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Wednesday, 6 December, 2000, 17:12 GMT
Health proposals: Analysis
Some elderly people will now get free care
By BBC Health Correspondent Richard Hannaford

The publication of the NHS Plan for England last summer made legislation inevitable in this session of parliament and much of it will prove surprisingly controversial.

With some commentators predicting a general election by May, the Prime Minister is known to be impatient that not enough progress is being made in improving patients experience of the NHS.

The decision to publish the plan for England in July - with all its new ideas, changes, and reforms - made it impossible to avoid at least one major bill on health being put before parliament in the run up to an election being called.

Of course, it could be argued that focusing on new ideas and promises of a better future for the NHS ahead of a poll could be helpful to a government that wants to suggest it has plenty of energy left and needs a second term in office to fulfil its potential.

Long term care

The proposed Health and Social Care Bill will confirm the government's response to the report by the Royal Commission on Long Term Care for the Elderly.

In future, all care provided by registered nurses will be paid for by the state.

With more than 164,000 people living in nursing homes, officials calculate the proposal could save up to 5,000 a year for some 35,000 of them.

Although the Royal Commission recommended that personal costs (a mixture of both nursing and social care) should be paid by the state after an assessment of need, the government has rejected that as too costly.

Social care will therefore continue to be means tested, something many groups are unhappy about.

And I would not be surprised to see some rebels in the Commons and the Lords try to amend that as the bill makes its progress.

Another element in the bill will be the extension of new Primary Care Trusts to take over many of the functions currently provided by local authority social services departments.

This will shock many old time Labour supporters who are already concerned about the future of local democracy.

The bill is designed to enable groups of GPs to integrate health and social care more effectively.

But it will also for the first time allow NHS organisations to means test patients - but only for existing social care procedures.

For some that might seem like the thin end of the wedge.

Watchdog controversy

Community Health Councils, the patients watchdogs set up in the 1970s are also to be abolished under the bill and replaced with patient forums and liaison teams - again a highly contentious issue.

While CHC's have proved variable in their quality so far ministers proposals for a new Patient Advocacy Liaison Service have not proved popular and there is a growing campaign to save the CHCs.

And in another radical move the bill will allow the Department of Health, the Treasury and a private sector financial institution - yet to be named - to form an statutory company called NHS Lift.

In this new development of the private public partnership the Company will invest more than a billion pounds in upgrading a third of all GPs surgeries in deprived areas of England over the next three years.

While no one doubts the need for investment many old labour supporters will again question the need for a such a close relationship with Bank or even Pension Fund when dealing with the Health Service.

So along with plans to ban tobacco advertising across the UK, its clear that whatever happens to the NHS this winter, Health Ministers are going to be in the political firing line come what may over the next few months.

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06 Dec 00 | Health
Tobacco ad ban back on agenda
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