The twilight zone? NHS services for older people in residential and nursing homes

Abstract

This paper reviews evidence about the relationships between NHS services and nursing and residential homes in England and Wales. Since the transfer in 1993 of responsibility for funding nursing and residential home care for less affluent older people to local authority social services departments, nursing and residential care has been widely assumed to constitute part of ‘social care’ services. This obscures the fact that residents of nursing and residential care homes frequently have substantial and complex healthcare needs. While some of these healthcare needs may be met through the care provided within homes themselves, most will require substantial contributions from NHS medical, nursing, pharmaceutical and other services. The National Service Framework for Older People (Department of Health, 2001) prioritises reinvestment in intermediate care services, building on the expectation in The NHS Plan (Department of Health, 2000a) that residential and nursing homes will play a major role in the development of these services. This expectation has been further reinforced by the Concordat with the private and voluntary healthcare provider sector (Department of Health, 2000b). However there is little evidence about the NHS services which are currently provided to nursing and residential homes, nor about the capacity of mainstream NHS services to meet the projected development of intermediate care services within the independent institutional sector. This paper reviews the evidence which is available and highlights some of the priorities which primary care groups in England (local health groups in Wales) will need to consider if they are to develop integrated and good quality services for frail older people.