The impact of national policy change for NHS continuing healthcare on the relationship between health and social care in England

• Main Author: Leaver, Sally Ann
• Published: University of Bristol 2012
• Subjects: 362.10941
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.559082

The central aim of this study was to explore the success of NHS Continuing Healthcare (CHC) policy in improving the joint working relationship between health and social care in England. Until the 2007 National CHC Framework, eligibility criteria had been set locally, resulting in significant area variations. The Framework aimed to standardise criteria and make the process clearer and fairer to access; joint working in key areas was a central mandate. Study objectives were to identify changes in consistency in application of CHC eligibility criteria and uniformity of practices in response to the CHC Framework, and to consider whether this had led to more equitable access to NHS funded care for individuals. The research was conducted at a national level, involving the collation of secondary quantitative data, supported by research evidence, and at a micro level through an in-depth, triangulated investigation of three Primary Care Trusts, and their coterminous Local Authorities from different areas of the country. Research with the sites involved identification of quantitative data, and face-to-face interviews to determine their organisational cultures for partnership working and how this was translated to CHC. Findings showed that the introduction of the National CHC Framework had clarified the joint working tasks within CHC processes more clearly than earlier CHC policy reforms, but by separating health and social care responsibilities for provision, it obstructed holistic care, and failed to counter the budgetary pressures that drove both towards their professional boundaries. Despite there having been major improvements in terms of increased CHC activity, reduced area variations and fewer complaints to the Ombudsman, evidence suggested that these might have been due to factors other than CHC policy reform. More individuals were receiving CHC, but processes were still impeded by poor information giving, process complexity, and continuing area variations particularly in access by older people.