A HUGE patient assessment takes place in Darlington borough next month to prepare for the delivery of free nurse care in all 21 nursing homes.

The process, to be initiated by Darlington primary care group, forms part of a massive change in government policy to transfer the cost of registered nursing care from nursing home patients to the NHS. However, some home owners fear the change could trigger the end for many nursing homes already struggling with spiralling costs.

The NHS will now pay for the nursing element of care that all patients, including mental health patients, require while resident in a nursing home.

Previously these costs were either funded by patients or through social services.

From October 1, the mammoth task of assessing the level of nursing need for 140 self-funding patients across the borough begins.

Each patient will then be placed into one of three new payment bands, either low, medium or high, to determine how much the NHS will pay the nursing home for the nursing care they require.

Payments of £35 per week will be paid to low band patients, the medium band rate is £70 per week and the high band, £110 per week.

It is not yet clear whether nursing homes are expected to reduce their fees or how assessors should differentiate between high banded patients and the existing continuing health care patient in which the NHS pays the full fees.

Once assessed, the nursing home will be paid the banded price applicable for that patient immediately. As yet no appeal or dispute procedure has been confirmed.

From April 1, 2002, the PCG, which is due to become a trust from that date, will fund the nursing care element for all other nursing home patients.

PCG chiefs anxiously await the Department of Health's guidelines on how to implement the process and how much funding they will receive for each patient assessment.

A figure of £85 per patient has been intimated, but some feel that is unlikely to cover such a vast task, particularly as Darlington has the largest number of general nursing beds in the region.

Mrs Linda Bailes, the PCG's primary care development manager, told the D&S Times: "We will do the best we possibly can to ensure that everybody is kept informed and nobody loses out through this process.

"We will work closely with nursing homes to achieve this."

Mrs Janet Malham, of Tamaris Care Homes in Darlington and a member of Care North-East, added: "This change represents a real threat to care home operators as income of already struggling homes could be significantly reduced.