?

Issued 17th August 2001

GOVERNMENT'S PLEDGE OF FREE NURSING CARE
FOR ALL FALLS WELL SHORT OF EXPECTATIONS:
RNHA RESPONSE TO CONSULTATION DOCUMENT

The Government looks like failing to meet its pledge that the NHS would pick up the nursing care costs of patients in registered nursing homes, according to the Registered Nursing Home Association (RNHA) in its response to a consultation document on the proposed scheme.

The RNHA labels the scheme 'significantly flawed' and likely to cause confusion and disappointment among those whom it is intended to help.

The RNHA says the Government has seriously under-estimated the true cost of providing nursing care, particularly for highly dependent patients with complex needs that are likely to require up to 28 hours of nursing care per week.

According to an RNHA survey of nursing homes, some very highly dependent patients' true nursing costs could be as high as ?420 a week. However, the maximum weekly payment envisaged by the Government is only ?110 a week.

The RNHA believes the scheme has been designed to keep costs down to an absolute minimum rather than genuinely to provide 'free nursing care' to nursing home patients. At best the payments will be merely a contribution towards costs, rather than comprehensive cover, says the RNHA.

"The proposed scheme appears to have been designed by accountants for implementation by accountants," said RNHA chief executive officer Frank Ursell. "Unless there are radical changes to what has been put forward, it will fall far short of what people have been led to expect by the Government's earlier statements."

END

For further information please contact: Frank Ursell, Chief Executive Officer, RNHA
(Tel: 0121-454 2511 or mobile 07785 227000)

Note: Summary of RNHA's response to consultation document is below.

?

The Registered Nursing Home Association's Response to the
Government's Consultation on Free Nursing Care

SUMMARY OF FULL RESPONSE

1. Not meeting expectations

The RNHA, which represents 1,000 registered nursing homes across the UK, believes that the Government's proposals for introducing free nursing care in nursing homes are seriously flawed. In the view of the association, the proposed scheme will fail to meet people's reasonable expectations of what 'free nursing care' means. It is also likely, as currently framed, to cause confusion among those whom the new policy is intended to help.

2. The origins of the problem

The Government's committed itself during the election campaign to end the anomaly whereby the vast majority of patients in registered nursing homes do not have their nursing care costs met by the NHS, whereas those costs are covered by the NHS for people in residential homes and all other settings. Ending the anomaly was recommended by the Royal Commission appointed by the Government to look into the funding of long-term care.

3. Narrow interpretation of what is or is not 'nursing care'

As proposed by the Government, there is a very narrow interpretation of what nursing care is and, therefore, what will be paid for. In NHS hospitals, for example, care is provided to many patients on the wards by healthcare assistants working under the overall supervision of qualified nurses. This is part of the overall cost of nursing in NHS hospital. Yet under the Government's plans, it appears that the work of care assistants that relates to patients' overall nursing needs will not be paid for by the NHS. This seriously under-estimates the true costs of nursing in nursing homes.

4. The imbalance in costs between the NHS, local authorities and nursing homes

In a long-term care ward of NHS hospital, the average costs of caring for patients work out at around ?1,000 a week. In local authority residential care homes, they work out at around ?450 a week. Yet registered nursing homes are expected to provide long-term nursing care for around ?336 per week, of which the Government assumes that only about ?70 to ?100 is for 'nursing'.

5. Meeting the needs of highly dependent patients

The most highly dependent patients with complex nursing needs require an average of four hours of nursing care per day or 28 hours per week. From a survey of nursing homes across the country, it is clear that the true cost of providing this level of care is nearer to ?420 per week, not the ?110 which the Government is proposing for this category of patient.

6. Simply a contribution towards costs - not a wholehearted attempt to provide free nursing care

The cost structure proposed by the Government appears designed to keep expenditure down to an absolute minimum, rather than to reflect the actual needs of individual patients. As the proposals stand, the payments that will be made by the NHS for the nursing care provided by nursing homes should be regarded simply as a 'contribution'. They will not meet full nursing costs and, as such, will not fulfil the pledge of free nursing care for patients in all circumstances.

The RNHA is asking the Government to look again at the way in which the NHS fee structure for nursing home patients is calculated. There needs to be a more accurate matching of payments to needs and costs.

7. A 'finance-driven approach

Experience since the introduction of community care in the early 1990s has shown how mistaken it was to allow the assessments of individuals' care needs to be undertaken by the same organisations that would have to fund it. This has resulted in a finance-driven approach by local authorities, rather than a needs-led approach. There is a great risk of history repeating itself now, as the Government is proposing that the nursing needs of patients in nursing homes should be assessed by nurses employed by the NHS organisations that will be paying for it. Whilst nurses will make the assessments, there is a risk that administrators and finance departments will ultimately decide what can and cannot be paid for

8. Overall conclusion

It is the assertion of the RNHA that the budget-conscious constraints built into the latest proposals for the introduction of free nursing care fall significantly short of the principle of the NHS being responsible for the meeting the cost of healthcare at the point of delivery. The principle that healthcare should be available to all irrespective of their ability to pay continues to be compromised by the proposals.

Registered Nursing Home Association
August 2001

Contact name: Frank Ursell, Chief Executive Officer
Tel: 0121-454 2511