The organisational changes currently underway in the health service were a key factor in the government's decision to delay full implementation of free nursing care paid for by the NHS.

The NHS took on paying for registered nursing care for self-funding residents of nursing homes last week, but payments for local authority-funded residents will not transfer to the NHS until April 2003 - a year later than planned. The Department of Health confirmed the move followed representations by the NHS Confederation, the Local Government Association and the Association of Directors of Social Services.

A DoH spokesperson said: 'The main reason was the transfer of finances from social services to the NHS. There were some concerns it wouldn't be sorted out by next April.'

NHS Confederation social care policy manager Janice Miles told HSJ: 'Working with the LGA and the ADSS, we felt the timetable was rather tight.' This was caused by the combination of NHS organisational changes with the need to implement the new system for self funders now, she said.

'Many primary care trusts are in the development stage - they'd have had to take this on.

'We are in the midst of changing to strategic health authorities so you wouldn't have HAs as a fallback. It is Shifting the Balance as well as free nursing care that made it more complicated.'

Transferring the funding between social services and the NHS was 'extremely complex', Ms Miles added. 'We said we really do need longer to work this through and make sure it works smoothly.'

Key issues include working through funding mechanisms when an elderly person moves to a nursing home within a different local authority.

LGA chair Sir Jeremy Beecham said: 'We are pleased the government agrees that an additional 12 months until full implementation will enable robust arrangements for joint working between councils and the NHS, which will ensure smooth implementation.'

A working group of the DoH, the confederation, the LGA and the ADSS had been set up to look at protocols for national implementation of the new system, Ms Miles said. 'This is a really good example of joint working.'

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