Editorial: Will intermediate care be the undoing of the NHS?
Government proposals to allow NHS bodies to levy charges for the personal elements of care will fundamentally change the way some English patients receive health care, says an editorial in this week's BMJ. Proposals in the NHS Plan to extend NHS provision to the private sector will further erode the goals of the NHS as a universal comprehensive service writes Professor Allyson Pollock.
Under the plan, new care trusts will be able to commission and deliver both primary and community care as well as social care. They will define what is NHS care and what is social care, with the social care elements subject to local authority charging policies. Because they can levy charges for personal care in the private sector, primary care trusts will have clear financial incentives to shift intermediate care into non NHS settings, says the BMJ editorial.
The NHS Plan announced 7000 extra NHS beds by 2004 of which 5000 will be intermediate care beds, building "a bridge between hospital and home". Cottage hospitals, private nursing homes and domiciliary and community settings will form the heart of the new intermediate sector. Professor Pollock says some of the 300,000 NHS patients expected to move annually from hospitals into intermediate care in nursing and domiciliary settings may have to pay for their personal care.
From October 2001 the NHS is committed to meet only the costs of nursing care for nursing home residents; personal care will be charged for. Professor Pollock says this will mean some patients in nursing homes may be financially worse off if the NHS switches some intermediate care to this sector.
The funding mechanism governing the payment of care providers will be critical, says Professor Pollock. A Government committed to a universal comprehensive high quality NHS would restore the risk-pooling model of universal provision by bringing the nursing elements of the workforce in the private sector under NHS control, she writes.
Contact:
Professor Allyson Pollock, School of Public Policy, University College London, UK Email: allyson.pollock@ucl.ac.uk