The boundary between health care and social care: a positive but insufficient step.(National Health Services policy on continuing care)

The Department of Health's recent guidance NHS Responsibilities for Meeting Continuing Health Care Needs(1) merits a cautious welcome. It follows a much criticised draft,(2) which originated in the health service commissioner's upholding of a complaint that Leeds Healthcare had failed to provide long term NHS care for a brain damaged patient.(3) Even so, it does not resolve all the uncertainties about responsibilities at the boundary between health and social care. Still less does it acknowledge the silent, if not surreptitious, shift in the balance between state and individual responsibilities for funding long term care that has taken place over the past 15 years. The profound implications of that shift for the expectations and finances of the current generation of elderly people and their families justify a long overdue public review of the current arrangements and their consequences.(4)

On the more positive side, however, the final guidance can be seen as more substantial, comprehensive, and prescriptive than its draft precursor. In a climate of increasing concern about pressure on resources in the acute sector and emergency medical admissions(5) its overt commitment to …