Scottish Government
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Hospital Based Complex Clinical Care

Expansion of intermediate care to support changes.

New guidance to simplify and clarify the care arrangements for people with highly complex needs, has been published by the Scottish Government.

Announced last year, the revised guidance replaces existing arrangements for NHS Continuing Healthcare, which were subject to independent review in 2014.

There are currently 385 people in Scotland in receipt of NHS Continuing Healthcare, who will continue to have their care fully funded by the NHS and will be unaffected by these changes.

And the Scottish Government yesterday committed to ensuring more use of intermediate or ‘step-down’ care capacity to support people who are making the transition from hospital to home care.

Last year’s review, led by Dr Ian Anderson, past president of the Royal College of Physicians and Surgeons of Glasgow, recommended that decisions about healthcare needs should remain a clinical judgement and that patients’ care needs should be assessed to see if they could be properly met in any setting other than a hospital.

The new guidance states that, where possible, people should be cared for at home or in a homely setting within their community, if their needs no longer require hospital-based care.

Where hospital treatment is no longer required, the NHS would continue to be responsible for funding clinical care in any setting, with free personal and nursing care available to those over 65. Individuals would continue to be responsible for their accommodation costs, based on their ability to pay.

Health Secretary Shona Robison said: “We have accepted the recommendations of the independent review which will simplify and clarify continuing health care arrangements. This guidance provides transparency about decision making and fairness and equity in funding arrangements.

“Hospitals should be for people who need specialist short-term or episodic care and, where appropriate, those with long-term care needs should be looked after at home or in the community. Research has consistently shown that people want to be cared for in their own homes or in a homely setting for as long as possible, and that ultimately this leads to a better outcome for the patient.

“With advances in technology and changes to the way the NHS operates, health professionals can safely care for people without the need for them to be in hospital.

“We are also expanding our intermediate or ‘step-down’ care capacity which will help people make the transition from hospital to home – providing a stepping stone for people who are well enough to leave hospital but are not yet ready to go back into the community.

“The integration of health and social care will also see a shift towards delivering more services within the community, with both the NHS and local authorities working together to look after people at home for as long as possible.

“This guidance will make the system fairer and more transparent for the public and reflects the new health and social landscape which will be brought about by the greater integration of NHS and social care services.”

Dr Ian Anderson, who led the review, said: “Hospital based complex clinical care does exactly what is says in the title. Only patients who cannot be looked after in any other setting will receive care in hospital. All others will be looked after in as homely setting as appropriate. No one should spend their life in hospital unless required on clinical grounds.”

In developing the guidance, the Scottish Government and the Health and Social Care Alliance co-hosted discussion events with stakeholders.

Director of the Health and Social Care Alliance, Irene Oldfather, said: “The new guidance demonstrates a commitment to clarity, transparency and consistency of decision making, which families and carers made it clear during the consultation, that they wanted to see.

“Older people tell us that having access to high quality accommodation in their own local communities, to live out their twilight years is what most would wish. Hospital is not a place “to live” it is a place to be treated, when clinically appropriate.

“The new guidance will I hope assist people to be treated with dignity and respect, to be involved in decisions about their care and support and to live their lives as fully and independently as possible”.”

Councillor Peter Johnson, COSLA’s health and wellbeing spokesperson, said: “We see these reforms as giving expression to the fundamental ideas promoted by health and social care integration: less people living in institutional settings; a more agile group of health professionals supporting people in their own homes ensuring the delivery of person centred care; and greater levels of specialist support outside of hospital. This is not about clarifying what was an outdated and inconsistently applied continuing care policy – but rather an opportunity to fundamentally reconsider how we support people with complex health needs.”

Notes To Editors

On 2 May 2014, the then Cabinet Secretary for Health and Wellbeing published the Independent Review of NHS Continuing Healthcare and announced he was accepting the recommendations. He committed to revising the guidance by Spring 2015.

Currently 76% of people receiving NHS Continuing Health Care are in hospital.

Personal and nursing care is available without charge for everyone in Scotland aged 65 and over who needs it, whether at home, in hospital or in a care home. Free nursing care is available for people of any age who need it. Full details on Free Personal and Nursing Care is available at


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