NHS responsibilities with those traditionally associated with social services. Catherine Attlee, director of commissioning and modernisation at Hounslow Primary Care Trust, said, "We are now looking at in terms of delivering a care package by a range of individuals, rather than dividing duties between the two camps."(Madeleine Brettingham)