Continuing Health Care Criteria: Their Use in a Specialist Disability Service

OBJECTIVE: to evaluate the British National Health Service (NHS) criteria for determining eligibility for continuing health care when applied to a population of younger people with severe, usually neurological disability. DESIGN: an observational study with descriptive analysis of the data. SETTING: the specialist disability service catering to the population of Oxfordshire (560,000). SUBJECTS: 196 patients in contact with the specialist services in January 1996. INTERVENTION: senior staff graded the extent to which each patient had one or more of five health and three non-health needs addressed by the service (rated on a scale of 0–3 for each item). MEASURES: the Oxfordshire Health Authority guidelines for determining eligibility were used, with an additional three criteria covering non-health needs (social interaction, supporting carers, supporting Social Service care packages). RESULTS: 196 patients were assessed: 128 (65%) had all health and non-health needs being satisfied by the service; multiple needs were being met in 165 (84%). Only 18 (9%) had no health needs being met. There was no clear-cut separation either between different categories of health need or between health and non-health needs. CONCLUSION: the current categories cannot be applied at the level of individual patients without conflict because: • they are unclear, not being based on any logical, coherent framework • in almost all patients the needs being met by health services include many non-health needs.