NHS Reforms in England – a quick guide
Predictably, successive UK governments have used elderly people as an election ‘tool’ – promising positive change before an election to win votes, and yet delivering very little once in office.
Health Needs vs. Social Needs
What governments and mainstream media don’t talk about as much, however, is how the NHS continually forces the elderly to pay for healthcare that should be provided free at the point of use – by defining it as ‘Social Care’.
Many elderly people needing care are assessed financially (means tested) before they are assessed for health needs. This practice is widespread – and it results in elderly people wrongly paying for care (for health needs) that should, in law, be provided free of charge.
The NHS reforms talk little account of this.
The government’s new Health and Social Care Act 2012 has been, and continues to be, the cause of much debate anc concern. It has, however, now become law.
In a nutshell…
- All 152 Primary Care Trusts (PCTs) and 10 Strategic Health Authorities will be abolished by April 2013.
- General Practitioners (GPs), along with hospital doctors and nurses, will form Clinical Commissioning Groups (CCGs) to buy in and provide health services for patients, and will have 80% of the NHS budget in their hands.
- These new CCGs will take full financial responsibility for commissioning care/services.
- Some existing PCTs are already starting to form ‘clusters’ as part of pilot schemes to work with new CCGs.
- A new National Commissioning Board will oversee these groups and will be responsible for some specialised services on a regional and national basis.
- New local and national ‘HealthWatch’ bodies will be set up – part of the Care Quality Commission (CQC) and located within local authorities; these will in theory be able to prompt inspections of the NHS.
- The CQC will have more power across health and social care. The CQC is itself the subject of much bad press for its failure to properly inspect care homes.
- Hospitals will be able to accept many more private patients.
- Health and social care bodies will work together more.
- The NHS regulator, Monitor, will have a duty to promote better integration between care services.
There are serious concerns about the impact of the reforms on elderly people.
Retrospective claims for care fees
Since the introduction of the new reforms, the government has also made drastic changes to the rules about reclaiming care fees retrospectively – through NHS Continuing Healthcare – effectively stopping most people who have been wrongly charged from claiming back anything after September 2012.
GP knowledge about NHS Continuing Care
GPs, who will now be responsible for commissioning NHS Continuing Healthcare funding, typically know very little about NHS Continuing Care. Where does this leave families who are already having to ‘fight the system’ to obtain the funding they’re entitled to.
Hospitals
Hospitals will be able to attract and treat many more private patients. Where will that leave priorities and resources for frail elderly people in hospital, who, as seen in the press, are already seriously neglected in hospital?
Personal Budgets
The government is rolling out Personal Budgets – and is first targeting people in receiptof NHS Continuing Care. However, Personal Budgets do not always cover the full cost of care- and this could be a viewed as a way of saving money, NOT of providing better care.
And who will manage a Personal Budget for an individual elderly person with dementia in full-time nursing care?
The Association of Directors of Adult Social Services (ADASS) in England has recommended that the National Commissioning Board is responsible for applying the National Framework for NHS Continuing Healthcare and that this Framework should remain under the Department of Health.
Patient choice
“Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment.”
If GPs hold most of the budget power and it is advantageous to live near the best GPs who happen to understand someone’s specific care needs, where does that leave someone who is isolated in a care home with no personal contact with a GP and no means to relocate?
It could potentially lead to a return to the postcode lottery that the National Framework sought to end, where every health authority had its own rules about funding nursing care.
Independent Review Panels (IRP)
ADASS also recommends that Independent Review Panels (currently held at Strategic Health Authorities for people appealing against decisions to deny NHS Continuing Care funding) should continue to be held, but as a National Commissioning Board responsibility.
Long term care
The government says:
“We are committed to promoting equality and will implement the ban on age discrimination in NHS services and social care to take effect from 2012.”
“We will introduce choice in care for long-term conditions as part of personalised care planning. In end-of-life care, we will move towards a national choice offer to support people’s preferences about how to have a good death, and we will work with providers, including hospices, to ensure that people have the support they need.”
Time will tell.
