?

Introduction

With the introduction of free nursing care due in ten days time, this Care Standards Update is focussed on bringing together all of the information currently available on the introduction of free nursing care in each of the four countries of the United Kingdom.

Survey of Nursing Homes

The survey undertaken by the Department of Health in July 2001 to identify the number of patients in nursing homes who were funding their own care has resulted in the need for the Government to review their estimates.

The survey indicated that there are a total of 42,000 people in nursing homes paying for their own care. This has resulted in the sum of money allocated to health authorities for the period 1 October 2001 until 31 March 2002 being increased from ?80 million to ?94 million. To this figure has been added ?6 million for the introduction of the free incontinence products initiative.

Following the survey the Department of Health have issued details of the amounts of money which will be forwarded to individual health authorities to meet the cost of free nursing care. The details of these payments are shown on the enclosed document from the Joint Unit within the Department of Health.

1. England

The most up to date information on the introduction of free nursing care in England was circulated to all members on 10 September 2001 which comprised:

• NHS Funded Nursing Care Practice Guide & Workbook
• Free Nursing Care - Frequently asked questions
• NHS Funded Nursing Care in Nursing Homes What it means for you. A guide for people living in or going into nursing homes, their families and their carers
• Appendix 4 - Determination of the Registered Nursing Contribution to Care

The Department of Health consider that the Practice Guide and Workbook is the definitive document in the way in which the free nursing care assessment will be undertaken.
Patients on Contract with Local Authority

In a special Chief Executive's bulletin the Department of Health advised all health authorities and local authorities that the proposed extension of free nursing care to all patients from April 2002 has been deferred until April 2003. The bulletin clearly states that local authorities will be responsible for placing and funding patients in nursing homes until 31 March 2003.

"The transfer of funds from councils to the NHS will not now take place until 2003 / 04. Councils will therefore continue to be responsible for placing and funding residents that they support until 31 March 2003. This extended transitional period will enable PCTs, councils and care homes to ensure a smooth handover of funding responsibility while at the same time allowing NHS nurses to be involved in the single assessment process for people entering nursing homes".

A public information leaflet will be issued to health authorities (for the attention of nursing home co-ordinators) and to councils (for information officers) during week commencing 24 September . Copies should be distributed to local care homes, residents, GPs surgeries, nurses and individuals.

Free Incontinence Products

The ?6 million included in the ?100 million allocation for free nursing care equates to ?12 million in a full year and should be considered to be a significant success on the part of those of us campaigning for funding for this initiative.

Members should be aware that, although there has not yet been any guidance from the Department of Health on how this money should be spent, it is intended that it should be needs led, following assessment. The Department issued a report last year entitled "Good Practice In Continence Service" which was critical of any suggestion of rationing in relation to the supply of incontinence products. Any local difficulties, or suggestions of rationing, should be reported to Head Office.

2. Northern Ireland

Of the four countries Northern Ireland appears to have taken the least action to date in relation to free nursing care. They appear to be taking a 'wait and see' approach to this initiative.
We have been unable to identify any proposals for the introduction of free nursing care, all of our enquiries have indicated that the authorities in Northern Ireland propose to monitor the introduction of free nursing care in England and free personal care in Scotland and then take a decision on what should be introduced into Northern Ireland and to what timescale.

2. Scotland

The proposals under consideration in Scotland have always been the most inclusive of the four countries. There was a price to pay for this inclusive approach in that the enquiry set up to investigate how paying for personal care could be introduced would, of necessity, delay the introduction of this initiative. The proposals detailed below are expected to be introduced in April 2002.

The report of the Care Development Group, "Fair Care for Older People" was published on Friday last, 14 September 2001 but is still to receive the approval of the Scottish Parliament. The Care Development Group included the following in their conclusions:

"For older people who are already in care homes, if their costs are already being met from the public purse, that will obviously continue. Those who move into a care home after a date to be named will be required to undergo an assessment of their level of need before qualifying for free nursing or personal care. Payment will then be made at a rate which reflects their level of assessed need for personal care up to a maximum of ?90 per week and at a flat rate of ?65 per week for nursing care.

"For those already in care homes on the named date who are funding their own care, we recommend that as from next April they should receive contribution towards their costs of ?90 per week for personal care and ?65 per week for nursing care without further assessment as a transitional measure towards the new arrangements. This is on the assumption that these individuals will continue to be eligible for Attendance Allowance.

"For those currently receiving care services at home, we recommend that where these come within the definition of "personal care" which we propose in our report, all charging should be ended from next April.

"Alongside these changes, we still expect people to pay for or contribute to their own living and accommodation costs whether they are at home or in a care home".

The second specific Care Standards Update for Scotland is currently being prepared and will be sent to our members in Scotland shortly. It will include a fuller report on the Care Development Group report and the response of the Scottish Executive to the Regulation of Care Project.

2. Wales

The consultation period on free nursing care only expired on Friday 21 September 2001. It is considered that it would be impossible to implement any initiative in relation to free nursing care from 1 October 2001.

Contacts within the Department of Health in London have indicated that they believe that the National Assembly for Wales are looking at introducing free nursing care with effect from the 1 January 2002.

Our contact within the National Assembly for Wales, whilst not identifying a commencement date have established that the National Assembly does not yet have processes in place to either undertake the assessment or source the appropriate funding.

V.A.T. on Incontinence Products

HM Customs & Excise have issued Business Brief No. 12 / 2001 which is concerned with V.A.T. on incontinence products. The changes announced will take effect from 1 October 2001.

In essence it is intended to make it easier for zero rating incontinence products to be purchased by entitled people through retail outlets. That is to say that individuals will be able to purchase incontinence products from, for example, chemists without paying V.A.T.

In order to prevent nursing home owners taking advantage of these easier arrangements Customs & Excise have introduced restrictions which require a signed declaration or other supporting evidence that the supply is to an incontinence individual where there is an attempt to buy more than:

• 200 disposable pads, or
• 50 washable pads, or
• 5 collecting devices, or
• 10 pairs of waterproof / leakproof underwear

Criminal Records Bureau

Despite all of the publicity the Criminal Records Bureau will not 'go live' in October 2001. There are significant delays within the CRB in registering organisations.

The R.N.H.A. has applied to be an umbrella body and we will advise members as soon as we have any information of the necessary procedures. The requirement to undertake police checks does not become effective until April 2002.