Continuing care funding often involves individuals in the most difficult circumstances with complex needs. Locally we have tried various formulas for considering the applications for NHS funding, most recently establishing a panel that social services were invited to join.

Despite our efforts, decision-making feels cumbersome and seems to have a limited influence. Users and carers are left frustrated. Are there any better models? A postal questionnaire of 160 primary care trusts found they were evenly split on whether they had specific client group eligibility criteria or one general set. In three quarters of PCTs, decisions about continuing care were not made alongside wider investment decisions. Just over half used a forum that handled complex cases and a fifth had client group-specific forums. Only six used specialist client group commissioning to decide on individual applications. In the remaining 30 PCTs, arrangements varied from devolved responsibility to clinical teams, to individual staff taking responsibility. While over 70 per cent of PCTs involved staff from commissioning, social services and a senior nurse, a further 44 groups were also listed.

Performance management elicited a wealth of ideas around three themes:standards, consistency in application of the criteria and benchmarking. Ideas for standards included set timescales to reach a final decision.Consistency in application involved a number of proposals such as peer review of individual decisions and clinical reviews of individual cases.

Proposals for benchmarking were largely around costs, year-on-year for specific client groups, or comparisons between different PCTs. Many commented on the difficulties faced by not having national eligibility criteria for continuing care. Lessons included the trend to share decision-making rather than holding one person responsible. But, although desirable, making decisions on individual cases alongside commissioning services for that client group may be too challenging. PCTs or strategic health authorities can set local standards, which can then be used as a more robust vehicle to influence assessment and application as well as service redesign and commissioning.

Dr Judith Bell is director of public health at Staffordshire Moorlands primary care trust and Sue Dunn is public health auditor at Newcastle-Under-Lyme PCT. For the full results, e-mail judith.bell@northstaffs.nhs.uk