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Friday, July 16, 1999 Published at 12:16 GMT 13:16 UK


Coughlan case sparks long-term care debate

Long-term care of the elderly is a contentious issue

The Court of Appeal ruling that some people will have to pay for nursing home care has provoked widely differing responses.

Long term care
Some campaigners claim the fact that many people will escape charges is a major step forward, others that the fact that anybody has to pay is profoundly unfair.

The Royal College of Nursing claimed the judgement could herald the end of means-testing for long-term health patients.

RCN general secretary Christine Hancock said after the hearing: "Pam Coughlan's brave decision to fight the closure of her home has brought her personal success but it should also bring an end to means-testing for nursing care for tens of thousand of people in nursing homes.

"The judgement clearly states that North and East Devon Health Authority's eligibility criteria for long-term NHS health care were unlawful. It rules that where a patient's primary need for accommodation is a health need, then the patient's nursing care is the responsibility of the NHS and not the local authority.

"Almost by definition, the primary need of the vast majority of people in nursing homes is a health one.

[ image: Christine Hancock welcomed the ruling]
Christine Hancock welcomed the ruling
Ms Hancock said the judgement also indicated that the Department of Health's eligibility criteria guidance issued in 1995 had shortcomings and was the basis of the flaws in the health authority's criteria.

"This means there are likely to be many other health authorities who are employing unlawful criteria to determine who should receive long-term NHS nursing care.

"The Secretary of State must now act decisively to clarity patients' rights to long-term nursing care.

"The simplest, fairest and most cost-effective solution would be to entitle all those assessed as needing long-term nursing care to receive that care free under the NHS, wherever it is provided.

However, Sally Greengross, director of Age Concern England, said the ruling perpetuated a fundamental inequality - the fact that people in nursing homes had to pay for care when it is free everywhere else.

"Nursing care is rightfully a health responsibility and Age Concern has long argued that nursing care should be free at the point of delivery to all those who need it, wherever they live."

"This judgement will add to the confusion which characterises the long-term care system."

Muddled mess

A spokesman for Help the Aged said: "This is good news for Ms Coughlan.

"Unfortunately it is not going to alter the funding arrangements of vulnerable older people in nursing care.

"We were hoping this case would clarify the situation, but the muddled mess continues.

"Thousands of people are desperate for a clear policy on how we fund long-term care. The sooner the Government responds to the Royal Commission's recommendations, the better."

[ image: Stephen Thornton is worried about costs]
Stephen Thornton is worried about costs
Stephen Thornton, chief executive of the NHS Confederation which represents all health authorities, said: "It seems to be a pretty sensible judgment.

"If it had gone the other way it could have bankrupted the NHS and therefore we are pleased with the decision.

"But the devil is really in the detail of this case. The existing criteria for who receives NHS-funded long term nursing care needs to be clarified and the judgment does not make that clear."

Health Secretary Mr Dobson has said the Government was reviewing the situation in the wake of today's judgment.

Mr Thornton added: "If the Government lowers the criteria there could still be huge cost implications for the NHS."

Shadow Health Minister Philip Hammond said the ruling underlined the urgent need for a government response on the Royal Commission long-term care of the elderly report.

He said: "Labour in opposition said they would deal as a matter of urgency with the problem of long term care funding.

"Once in Government they used the Royal Commission to delay any decision for two years and now they are delaying again."

The Royal Commission recommended that all nursing home care should be free to the patient.

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