Strategic health authorities are having to rescue primary care trusts flooded with 'continuing care' cases, a year after the government made it easier for service users to claim NHS funding.

Overburdened PCTs have been forced to give SHAs control over all appeals held to decide who is eligible for continuing care.

Continuing care funds services for people who need long-term help with dressing and washing and whose main need is health, rather than social, care.

The decision represents a further shift of continuing care powers away from PCTs.

Care funding

It comes a year after the national framework for NHS continuing healthcare and NHS funded nursing care in England came into effect. The framework standardised eligibility criteria for continuing care across England, leaving PCTs having to invest more staff and money in providing long-term care.

A deadline for appeals of decisions made before 2004 to be registered by November 2007 created added pressure.

Recent board papers indicate the extent of the burden. North Yorkshire and York PCT minutes reveal "serious concerns" over the workload and uncertainty over the financial risk and the lack of adequate resources.

The increase in cases carried a risk of£3.7m, according to Derbyshire PCT. Lincolnshire PCT said the new criteria could create an overspend "well in excess" of£1m over budget.

The decision of SHAs to take more responsibility for reviews means they will now carry out all current as well as pre-2004 cases. These appeals were previously done by PCTs and should have been completed by this March.

SHA expertise

NHS South Central continuing care project manager Paula Williams said: "SHAs made the decision to align the process we use for reviewing cases because of the expertise we've built up."

South Central PCTs have invested an additional£53m in continuing care -£30m in 2007-08 and£23m in 2008-09 - because of the national framework and demographic changes.

The DH predicted that the framework would cost the health service£219m in its first year.


July 2000 Government commitment: "We will make nursing care available free under the NHS to everyone in a care home who needs it... in any setting."

December 2004 Criticism of uneven provision of NHS continuing care sparked development of national framework.

June 2007 National framework published. Plans to give primary care trusts total autonomy to set funding policies dropped. SHAs to manage PCTs' performance in implementing framework.

November 2007 Deadline for claims for retrospective (pre-2004) continuing care funding.

March 2008 Deadline for retrospective claims to be reviewed.