National Health Service

Part of Opposition Day – in the House of Commons at 6:37 pm on 24th January 1996.

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Photo of Mrs Marion Roe Mrs Marion Roe , Broxbourne 6:37 pm, 24th January 1996

I am pleased that the House has the opportunity to debate the state of the national health service because I want to draw attention to the work that the Select Committee on Health, which I have the honour to chair, is currently undertaking in respect of long-term care—an issue of enormous importance in future policy and direction and to the public.

How the disabled elderly are to be cared for and who is to pay for that care is a question that affects us all potentially. Last November, the Committee published the results of phase 1 of its inquiry, which considered the implications of Department of Health guidance on NHS responsibilities for meeting continuing health care needs. That report was unanimous, and I thank all my colleagues on the Committee for the constructive way in which that topic was discussed. It was a very good advertisement for the Select Committee system. We are now well into phase 2 of our inquiry, which is considering the potential demand for long-term care in the future and the possible consequences of funding arrangements.

I shall begin by outlining the main conclusions in our report and the main points of the Government's response, which was published yesterday. The Select Committee has not yet had an opportunity to discuss the response, so I shall give my own personal view. I will also touch on the main issues that we are considering in phase 2 of the inquiry.

The Select Committee was pleased that the Department of Health had recognised the need to clarify NHS responsibilities for continuing health care services. We commended the Department for the extent to which it was able to accept views expressed during its consultation period. Nevertheless, there were some areas where we thought that further clarification would be helpful for the NHS, for local authorities and also, of course, for the users of those services.

The guidance calls on health authorities to develop local policies for purchasing continuing health care services. All the members of the Select Committee were struck by the desire of witnesses that health authorities should not focus solely on the important question of defining eligibility criteria for NHS continuing health care, but should also ensure that the full range of high-quality continuing health care services is available to support people in their own homes for as long as possible. I am pleased to note that the Government strongly agree with our sentiments.

The Select Committee shared the concerns of many witnesses who argued that locally set eligibility criteria might create unacceptably wide variations in the provision of NHS services. We recognised that the Department of Health's guidance provided a framework which went some way towards meeting those concerns, but on the grounds of equity we recommended that the nationally set framework should include eligibility criteria for long-term care so that it is absolutely clear what the NHS, as a national service, will always provide.

I am also pleased that the Government, in their response to our report, agreed that the current variation in continuing health care arrangements needs to be addressed. The Government have also committed the national health service executive board to reviewing, during the coming year, how eligibility criteria are operating in practice and to issuing further guidance on priority issues relating to eligibility criteria, which may, in effect, lead to the national criteria that we called for in our report.

The Select Committee felt that it was important that patients, together with their families and carers, should be left in no doubt as to the circumstances in which health authorities rather than local authorities will be responsible for purchasing continuing care services, especially nursing home care which, as the House will be aware, can be purchased both by health authorities and by local authority social services departments. We were not convinced that the Department of Health's refusal to provide information on the types of cases that might be expected to come within the eligibility criteria was justifiable. We therefore recommended that the Department of Health should prepare illustrative case studies and widely disseminate them.

I am pleased that the Government have recognised the strength of our case by accepting in their response that there is value in health authorities testing their eligibility criteria against case studies. I fear, however, that the members of the Select Committee will be disappointed that the Department of Health is still only considering whether it would be helpful to issue the kind of illustrative case studies that we call for. In our view, those are clearly necessary to help members of the public to understand their position.

Our report also recommended that the Department of Health should introduce a national long-term care charter, which would specify the minimum levels of provision that people could expect from health authorities, NHS trusts, GP fundholders and local authorities. It would also specify access to a named range of services, a minimum list of specialist equipment and home aids, time limits for assessment, and provision of services where need is identified.

The Government have told us that they have not reached a final decision on whether to issue such a charter, which would cover some of the ground already covered by the forthcoming local community charters, but that before April they will issue a national leaflet on long-term care. We look forward to seeing that.

The guidance issued by the Department of Health also deals with hospital discharge arrangements for patients who are assessed as not requiring further NHS-funded continuing health care. The Select Committee recommended that health authorities and NHS trusts should not discharge patients home without a package of care being prepared, which can be demonstrated to meet their assessed needs fully and, as far as possible, agreed in advance with them and their informal carers. We also called for NHS-funded patients entering a nursing home to have the right, subject to the necessary clinical and financial conditions, to choose their nursing home—a right which currently exists for local authority-funded patients in nursing homes.

The Select Committee welcomed the proposed establishment of independent panels to which patients being discharged from hospitals, who are not to be funded by the NHS, can appeal. Those panels will provide an extra safeguard for patients facing important and sensitive decisions about their future. We also urged the Department of Health to clarify the arrangements under which those panels would seek independent clinical advice. We also recommended that the right of appeal to the review panel should he extended to all patients assessed as requiring nursing home care, wherever they live, when that care is not to be funded by the NHS, and that the right of appeal should not be restricted to those being discharged from hospital.

I am pleased that the Department of Health's further guidance on the review procedure makes it clear that patients, families and their carers have the right to request a second clinical opinion, which should be offered routinely before their case reaches the independent review panel. However, it is disappointing that the Department of Health has not clarified our concerns about how the provision of independent clinical advice to the review panel can be conducted fairly from the patient's point of view, if an opinion is to be given only on whether the clinical judgments made match the health authority's eligibility criteria, rather than on the clinical diagnosis, management or prognosis of the patient.

The Select Committee warmly welcomed the decision that implementation of the new guidance should be one of the six national priorities set by the Department of Health for the NHS over the next three to five years. We called upon the Department of Health to set firm target dates for the completion of NHS reinvestment programmes by all those health authorities whose reviews indicated a need for such a programme. We also considered that to aid public confidence in the equity of access nationally to NHS-funded continuing health care, the Department of Health should publish the outcome of its review of individual health authorities' policies and eligibility criteria and outline the action that it would take against any authority which significantly departed from the national framework. I welcome the Government's assurance that health authorities will have to publish plans clearly setting out the target dates for completion of any necessary reinvestment programmes; and the Committee will look to the NHS executive to monitor health authorities closely to ensure that the policies are fully implemented.

I should like now briefly to outline how the Select Committee is taking forward its work on long-term care in phase 2 of the inquiry. Many of our witnesses have commented on the need for the Government, Parliament, providers and the public to participate in a far-reaching debate about the future of long-term care provision and funding. We hope that our Committee is currently stimulating that debate. We are considering what models of care exist for long-term care services, and we are further examining the differing models of care which can meet future demand for long-term care.

Some of our earlier witnesses stressed the potential impact that health promotion might have on reducing demand, while others drew attention to the potential offered by further investment in rehabilitation services. We are also considering who should manage long-term care.

An aging population is a widely recognised phenomenon throughout most of the developed world, including the United Kingdom. The state of health of older people is also a key determinant of the need for, and hence the cost of, long-term care. We shall therefore be considering the cost implications of long-term care, given projected demographic trends, and whether talk of a demographic time bomb is realistic or alarmist.

We have been exploring the question of whether longer life expectancy is likely to lead to longer periods of illness and disability, in addition to other factors which may impact on the demand for long-term care, such as changing social and demographic conditions.

Whatever the scale of the likely increase in demand for long-term care, one thing is clear: it will have to be financed from one source or another. Where the balance of responsibility for funding as between the individual and the state should lie is being debated in just about every western country, as well as in many Asian countries. It is probably true to say that this issue potentially eclipses in its future importance every other issue that we daily discuss in this House. I hope to be able to address the House on this subject again in the near future, when the Select Committee has produced its final recommendations.