At the heart of the NHS plan is its aim to improve services for older people, as one in five people in England is over 60, and over-60s are the largest users of the health service.
How will older people benefit from the plan?
A new tier of services called "intermediate care", which focus on rehabilitation and home care, is to be delivered jointly by health and social services. An extra 6,700 hospital beds are to be available by 2004.
In Yorkshire, councils and health authorities have a pooled annual budget of £681,000 to support rehabilitation units such as Scarborough's Homeward unit. Rosemary Archer, social services director at North Yorkshire county council, said: "Older people made it clear they wanted us to help them return home. These schemes help avoid unnecessary admission to hospital or permanent residential and nursing care."
However, for those who do need those services, the plan pledged that "funding of long term care is fair and promotes rather than obstructs good partnership working across health and social services".
What are the changes?
• From April 2001, means testing will disregard property value for three months after admission to residential care, so that people can return home
• Capital limits set in 1996 will dictate how much older people can contribute to residential care. Councils will not contribute to care if patients have assets worth more than £18,000
• Councils will standardise the cost of home care
• A national service framework is to regulate services from 2001. A national care standards commission will take over in April 2002
• Residential allowance for new care home residents will be stopped and resources will be transferred to local councils
• Local councils become responsible for assessment, care management and financial support of anyone who went into residential care before April 1993. Only in exceptional cases will people be moved against their wishes and councils will be able to protect against eviction those who can't pay fees
• A new grant supporting local authority loans aims to avoid the politically sensitive issue of houses being sold during people's lifetime to meet long-term care costs
• The government plans to consider regulating long-term care insurance
• By April 2002 there will be a single assessment for health and social care agreed locally. This will initially be for the most vulnerable such as those living alone, recently bereaved, recently discharged from hospital or entering residential or nursing care. During 2002, personal care plans will be agreed for everyone in this group. The plans will detail health and social care packages, care coordinators, monitoring arrangements and a list of key contacts. Providers, users and carers will be involved in agreeing the plans and there is talk of coordination by nurse consultants or specialist nurses
• Social and health services will be required to work together to provide better respite provision for carers
• Care Direct, which includes drop-in centres, online and outreach services, is to give advice about health, social care, housing, pensions and benefits
How will it be funded and led?
£150m is allocated this year, and £900m by 2003-04. In 2004 there will be an additional £1.4bn annually for investment in services for older people. A national director for services for older people will lead the reform programme.
