The question of who pays for long term care was thrown into chaos last week by the Court of Appeal judgement in the 'Coughlan' case.

The Royal College of Nursing has written to health secretary Frank Dobson, calling for 'swift action' to clarify the situation. Managers and unions also renewed calls for a government response to the Royal Commission on Long-Term Care, which recommended in March that all nursing care should be free, wherever it was provided.

The judgement threw out an appeal by North and East Devon health authority against a High Court decision that it could not withdraw free nursing care from Pamela Coughlan, a disabled resident of a home it sought to close. But it went on to say that the 'NHS does not have sole responsibility for all nursing care.'

Health secretary Frank Dobson said he was 'delighted' because it confirmed his understanding of the legal position.

But the judgement also said that the nursing care provided by a social services authority, and therefore subject to charges, was only legal if it was 'merely. . . incidental or ancillary' to the provision of accommodation.

That led the Royal College of Nursing to the view that the judgement set a precedent covering tens of thousands of people now paying for nursing care because they live in nursing homes.

RCN solicitor Helen Caulfield forecast many more individual legal challenges to HAs if Mr Dobson did not take urgent action to clarify guidance.

RCN general secretary Christine Hancock claimed the 'simplest, fairest and most cost-effective solution' would be to make all nursing care free, in line with the royal commission recommendations.

But NHS Confederation chief executive Stephen Thornton said the NHS could have been bankrupted this year if the court had come to a different conclusion.

'This seems a very sensible judgement that makes clear that the NHS is not responsible for paying for all nursing care provided in nursing homes, ' he said.

The government has responded to the health select committee's report on long-term care by listing announced initiatives it says comprise a 'massive programme' to improve older people's lives.

The response says: 'After detailed consideration the government will discharge its own responsibility by announcing how it intends to tackle the issues raised in a way which will be fair to both the taxpayer and the individual.'

But it has declined to respond to the royal commission's report, as the committee demanded.