Principle of free healthcare

In her article "Clause that will savage the NHS" (13 August), Rosie Waterhouse confuses a number of issues. She states, with regard to the Health and Social Care Act, ". . . the new act introduces a category of 'intermediate care', a halfway house for the elderly between hospital and home, in which personal care and 'hotel' costs will be charged after a maximum of six weeks, thereby introducing charges in the NHS for the first time in 50 years".

First, the act does not introduce intermediate care. In fact, it makes no reference to it at all. The development of intermediate care services was envisaged as one of three scenarios - "care closer to home" - put forward in the report of the National Beds Inquiry (February 2000). Following overwhelming support for that approach in the consultation on the report's findings, the government announced in the NHS Plan (July 2000) that it intended to invest significantly in the development of intermediate care as a key element in its policies aimed at promoting the independence of older people. This was reinforced in the National Service Framework for Older People, published in March this year.

Second, the development of intermediate care has not led to new charges being introduced for NHS services. With its emphasis on active rehabilitation and therapy to maximise independence and enable people to resume living at home, intermediate care is by its nature time-limited - usually no longer than six weeks, and frequently less. Other forms of longer-term rehabilitation or support services, or transitional care not involving interventions to maximise independence, do not fall within the definition of intermediate care.

The Department of Health has made clear its view that all intermediate care should be free at the point of use. If further care or treatment is required, and is to be provided by the NHS, that will, as now, be provided free at the point of use. If care is provided by local authorities, then the normal charging rules may apply, as they do now. The introduction of intermediate care has in no way changed the rules on charging for care. NHS care remains free at the point of use, as it has for more than 50 years.

Helen Robinson
Branch Head, NHS Services for Older People
London SW1