Government proposals for the funding of long-term care for people outside hospital will exacerbate the financial crisis facing primary care trusts, according to the NHS Confederation.

Government proposals for the funding of long-term care for people outside hospital will exacerbate the financial crisis facing primary care trusts, according to the NHS Confederation.

A consultation on proposals to improve clarity on the boundary between care being paid for by the NHS and that funded by local authority social services departments closed on Friday.

And the document also suggests moving responsibility for commissioning continuing care from strategic health authorities to PCTs.

NHS Confederation deputy policy director Jo Webber said the proposals would help increase consistency in the long term, but 'will have an impact on continuing care budgets' in the short-term.

'Some PCTs are dealing with deficits already and have had to look at services,' she said. 'We would like the Department of Health to be considering the impact of this.'

She said one PCT had estimated its continuing care caseload under the new framework would increase from 98 to 155 patients, at a cost of£3.3m this financial year.

NHS Alliance chair Dr Michael Dixon said: 'Anything that threatens the new PCTs is sub-optimal. If the NHS is being asked to balance its books, we must ask the centre not to change the goalposts at the moment. However good in the long-term, this isn't the right time.'

But Jeff Jerome, co-chair of the Association of Directors of Social Services disabilities committee and director of adult social care and housing at Richmond-upon-Thames council, said councils had often footed the bill for what should have been provided by the NHS.

He stressed that liability for costs should take careful note of where local authorities' financial responsibility for care ended.

'In many cases we may have been accepting the views of PCTs and the NHS that may have been illegal. It will require careful monitoring and auditing to ensure decisions are consistent.'

The ADSS wants an independent process for appeals and dispute resolution that mirrors the model of mental health tribunals.

Mr Jerome said: 'The ADSS thinks many decisions around NHS continuing care have been made with reference to NHS and PCT budget pressure.'

The Royal College of Nursing said the NHS should pay for all nursing care.

RCN adviser for nursing and older people Pauline Ford said: 'If someone's needs can only be met within a nursing home, the level of nursing they need means they should get full NHS funding.'