HL Deb 28 June 2004 vol 663 cc10-1

3.12 p.m.

Baroness Greengross

asked Her Majesty's Government

When they are going to issue clear guidance to local authorities and the National Health Service on a definition of continuing care outside of a hospital, so as to avoid people being incorrectly charged.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, the recent ministerial Statement made in both Houses showed that the strategic health authorities have investigated 6,713 cases where people may have been wrongly denied continuing care and found that 770 were eligible for recompense. A report on the revised criteria used in a sample of strategic health authorities will be published before too long. In the light of that and progress in completing the 5,000 or so investigations under way, the Government will consider whether any further guidance is necessary.

Baroness Greengross

My Lords, I welcome what the Minister says about the efforts his department is making to recompense those people who have been wrongly charged for care. I am still concerned that past mistakes identified by the health ombudsman's report last year will continue so long as there is such enormous confusion among social services departments, the NHS and others about what qualifies as continuing healthcare.

Surely a healthcare need is a healthcare need. Does the Minister agree that we must focus on a person's health needs and not whether that need is for personal or nursing care; and that the Department of Health guidelines must reflect that?

Lord Warner

My Lords, it is worth bearing in mind that the department's guidance, which was issued in 2001, was based on the Coughlan legal judgment in 1999, which followed an ombudsman report. In her 2003 report the ombudsman said that she did not underestimate the difficulty of setting fair, comprehensive and easily comprehensible criteria dividing between social services and health. That is absolutely right. We believe that these are complex issues where it is inevitable that there will be a degree of individual judgment depending on the circumstances of the case.

Lord Clement-Jones

My Lords, the Minister talked about the guidance perhaps being revised. The health ombudsman criticised it 18 months ago. Is it clear that there are substantial variations in the assessments made by strategic health authorities, and is it high time that the Government produced new guidance?

Lord Warner

My Lords, the noble Lord should bear in mind that the health ombudsman made six main recommendations in her report in February 2003 and essentially we are implementing them. As I said. we have commissioned an independent review of the strategic health authority's guidance and we will consider that and the results of the investigations in the summer before deciding whether further guidance is needed.

Baroness Pitkeathley

My Lords, does my noble friend agree that the guidance is urgently needed, not only for government and local agencies but also for the families who are, after all, the providers of most continuing care except in the Department of Health definition? In that regard, does he agree that the Carers (Equal Opportunities) Bill of my noble friend Lord Ashley, which was before the House on Friday, will be significant in enabling families to obtain the right amount of information about what services are available and their rights to them?

Lord Warner

My Lords, having enjoyed my Friday morning on that Bill, I am more than delighted to assure my noble friend that it is an excellent Bill and I hope that the House will give it a speedy passage.

Baroness Masham of Ilton

My Lords, would it not be easier to drop means testing and would it not be quicker and more successful for those people who sometimes cannot wait for assessment and care?

Lord Warner

My Lords, we have said on many occasions in this House and in the other place that free personal care for everyone is not the Government's policy. The £1 billion or so that it would cost will be better spent developing community-based services for those who need them, particularly those in greatest need.

Earl Howe

My Lords, will the Minister say how strategic health authorities set about the process of trawling for cases? Have they only reviewed those older people or their families who have come forward to ask for their cases to be reviewed?

Lord Warner

My Lords, there has been a variety of measures. The publicity given to the issue meant that a much larger number of applications was made in relation to previous cases. In some cases the strategic health authority had access to the records and had begun the process, so it is a mixture. We have now had about 12,000 people applying to have their cases reviewed. As I said in my Answer, so far only 770 cases have resulted in recompense being required.