North and East Devon Health Authority lost an appeal to move physically disabled residents from an NHS home to the independent sector. The Court of Appeal ruled the NHS cannot pass on responsibility for nursing care to social services if a patient's primary need for assistance with accommodation is a health need. The RCN argues that the primary need of the vast majority of people in nursing homes is a health one. In recognition of the deep flaws in the long term care system, this Government promised in its general election manifesto that it would set up a Royal Commission to investigate and produce recommendations for a fairer system. This it did in January 1998 and the Royal Commission on Long Term Care reported back in March 1999.
Nursing care has a narrower definition, although it does include some personal care.
For example, helping someone with a stable health condition bathe can be defined as personal care but would not necessarily be nursing care. However, bathing a vulnerable and sick older person may be defined as nursing care as it could involve checking for signs of further health need. The Government has not yet responded in any detail to the central recommendation of the Royal Commission, and we are currently in the position that central Government guidance on who should be entitled to long term care had now lapsed. The single most important issue that the white paper must resolve is to ensure that the NHS takes responsibility for providing nursing care to all who need it - making it free at the point of delivery to everyone, including those in nursing homes. The RCN has been lobbying for this since the early 1990s and was greatly encouraged by hints made by the Health Secretary Alan Milburn at RCN Congress this year that this was the Government's intention.