from Jenny Mudge, a civil servant based at Wellington House:

Your ref: JREID1.RTF
Our ref: TO1032493
Mr Robin Lovelock
22 Armitage Court
Berkshire SL5 9TA
5 September 2003

Dear Mr Lovelock

Thank you for your letter of 1 July to John Reid, regarding your concerns about eligibility for continuing NHS health care. I am sure you will understand that the Secretary of State for Health cannot reply to all the letters he receives personally. I have been asked to reply, and I apologise for the delay in doing so, due to the very large volume of correspondence received at the time.

I was sorry to hear about the death of your mother, Evelyn, in February of this year, and of your father, Len, in January 2002. I can understand your concerns that your late mother, in particular, may not have received the care to which she was entitled, under NHS provision.

As you are well aware, the NHS has important responsibilities for arranging and funding a range of services to meet the needs of people who require continuing medical, physical or mental health care. Such care can be provided at home, in a nursing home or a residential home. This is dependent on the individual's need for healthcare ? it does not depend on the setting or the qualification of the staff providing the care. At the same time, it is important to recognise that the NHS has never been responsible for the needs of everybody requiring continuing support. The judgement in the Court of Appeal case of R v. North and East Devon Health Authority ex parte Coughlan, confirms that local authorities may require clients to contribute to the costs of their care package, subject to a means test.

The Department issued updated guidance on NHS continuing care and responsibilities for funding on 28 June 2001, in circular HSC2001/015:LAC (2001)18, 'Continuing Care: NHS and Local Councils' responsibilities'. The guidance establishes that a need for continuing NHS healthcare may be indicated where the nature, complexity, intensity or unpredictability of the individual's healthcare needs (and any combination of these needs) requires regular supervision by a consultant, palliative care, therapy or other NHS member of the team.

Since the publication of the Health Service Ombudsman's report in February this year, good progress has been made by the Department, Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) to agree procedures to investigate cases where people may have wrongly denied continuing care and to review past criteria.

We have asked all SHAs and PCTs to thoroughly investigate all cases brought to their attention and where it is properly claimed and validly established that the NHS should have funded a person's care, the NHS should make appropriate recompense. We have also asked SHAs and PCTs to take reasonable steps to identify other cases since 1996 where people may have been wrongly denied continuing care and to ensure that local people are aware of the review process.

In order to ensure that new continuing care criteria follows the Department's guidance, we have asked the Commission for Health Improvement to include continuing care in the current consultation on the scope of the review of the NSF for older people.

It was announced during debate on the Community Care (Delayed Discharges etc) Act on 10 March this year, that new regulations governing the form and content of a notice issued in accordance with section 2 of the Act (the initial communication between the NHS and social services, where the NHS considers that it would be unlikely to be safe to discharge the patient unless community care social services are made available when the patient leaves hospital) will require the NHS to assess people for continuing care before a section 2 notice is issued. This was confirmed in a further debate on the Community Care (Delayed Discharges etc) Act on 17 March that the NHS will be required in directions to carry out an assessment for continuing care before a section 2 notice is issued and a patient can be discharged from hospital. This assessment should be informed by the single assessment process. The Ombudsman's report highlighted the variation in hospitals' assessment procedures, and this new legal requirement responds to this issue. This part of the Community Care (Delayed Discharges etc) Act comes into force in October this year.

The recommendations in the Ombudsman's report do not discuss Alzheimer's disease specifically. They concentrate on the overall system and processes for determining access to continuing NHS health care. Access to continuing NHS health care must be decided on a case by case basis, and not on the basis of whether someone suffers from one disease or another. I recognise that caring for someone with Alzheimer's often requires the involvement of a registered nurse. The complexity of the problems faced by people who have dementia means that they may require frequent review and supervision of their care. As you no doubt are aware, the disease often results in problems with behaviour, which require different care management strategies. These will be assessed on an individual basis and will be reflected in the resulting care plan.

I can only suggest that any continuing concerns you may have about your late mother's care should be directed to the Thames Valley Strategic Health Authority.

Yours sincerely

Ms Jenny Mudge

Health and Social Care Joint Unit